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Final Flashcards

1
Q

What does normal visual acuity imply?

A
  1. ocular media are relatively clear 2. fovea centralis is intact. 3. CN II and visual pways are intact. 4. visual centers are intact
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2
Q

T or F: Normal visual acuity indicates that the eye is free of disease.

A

False - does NOT indicate lack of dz

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3
Q

What is the hardest letter to recognize?

A

B

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4
Q

What is the easiest letter to recognize?

A

L

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5
Q

What are the minimums for legal blindness?

A

< 20/200 in better eye OR a visual field that subtends an angle of <20 degrees

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6
Q

What chart do you use to indicate acuity for near vision?

A

Rosenbaum chart

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7
Q

What is known as “old vision”?

A

Presbyopia

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8
Q

What is presbyopia?

A

age-related loss of elasticity in lens => far-sightedness for near vision

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9
Q

Which msls are relaxed for far vision?

A

ciliary msls

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10
Q

When ciliary msls contract, what are they accomodating for?

A

near vision

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11
Q

What is known as the bending of light rays?

A

refraction (80% cornea, 20% lens)

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12
Q

What is emmetropia?

A

normal acuity (refraction of cornea and lens match the eye’s length)

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13
Q

What is it called when parallel light rays come to focus in front of the retina?

A

refractive myopia and near-sightedness. (refractive power of cornea/lens is too great)

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14
Q

What is it called when parallel light rays come to focus way in front of the retina?

A

axial myopia/high myopia and extreme near-sightedness (eyeball is too long for refractive power of eye)

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15
Q

What condition would have an increased chance of retinal detachment?

A

axial myopia/high myopia/extreme near-sightedness

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16
Q

What is it called when parallel light rays come to focus behind the retina?

A

refractive hyperopia and far-sightedness (refractive power of cornea/lens is too little)

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17
Q

What is it called when parallel light rays come to focus way behind the retina?

A

axial hyperopia and extreme far-sightedness (eyeball too short for refractive power of eye)

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18
Q

What has an increased chance of acute glaucoma?

A

axial hyperopia and extreme far-sightedness

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19
Q

What is defined as “unequal refraction in different meridians of the eyeball”?

A

astigmatism

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20
Q

What does an astigmatism cause difficulties in seeing?

A

fine detail

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21
Q

What is a “regular” astigmatism?

A

different degrees of refraction in vertical and horizontal planes => two focal points (right angle)

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22
Q

What is an “irregular” astigmatism?

A

different degrees of refraction in 2 or more meridians (NOT at right angle)

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23
Q

What are objective blind spots when assessing peripheral vision called?

A

negative defects

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24
Q

What are perceived blind spots called when assessing visual fields?

A

positive defects

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25
Q

What is blindness in one half of the visual field of one or both eyes called?

A

hemianopia

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26
Q

What is blindness in one quarter of the visual field of one or both eyes called?

A

quadrantanopia

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27
Q

What would a lesion of the midline optic chiasm cause?

A

bitemporal hemianopia

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28
Q

What would a lesion of the right optic radiation cause?

A

left homonymous hemianopia w/ macular sparing

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29
Q

What is “blind island”?

A

scotoma

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30
Q

What are “blind islands”?

A

scotomata

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31
Q

What is the space b/t the lens and retina filled with?

A

vitreous

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32
Q

What is it called when the vitreous thins w/ age and possibly separates from the back of the eye?

A

posterior Vitreous detachment (PVD)

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33
Q

What are floaters caused by?

A

tiny bits of vitreous gel or cells that cast shadows on the retina

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34
Q

When do flashes occur?

A

when vitreous tugs on sensitive retina tissue

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35
Q

What does PERRLA stand for?

A
  1. Pupils Equal in size and Round 2 pupils React to Light 3. pupils Accommodate to near vision
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36
Q

What is used to test the alignment of the eyes in a neutral position?

A

corneal reflection test

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37
Q

What does the cardinal fields of gaze assess?

A
  1. fixation of eyes 2. conjugate pursuit movements (“yoked” EOMs)
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38
Q

T/F: Ptosis is not always neurologic in origin.

A

TRUE

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39
Q

What is the most common cause of congenital ptosis?

A

localized myogenic dysgenesis (no abnormalities in pupil size)

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40
Q

What is Horner syndrome aka? Are there abnormalities in pupil size?

A

congenital CN III palsy; there are abnormalities in pupil size

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41
Q

What is the most common cause of acquired ptosis?

A

acquired aponeurotic ptosis

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42
Q

What are the 2 main findings for acquired aponeurotic ptosis

A
  1. lumps on eyelid (don’t squeeze) 2. No abnormalities in pupil size
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43
Q

Are there abnormalities in pupil size with acquired Horner syndrome?

A

Yes

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44
Q

What is acquired myogenic ptosis aka?

A

ocular myasthenia gravis

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45
Q

What is pupillary dyscoria?

A

abnormalities in the shape of the pupil

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46
Q

What would malignant melanoma of the iris and ciliary body cause?

A

acquired coloboma

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47
Q

What is an apparent absence or defect of tissue?

A

coloboma

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48
Q

What is synechia?

A

adhesion of the iris to the cornea or lens (type of acquired coloboma)

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49
Q

What is inequality in pupil size?

A

anisocoria

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50
Q

How are the pupillary reflexes affected in physiologic anisocoria?

A

pupillary reflexes are intact

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51
Q

What type of anisocoria is seen in 20% of the population?

A

physiologic

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52
Q

What are the 3 types of anisocoria?

A
  1. physiologic 2. pharmacologic 3. neurogenic
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53
Q

What is an example of neurogenic anisocoria that presents with a dilated pupil w/ sluggish and delayed rxns?

A

Right Adies tonic pupil/Adie’s pupillotonia

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54
Q

What is Argyll-Robertsons pupil a highly specific sign of?

A

neurosyphilis/tabes dorsalis

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55
Q

How does acute iritis present?

A

painful, aching, bloodshot, small pupil (unequal size)

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56
Q

What is the most important thing to do when pt has a bloodshot eye?

A

compare pupil size side-to-side

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57
Q

Urgency or emergency: anterior uveitis?

A

true medical urgency

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58
Q

How does acute glaucoma present?

A

very painful, bloodshot, large pupil

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59
Q

Does acute iritis or acute glaucoma look worse?

A

acute iritis looks worse/acute glaucoma has worse prognosis

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60
Q

Urgency or emergency: acute glaucoma?

A

true medical emergency

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61
Q

How do you differentiate acute glaucoma/iritis from conjunctivitis/pink eye?

A

conjunctivits is not an intra-ocular inflammation. Conjunctivitis does NOT cause changes in pupillary size or shape

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62
Q

What is a normal variant called for pupillary rxn to light?

A

Hippus

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63
Q

What presents with excessive constriction of the pupil and possibly the pupil won’t dilate in dark

A

miosis

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64
Q

What presents with excessive dilation of the pupil and possibly won’t constrict in bright light?

A

mydriasis

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65
Q

What is the accommodation triad?

A
  1. accomodative convergence 2. pupillary constriction 3. accommodation of lens for near vision
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66
Q

What an eye deviation that occurs when both eyes are open and uncovered?

A

tropia (detected by reflection test)

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67
Q

What is an eye deviation that occurs only when one eye is closed or covered?

A

phoria (not detected by reflection test)

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68
Q

What does the cover-uncover test detect?

A

Phoria

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69
Q

what are 2 normal variants for cardinal fields of gaze?

A
  1. hyper-dominant eye 2. physiologic end-point nystagmus of brief duration
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70
Q

When will “undershoot” or “overshoot” be seen?

A

Pts w/ cerebellar dz OR acute alcohol intoxication (aka homeboy is wasted)

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71
Q

What are jittery eye movements an early indication of?

A

MS

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72
Q

What is known as non-paralytic strabismus?

A

concomitant strabismus/constant tropia

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73
Q

T/F: degree of deviation between the eyes with constant tropia varies with position of gaze.

A

False - does not vary

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74
Q

What does concomitant strabismus imply?

A
  1. abnormality of msl origin or insertion 2. abnormality of msl length
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75
Q

What is seen with paralysis and/or restrictions to movement of EOMs?

A

non-concomitant strabismus/non-constant tropia

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76
Q

T/F: degree of deviation between the eyes with non-constant tropia varies with position of gaze.

A

True

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77
Q

What can cause restricted EOM movement?

A
  1. ophthalmic Graves dz (hyperthyroidism) 2. orbital fx
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78
Q

Non-concomitant/non-constant EOM palsy will have the worst deviation and double vision occuring when the pt looks in what direction?

A

In the direction of the weak msl

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79
Q

What palsy presents with ptosis and marked eye deviation?

A

CN III palsy/oculomotor

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80
Q

What palsy presents with pt unable to move eye downward?

A

CN IV palsy/trochlear

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81
Q

What palsy presents with eye deviated inward from neutral position?

A

CN VI palsy/abducens (impaired outward gaze)

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82
Q

Which palsy is the most common CN anomaly?

A

CN VI palsy/abducens

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83
Q

Which palsy presents with a characteristic head tilt?

84
Q

What is eversion of the eyelid margin?

85
Q

What are the 2 types of acquired ectropion?

A
  1. involutional (age-related laxity) 2. paralytic (CN VII)
86
Q

What is an example of paralytic ectropion?

A

Bells palsy

87
Q

What is inversion of the eyelid margin?

88
Q

What does acute spastic entropion result in?

A

orbicularis spasm overwhelms retractors of lower lid

89
Q

What is a potential complication of entropion?

A

trichiasis (eyelashes irritate cornea)

90
Q

What is anterior blepharitis?

A

Inflammation of eyelid margin (eyelashes and follicles)

91
Q

What are 2 types of anterior blepharitis?

A
  1. staphylococcal 2. seborrheic
92
Q

What is posterior blepharitis?

A

inflammation of meibomian gland (internal hordeolum)

93
Q

What does external hordeolum present with?

A

painful, localized, erythematous inflammation of eyelash follicle

94
Q

What is external hordeolum aka?

95
Q

what causes most cases of hordeolum?

A

staph aureus

96
Q

What increases the blockage rate of sebaceous glands?

A

High lipid levels

97
Q

What is a chalazion aka?

A

retention cyst/internal stye/meibomian cyst/tarsal cyst

98
Q

How does a chalazion present?

A

hard, painless swelling of eyelid d/t lipogranuloma formation

99
Q

What may follow hordeola/blepharitis?

100
Q

What is xanthelasma?

A

subcutaneous lipid depositions resulting in well-defined yellowish plaques that are often found near the medial canthus

101
Q

Where is the lacrimal gland located?

A

superolateral aspect of orbital cavity

102
Q

What is dacryoadenitits?

A

painful inflammation and swelling of lacrimal gland

103
Q

What is keratoconjunctivitis sicca?

A

dry eyes d/t insufficient tear production (lacrimal gland)

104
Q

What can KS be a component of?

A

Sjogren syndrome

105
Q

What is sjogrens syndrome?

A

chronic autoimmune disorder with xerostomia, xeropthalmia, and lymphocytic infiltrations of exocrine glands

106
Q

Where is the lacrimal sac?

A

superior end of nasolacrimal duct

107
Q

What is dacryocystitis?

A

infection of the lacrimal sac

108
Q

What is injection?

A

Bloodshot eye

109
Q

What is covered by the non-visual portion of the cornea?

A

limbus of the iris

110
Q

What is a peri-limbal injection?

A

vasodilation near the limbus of the eye

111
Q

What implies conjunctival irritation near the cornea with no peri-limbal injection and no intra-ocular involvement?

A

peri-corneal injection

112
Q

How does mixed ciliary and conjunctival injection present?

A

The peri-limbal injection implies corneal disease with intra-ocular involvement

113
Q

How does ciliary injection present?

A

The peri-limbal injection implies inflammation of deeper structures with intra-ocular involvement

114
Q

What is defined as a highly vascular, transparent, modified mucous membrane that is not very pain-sensitive?

A

conjunctiva

115
Q

What are the 3 parts of the conjunctiva?

A
  1. palpebral (thicker layer, inner surface of eyelids) 2. fornix (junction of palpebral and ocular conjunctiva) 3. ocular conjunctiva (thinner layer, non-corneal)
116
Q

What is the difference between peri-corneal injection and conjunctivitis?

A

Aside from location of redness, findings are the same. Peri-corneal is very localized to conjunctiva near non-visual portion of cornea.

117
Q

What is the most important clinical feature of acute allergic conjunctivitis?

A

Ocular itching

118
Q

What is chemosis?

A

conjunctival edema (milky appearance)

119
Q

What could cause a possible lymphoid follicular response?

A

acute allergic conjunctivitis

120
Q

What is adenoviral conjunctivitis aka?

121
Q

What is the most common cause of viral conjunctivitis?

A

adenovirus

122
Q

What are the common pathogens in children that can lead to acute bacterial conjunctivitis?

A

staph pneumonia and h. influenza

123
Q

What is considered a strong predictor of acute bacterial conjunctivitis?

A

mucopurulent discharge that crusts the eyelashes

124
Q

What is the potential problem with bacterial conjunctivitis involving gonorrhea and chlamydia?

A

infection spreading to the cornea (starts eating away cornea)

125
Q

What provides about 85% of refractive power of the eye?

126
Q

What are the characteristics of the cornea?

A

transparent, multi-layered, avascular

127
Q

What is common with foreign bodies near the limbus?

A

peri-corneal injection

128
Q

What is a possible concern for peri-corneal injection?

A

keratoconjunctivitis

129
Q

How does the cornea appear with corneal dz?

A

Cloudy/hazy

130
Q

Is PERRLA intact with corneal dz?

131
Q

What is considered pain-sensitive and possibly the most densely innervated tissue in mammals?

132
Q

How can the cornea eventually become pain-insensitive?

A

infections/lesions that can ulcerate the cornea

133
Q

How do pts with keratitis d/t herpes simplex present?

A

vesicular eruptions, photophobia, blurred vision

134
Q

What is the most common cause of blindness in the US?

A

herpes simplex keratitis

135
Q

what is the most common cause of blindness in the world?

A

chlamydial keratitis (d/t inadequate sanitation)

136
Q

What does gonococcal keratitis present with?

A

copious purulent discharge, blurred vision d/t ulcerative keratitis

137
Q

Urgency or emergency: gonococcal keratitis?

A

ophthalmologic emergency (=> perforation of cornea)

138
Q

What produces aqueous humor?

A

ciliary body

139
Q

What is normal intra-ocular pressure?

A

14-20 mmHg

140
Q

What are the indications of a deeper inflammation involving the iridocorneal angle/ciliary body?

A

mixed conjunctival and ciliary injection, ciliary injection, pupil is NOT normal, NO PERRLA

141
Q

What is acute glaucoma aka?

A

closed-angle glaucoma

142
Q

What is a predisposing factor for acute primary angle closure glaucoma?

A

a “crowded” anterior chamber

143
Q

What is acute iritis?

A

inflammation in the anterior chamber (aka anterior uveitis)

144
Q

Does scleritis present with pain?

A

Yes, almost always painful

145
Q

How does allergic conjunctivitis present?

A

Itching, burning

146
Q

Describe the discharge for bacterial conjunctivitis?

A

mucopurulent

147
Q

How does ulcerative keratitis present?

A

purulent discharge, photophobia, and visual changes

148
Q

How does scleritis present?

A

pain, photophobia, and possible visual reduction

149
Q

How does acute iritis present?

A

“ache”, photophobia, mild to moderate reduction of vision, pupils small and slow to react

150
Q

How does acute glaucoma present?

A

moderate to severe pain, photophobia, severely reduced vision, pupils are larger and non-reactive

151
Q

What is described as a rupture of conjunctival and/or episclerotic blood vessels with bleeding into the potential space b/t the conjunctiva and sclera?

A

subconjunctival hemorrhage

152
Q

What can cause subconjunctival hemorrhage?

A

local hypertension, coughing, vomiting or straining

153
Q

What is described as accumulation of blood in the anterior chamber following trauma?

A

traumatic hyphema

154
Q

What is described as elevated benign, yellow fibrovascular connective tissue masses?

A

pinguecula

155
Q

What is described as a benign, fleshy, wing-like fibrovascular connective tissue growth?

156
Q

What does a normal optic disc look like?

A

flat, well defined margins, bilaterally equal size, round

157
Q

What is the cup-to-disc ratio?

158
Q

What are the objectives of an opthalmoscopic exam?

A
  1. check red reflex 2. examine the fundus of the eye
159
Q

What are linear splinter hemorrhages?

A

small, superficial intra-retinal hemorrhages

160
Q

What are linear flame hemorrhages?

A

larger superficial intra-retinal hemorrhages

161
Q

What are round dot microaneurysms?

A

deeper intra-retinal micro-aneurysms that may hemorrhage

162
Q

What are round blot hemorrhages?

A

deeper intra-retinal hemorrhages (assoc w/ diabetic retinopathy)

163
Q

What causes soft exudates/cotton wool spots?

A

occlusion of pre-capillary retinal arterioles

164
Q

What causes hard exudates/lipoid exudates?

A

leaky capillaries or micro-aneurysms. Often appear in rings

165
Q

What is papilledema aka?

A

“choked disc”

166
Q

What is papilledema caused by?

A

increased intra-cranial pressure. Possibly d/t grade IV HTN

167
Q

What is a cataract?

A

“waterfall”, any opacity in the lens

168
Q

What is the most common cause of cataract formation?

169
Q

What is in charge of the fine tuning of the eye?

170
Q

What type of cataracts have less of an impact on vision?

A

cortical (radial or spoke-like appearance)

171
Q

What type of cataracts lead to trouble with vision?

A

nuclear (yellow-brown deposits and sclerosis)

172
Q

How do nuclear cataracts appear?

A

black on red-reflex (mature is visible to naked eye)

173
Q

What is the most common age-related cataract?

A

posterior subcapsular cataracts

174
Q

What is the prime symptom of age-related cataract formation?

A

decreased visual acuity (hazy or fuzzy vision)

175
Q

What does the screening exam for cataracts involve?

A

cataracts cast opacities/shadows/dots in the red reflex

176
Q

What is the second leading cause of IRREVERSIBLE blindness in the US?

177
Q

What is primary open-angle glaucoma?

A

dysfunction of trabecular meshwork over the canal of Schlemm

178
Q

In which ethnicity is glaucoma more common?

A

3-5x more common in African Americans

179
Q

What is the classic progression of POAG?

A

gradual and insidious increase in IOP. Can lead to atrophy of optic n., displacement of physiologic cup, and nasal displacement of retinal vessels

180
Q

What is known as the “sneak thief of vision”?

181
Q

What is the first indication of POAG?

A

slow progressive loss of peripheral vision

182
Q

What is tonometry?

A

measurement of intra-ocular pressure

183
Q

What is perimetry?

A

testing of visual fields

184
Q

What should you look for while performing an ophthalmoscopic exam of the optic disc (for POAG)?

A

increased cup-to-disc ratio, nasal displacement of retinal vessels, loss of continuity of retinal vessels, optic nerve atrophy

185
Q

What is gonioscopy?

A

assessment of the iridocorneal angle

186
Q

What does the degree of glaucomatous cupping correlate with?

A

degree of vision loss

187
Q

What is papilledema?

A

optic disc swelling d/t increased intracranial pressure (vision usually preserved, no pain)

188
Q

What is splinter hemorrhage caused by?

A

HTN. Can be observed in papilledema at the disc margin

189
Q

What can be observed in advanced papilledema?

A

obliterated cup, flame hemorrhages (optic disc), soft exudates (cotton wool spots, retina), hard exudates (lipoid exudates, disc margins), vision problems

190
Q

What is one of the target/end organs of systemic HTN?

191
Q

What is copper wire deformity associated with?

A

Stage I hypertensive retinopathy

192
Q

What is A-V nicking assoc. with?

A

Stage II hypertensive retinopathy (advanced)

193
Q

What is present in early malignant hypertensive retinopathy (stage III)?

A

flame and splinter hemorrhages, soft exudates, poss. Areas of retinal edema

194
Q

What is present in advanced malignant hypertensive retinopathy (KWB stage IV)?

A

swollen disc/choked disc/ischemic papilledema

195
Q

What are the ways diabetes can cause vision changes?

A
  1. transient refractive errors 2. diabetic cataracts 3. glaucoma 4. diabetic retinopathy 5. diabetic macular edema
196
Q

What percentage of diabetic pts have some degree of retinopathy after 20 years?

A

Type 1 = nearly all Type 2= 60%

197
Q

T/F: Diabetic retinopathy has more impact on the retinal arteries.

A

False - retinal veins

198
Q

What is the earliest clinical sign of diabetic retinopathy?

A

microaneurysms

199
Q

Dot and blot and flame hemorrhages, plus soft and hard exudates, and retinal edema are present in what kind of diabetic retinopathy?

A

non-proliferative

200
Q

What is the typical complaint in a pt with advanced macular edema?

A

distorted central vision (tested with Amsler grid)

201
Q

What are the common S/Sx of macular dz?

A

progressive blurring/loss of central visual acuity, image distortion, central blind spot (scotoma)

202
Q

What are the 2 most common causes of adult-onset legal blindness in the US?

A
  1. macular degeneration 2. diabetic retinopathy
203
Q

What takes care of the macular blood supply?

A

capillary beds in the choroid layer

204
Q

What is the most common cause of reduced vision in the elderly?

A

age-related macular degeneration

205
Q

What is dry (atrophic) macular degeneration?

A

macular dz without choroidal neovascularization, an ischemic macular degeneration with Drusen formation

206
Q

What is wet (exudative) macular degeneration?

A

macular dz with choroidal neovascularization (85-90% of AMD cases)

207
Q

What could be considered a retinal detachment prodrome?

A

a sudden “shower of spots” (photopsia or floaters)

PDX 2 (2 decks)

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