Fundoscopy

Question 1

what should you do before starting the fundoscopy

Answer 1

hand hygiene
introduce yourself
dim the lights
ask patient to remove their glasses and remove your own glasses unless you have a high prescription
use short acting mydriatic drops to dilate the pupils eg. tropic amide 0.5 or 1%

Question 2

what should you do prior to pupil dilation

Answer 2

examine pupil reflexes and visual acuity and visual field because you won’t be able to do this once their pupils are dilated

Question 3

where should the patient look and where should you stand

Answer 3

give the patient a target in the distance straight ahead of them
stay out of the patients line of sight (by standing about 15° to the side) to keep their eyes still and prevent pupil constriction which is caused by the accomodation reflex

Question 4

to examine the patient’s right eye

Answer 4

use your right eye with the ophthalmoscopy in your right hand
line up their right with your right and vice versa
stand/sit at arms length

Question 5

prior to fundoscopy you should examine

Answer 5

red reflex and examine the anterior segment (front part) of the eye

Question 6

red reflex looks like

Answer 6

assessed at arms length by aiming the light beam into each pupil and observing the reflected glow which would be symmetrical orange/red colour

Question 7

if the red reflex is absent or dull

Answer 7

this indicates an opacity somewhere in the ocular media (cornea, anterior chamber, lens or vitreous)

Question 8

absent or dull red reflex in a newborn baby or infant

Answer 8

requires urgent referral to ophthalmology
may be due to a rare but serious intraoccqular tumour called retinoblastoma

Question 9

tp examine the anterior segment

Answer 9

place the offhand on the patients forehead for stability
sit at 15° to the patient
examine the eye for conjunctival injection or corneal opacities
you’ll need to dial the lens to 10 for a clear view here

Question 10

what does fundoscopy look like and what are the features you see on fundoscopy

Answer 10

Question 11

how do you tell a vein from an artery

Answer 11

they’re wider and darker

Question 12

vascular tortuosity looks like

Answer 12

this is seen in systemic hypertension

Question 13

AV nicking looks like

Answer 13

this is seen in systemic hypertension

Question 14

venous beading looks like

Answer 14

seen in severe diabetic retinopathy

Question 15

two indicators of systemic hypertension seen on fundoscopy

Answer 15

AV nicking and tortuousity

Question 16

perivascular abnormalities seen on fundoscopy include

Answer 16

cotton wool spots
retinal haemorrhages

Question 17

retinal haemorrhage looks like

Answer 17

Question 18

cotton wool spots looks like

Answer 18

Question 19

you might see cotton wool spots in someone with

Answer 19

diabetic retinopathy

Question 20

you may see retinal haemorrhages in someone with

Answer 20

central retinal vein occlusion

Question 21

infratemporal quadrant

Answer 21

Question 22

intranasal quadrant

Answer 22

Question 23

supra nasal quadrant

Answer 23

Question 24

supratemproal quadrant

Answer 24

Question 25

where is the optic nerve located

Answer 25

in the nasal aspect of the fundus

Question 26

remember nerve is

Answer 26

nasal

Question 27

the three C’s of the optic disc

Answer 27

1. colour
2. cup
3. contour

Question 28

the colour of the optic disc

Answer 28

normal colour is yellow
becomes pale is cases of ischaemic optic neuropathy or giant cell arteritis
or reddish in a hyperaemic optic disc from optic disc swelling

Question 29

contour of the optic disc

Answer 29

(margins/circumference of the disc)
should be well defined
if the contour is blurred this may be due to optic disc swelling

Question 30

if optic disc swelling is present in both eyes this is

Answer 30

this is papilloedema

Question 31

papilloedema is from

Answer 31

raised intracranial pressure or malignant hypertension
requires urgent attention

Question 32

causes of raised intracranial pressure that may cause papilloedema

Answer 32

intracranial tumour
idiopathic intracrhail hypertension
cerebral abscess
hydrocephalus

Question 33

central pale portion of the optic disc is called the

Answer 33

optic cup

Question 34

normal ratio of diameter between the optic cup and the optic. disc is

Answer 34

average cup to disc ratio is .3 to 0.5

Question 35

if the ratio above normal or there is a lot of asymmetry between the two discs this may indicate

Answer 35

possible glaucoma

Question 36

optic disc neovascularisation

Answer 36

fne frilly vessels seen in patients with diabetes

Question 37

how do you find the macula

Answer 37

temporal to the optic disc
or ask the patient to look directly into the light which should automatically should you their retina

Question 38

normal macula looks

Answer 38

dark orange or reddish

Question 39

drusen

Answer 39

seen in age related macula degeneration
seen over the macula

Question 40

hard exudate looks like

Answer 40

seen in diabetic retinopathy

Question 41

in patients with sudden painless loss of vision you should look for

Answer 41

a pale whiteish macula with a cherry red centre (“cherry red spot”)
this indicates central retinal artery occlusion

Question 42

how do you examine the retinal periphery

Answer 42

ask the patient to look up, down, left and right

Question 43

what abnormalities should you look for on the retinal periphery

Answer 43

pigmented ocular tumour
retinal detachment

Question 44

pigmented ocular tumour might look like

Answer 44

Question 45

normal fudus consists of

Answer 45

Question 46

green filter

Answer 46

also known as the red free filter
good for highlighting red structures
such as outline of blood vessels or micro aneurysms also known as dot haemorrhages

Question 47

what do dot haemorrhages look like under green filter

Answer 47

Question 48

papilloedema should be assumed to be

Answer 48

papilloadema should be assumed to be raised intracranial pressure due to a space occupying lesion in the brain until proven otherwise