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Part 1 > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

What is the extent of the nasal, temporal, superior, and inferior absolute fields?

A

N=65 degrees (60 degrees due to nose)

I=75 degrees

S=75 degrees (60 degrees due to brow)

T=100 degrees

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2
Q

What is the diameter of the binocular overlap fields?

A

120 degrees

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3
Q

How much more intense is a stimulus that has a difference of 3 dB?

A

2X intensity

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4
Q

Describe threshold testing for visual fields.

A

It is the WEAKEST stimulus strength that is seen 50% of the time, measures/quantifies the performance at some or all locations

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5
Q

What type of monocular descriptor is this: involves fixation & extends temporally to B.S.?

A

Cecocentral or centrocecal scotoma

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6
Q

What type of monocular descriptor is this: the region adjacent to but not including fixation

A

Paracentral scotoma

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7
Q

What type of monocular descriptor is this: defect that ends abruptly at the vertical midline

A

Vertical step

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8
Q

What are some optical factors that may cause general depression?

A

Media changes

Uncorrected refractive error

NOTE: cannot produce an absolute scotoma and will not ‘point’ or respect midlines!

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9
Q

What is the cause of ‘pointing’ at the blind spot?

A

Lesion in the retina most likely

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10
Q

What is the cause of ‘pointing’ at fixation?

A

Lesion at chiasm or posterior in the visual pathway most likely

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11
Q

What does a nasal step indicate?

A

Lesion in:

  1. Ganglion cells
  2. RNFL
  3. Optic nerve
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12
Q

What does a vertical step indicate?

A

Lesion at the optic chiasm or posterior in the visual pathway

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13
Q

What does a ring scotoma indicate?

A
  1. Incorrectly placed trial lens
  2. Glaucoma
  3. Retinitis pigmentosa
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14
Q

What causes an altitudinal defect?

A
  1. AION
  2. Glaucoma
  3. Bilateral cortical lesions
  4. R/O prominent brows, deep-set eyes, ptosis

NOTE: any process that damages the RNFL can produce this defect

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15
Q

What causes a nasal defect?

A

RARE

Binasal –> rare complication of lesion involving the chiasm

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16
Q

How does a FULL THRESHOLD test work?

A
  • Initial stimulus presented at level pt is expected to see
  • If seen –> stimulus is DEC by 4 dB until no longer able to see.
  • The instrument then changes direction, moving in 2 dB steps until change in response
  • The last stimulus seen is threshold

NOTE: this was used prior to SITA

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17
Q

How does FastPac work?

A

Similar to Full Threshold but DEC time by ~40%

  • Similar stair stepping technique as Full Threshold, but uses 3 dB increments instead of 4 dB & crosses the threshold only once
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18
Q

How much faster is SITA-Std compared to Full threshold? What is it available in?

A

50% faster

Available in: C30-2, C24-2, C10-2, Peripheral 60-2

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19
Q

How much faster is SITA-Fast compared to FastPac? What is it available in?

A

50% faster than FastPac

Available in: C30-2, C24-2, C10-2, Peripheral 60-2

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20
Q

How much faster is SITA-Faster vs SITA Fast? What is it available in?

A

30% faster than SITA-Fast & 50% faster than SITA-Std

Available in: C24-2 ONLY

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21
Q

What VF test should you order for glaucoma?

A

HVF 24-2 SS (SF or SFR if necessary)

HVF 10-2 SS (SF if necessary), alternate w 24-2 in adv cases

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22
Q

What VF test should you order for NEUROLOGICAL CASES?

A

HVF 30-2 SS (SF if necessary)

HVF 120-point full field screener

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23
Q

What VF test should you order for PLAQUENIL?

A

HVF 10-2 SS (SF if necessary)

HVF 24-2 or 30-2 SS for asian (SF if necessary)

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24
Q

What VF test should you order for MVD/SSA disability?

A

HVF Kinetic III4e

GVF III4e

25
Q

When a sufficiently large number of vectors are tested throughout the VF w the same stimulus, the response points of each vector can be connected to form a boundary of equal sensitivity. What is this boundary called?

A

An Isopter

It is comparable to the contour line on a topographical map

NOTE: if a person has normal vision, then all points inside the isopter are areas of seeing & all points outside the isopter are areas of non-seeing for a given light intensity.

26
Q

True or False. SITA-Faster uses a Heijl-Krakau blind spot monitor?

A

FALSE. HVF does though.

NOTE: other ways of monitoring fixation include direct observation, BS monitor, and gaze tracking

27
Q

Causes for FP?

A
  1. Trigger happy
  2. Lacks understanding of the test
  3. Anxious
28
Q

Causes for FN?

A
  1. Fatigue
  2. Inattentiveness
  3. Slow reaction times
  4. Hysteria/malingering
    - -
  5. Disease field regions
  6. More variability
  7. Small scotoma
29
Q

True or false. SITA Faster does NOT monitor FN.

A

TRUE that test does NOT. Maybe that’s why it’s faster.

30
Q

What % does HVF StatPac use to ‘flag’ unreliable results?

A

Fixation losses: >20%

FP errors: >33`%

FN errors: >33%

31
Q

When would you use a lower % to determine if a field is reliable?

A

When the pt has high suspicion for disease

~15% or lower

32
Q

What is corrected pattern standard deviation (CPSD)?

A

Index that weights the PSD index for the pt’s intratest variability (SF)

It attemps to factor out effect of SF on PSD

33
Q

Where is SF & CPSD ONLY found?

A

Full Threshold testing NOT SITA statpac

34
Q

What makes a field loss abnormal?

A

Clustered losses

Sig if p<0.05 (5%)

35
Q

Describe Glaucoma Hemifield Test.

A

5 mirror image zones compared in superior and inferior hemifield

Scores are assigned based on the pattern deviation of points within each zone

36
Q

What are the possible outcomes of GHS?

A
  1. Abnormally high sensitivity
  2. Outside Normal Limits
  3. Borderline
  4. General Reduction of Sensitivity
  5. Within Normal Limits
37
Q

Name causes for artifact?

A
  1. Lens rim
  2. Edge artifact
  3. Lid/brow
  4. Improper alignment
  5. Dim projector bulb
  6. Pupil size
  7. Incorrect fixation
38
Q

Additional challenges to interpretation.

A
  1. Inexperience/insufficient instructions
  2. Uncorrected RE or incorrect trial lens power
  3. Long-term fluctuation
  4. Cataracts
  5. Retinal disease
  6. Non-glaucomatous optic nerve conditions
39
Q

What may cause you to think glaucomatous VF defect?

A
  1. GHT is outside of normal limits
  2. 3+ points depressed to p<5% one of which depressed to a p<1% (30-2 or 24-2)
  3. PSD in <5%
  4. > or = 1.5 dB repeatable difference btwn the 2 eyes is suspicious esp in light of other suspicious clinical findings
  5. INC short-term fluctuation
40
Q

What MD is considered a mild defect?

A

0 to -6 dB

41
Q

What MD is considered a moderate defect?

A

-6 to -12 dB

42
Q

What MD is considered a severe defect?

A

> -12 db

43
Q

On the pattern deviation plot, describe what you may find for a mild defect.

A
  1. <25% (13) points are depressed at 5%

2. <20% (10) points are depressed at 1%

44
Q

On the pattern deviation plot, describe what you may find for a MODERATE defect.

A
  1. <50% (27) points are depressed at 5%

2. <40% (20) points are depressed at 1%

45
Q

On the pattern deviation plot, describe what you may find for a SEVERE defect.

A
  1. > 50% (27) points are depressed at 5%

2. >20% points are depressed BELOW 1%

46
Q

Describe the central 5 degrees for a MILD glaucoma defect.

A

No points within central 5 degrees w sensitivity < 15 dB

47
Q

Describe the central 5 degrees for a MODERATE glaucoma defect.

A

No points within central 5 degrees w sensitivity of 0 dB

Only 1 hemifield w a point <15 dB

48
Q

Describe the central 5 degrees for a SEVERE glaucoma defect.

A

Any of the central 5 degrees are at 0 dB or <15 dB in both hemifields

49
Q

How do you know if a pre-existing defect VF is deepening?

A
  1. Cluster of 3+ non-edge points, each of which declines >= 10 dB compared to baseline in 2 consecutive fields (NOTE: confirming points may vary if they are part of a contiguous defect)
  2. Cluster of 3+ non-edge points, each of which worsens at least 5 dB & is depressed at the p<0.05 level in 2 consecutive fields (NOTE: confirming points may vary if they are part of a contiguous defect)
50
Q

How do you know if there is a new defect in a previously normal area?

A
  1. Cluster of 3+ non-edge points, each of which declines >= 5 dB compared to baseline in 2 consecutive fields
  2. A SINGLE non-edge point that declines >= 10 dB compared to baseline in 2 consecutive fields
  3. Cluster of 3+ non-edge points, each of which declines to p<0.05 level in 2 consecutive fields
51
Q

How do you know if a pre-existing scotoma is enlarging?

A

At least 2 previously normal points within the central 15 degrees or 3 previously normal points outside 15 degrees:

  1. Declines >10 dB in 2 consecutive fields
  2. Depressed at p<0.05 level in 2 consecutive fields
52
Q

What will the MD show in a generalized depression?

A

Decline in MD to p<0.01 that is NOT explained by media opacity or pupil size

53
Q

How much is the decline in dB in a generalized depression?

A

> 3 dB at all points in 2 consecutive fields that is not explained by media opacity or pupil size

54
Q

What are some problems in detecting progression?

A
  1. Variability/long term fluctuation (abnormal sensitivities tend to have wider fluctuation)
  2. Cataracts (paracentral defect on pattern deviation plot)
  3. Must be able to compare apples to apples (be consistent in testing)
55
Q

What does a small open triangle mean on GPA analysis?

A

IDs degree of deterioration expected <5% of the time at that location in stable glaucoma pts

56
Q

What does a half-filled triangle mean on GPA analysis?

A

Indicates sig deterioration at that point in 2 consecutive tests

57
Q

What does a SOLID triangle mean on GPA analysis?

A

Indicates sig deterioration at that point in 3 consecutive tests

58
Q

What does a “likely progression” mean on GPA alerts?

A

3+ points showing deterioration in at least 3 consecutive tests

59
Q

What does a “possible progression” mean on GPA alerts?

A

3+ points show deterioration in at least 2 consecutive tests

Part 1 (31 decks)

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