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PPO Midterm 1 > Health Entrance Testing 2 > Flashcards

Health Entrance Testing 2 Flashcards

1
Q

What is the aperture within the iris through which light penetrates into the eye?

A

Le Pupil

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2
Q

What is the anterior section of the vascular tunic of the eye?

A

Le Iris

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3
Q

What is the area in front of the crystalline lens and behind the cornea called?

A

Le Uvea

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4
Q

What is Persistent Pupillary Membrane?

A

Trace of embryologic mesoderm tissue

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5
Q

What is Epicapsular Stars?

A

Persistent pigment on anterior surface of lens

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6
Q

What is Mittendorf dot?

A

(Bergmeinster pailla) on posterior surface of lens

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7
Q

Mydriasis

A

Dilation, increase in diameter

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8
Q

Miosis

A

Constriction, decrease in diameter

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9
Q

Anisocoria

A

Different size pupils

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10
Q

Name the functions of the pupil

A
  1. Control retinal illumination
  2. Facilitate light/dark adaptation
  3. Reduce optical aberrations
  4. Increase depth of focus (reduce blur circle in retina -> pinhole effect)
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11
Q

What is Pupillary Hippus?

A

Oscillations of the pupil independent of illumination level, convergence or psychological state

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12
Q

Parasympathetic effect on the pupil

A

Constriction

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13
Q

Sympathetic effect on the pupil

A

Dilation

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14
Q

What is an Afferent pathway?

A

From the Eyes to the CNS

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15
Q

What is an Efferent pathway?

A

From the CNS to the Eyes

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16
Q

What is the pupillary Sphincter?

A

Annular band of smooth muscle that encircles the pupillary border. Constriction causes miosis

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17
Q

What is the Pupillary Dilator?

A

Myoepithelial cells run radially as a sheet in posterior iris. Construction causes mydriasis

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18
Q

What is the sympathetic pupillary pathway mediated by?

A

Hypothalamus

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19
Q

What is a direct response

A

when you observe the pupil you shine light into

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20
Q

what is a consensual response

A

when you observe the pupil you don’t shine the light into

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21
Q

What is grade 1 in the swinging flashlight test

A

weak initial constriction followed by earlier release

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22
Q

what is grade 2 in the swinging flashlight testq

A

initially pupillary stall, no change, follwoed by dilation

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23
Q

what is grade 3

A

immediate pupillary dilation

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24
Q

what is grade 4

A

no rxn to light, amaurotic (blind eye)

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25
Q

in anisocorica, you must ____ and _____ pupil sizes in dim and bright light

A

measure and record

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26
Q

which eom are innervated by the oculomotor nerve

A

SR, IR, MR, IO

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27
Q

which eom is innervated by the trochlear

A

SO

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28
Q

which eom is innervated by the abduces

A

LR

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29
Q

Name the 3 important points of the Sympathetic Pupillary Pathway

A
  1. Hypothalamus
  2. Apex of Lung
  3. Internal Carotid Artery
    * *Does not decussate (ipsilateral)
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30
Q

what is primary action

A

the major moving force of a muscle

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31
Q

what is secondary action

A

additional forces based on muscle’s orientation

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32
Q

what is duction

A

movement of one eye along one axis

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33
Q

what is convergence

A

both eyes more inward

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34
Q

what is divergencw

A

both eyes move outwards

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35
Q

what is version

A

movement of both eyes by same distance and in same direction

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36
Q

why is the IO special

A

the only eom with no origin in apex of orbit, but directly on the floor of the orbit

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37
Q

what are antagonists

A

pair pulls one eye in opposite direction

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38
Q

what are synergists

A

pair pulls one eye in the same direction

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39
Q

what is sherrington law of reciprocal innervation

A

increased contraction of an eom in is normally associated by diminished contraction of its antagonist muscle

40
Q

what is torsion

A

movement of one eye along y axis

41
Q

what is intorsion

A

turning upper part of your globe towards your nose

42
Q

what is extorsion

A

turning upper part of your globe towards your ear

43
Q

what is the action of the MR

A

adduction

44
Q

what is the action of the LR

A

abduction

45
Q

what are the primary and secondary actions of the SR

A

primary: elevation
secondary: intorsion and adduction

46
Q

what are the primary and secondary actions of the IR

A

primary: depression
secondary: extorsion and adduction

47
Q

what are the primary and secondary actions of the SO

A

prim: intorsion
sec: abduction and depression

48
Q

If +RAPD, the doctor must include what information?

A

Which eye is +RAPD as well as the grade

49
Q

what is the goal of eom testing

A

to isolate actions of each EOM so the function is evaluated

50
Q

what is muscle paresis

A

mild/moderate muscular weakness

51
Q

What is muscle paralysis?

A

severe/complete loss of motor function, inability to contract

52
Q

What is nerve palsy?

A

Partial/complete defect of nerve, will affect all or some muscles

53
Q

What EOMs are affected in CN-3 palsy? What other muscles are affected?

A

IR, SR, MR, IO

as well as spincter of the iris and levator palpebrae superiosis

54
Q

What are examples of Extensive and Asymmetric Retinal disease?

A

central/branch retinal artery occlusion, retinal detachment

55
Q

what is the distance you should be to test eom?

A

40-60 cm from patient

56
Q

What is the Hirshberg Test?

A

the ojective evaluation of binocularity using light reflected cornea

57
Q

How would you record normal findings for the Hirshbert Test?

A

FESA or SAFE

58
Q

What is Nystagmus?

A

Bilateral, involuntary and conjugate oscillation of eyes

59
Q

What information does the size of the pupil give you?

A

Photophia, Glare, Aberrations, and depth of focus.

60
Q

What happens to the Nasal Fibers as compared to the Temporal Fibers at the Optic Chiasm?

A 
Nasal Fibers (54%) decussate at Chiasm
Temporal Fibers (47%) remain on same side -> ipsilateral
61
Q

After traveling through the Optic Chiasm, ganglion cell axons synapse with Interneurons where?

A

The Pretectal Olivary Nuclei (in the upper midbrain)

62
Q

The crossed and uncrossed fibers in the optic tract produce what effect?

A

Direct and Consensual Responses

63
Q

Where is the Edinger-Westphal structure in the optic tract?

A

After the Pretectal nucleus and before the Ciliary Ganglion

64
Q

What is the Efferent Pupillary Light Reflex Pathway?

A

From the E-W to Oculomotor Nerve

65
Q

What do the Short Ciliary Nerves innervate?

A

Iris Sphincter and Ciliary Body

66
Q

What 3 responses happening during Synkinetic Triad?

A
  1. Converge
  2. Accommodate
  3. Pupils Constrict
67
Q

Name 2 Parasympathetic Antagonists

A
  1. Tropicamide

2. Cyclopentolate

68
Q

Name the Sympatheic Agonists

A
  1. Phenylephrine
69
Q

What is the Sympathetic Pupillary Pathway mediated by?

A

Hypothalamus

70
Q

Name the 3 important points of the Sympathetic Pupillary Pathway

A
  1. Hypothalamus
  2. Apex of Lung
    3.
71
Q

What is Direct Response?

A

The eye being stimulated constricts

72
Q

What is Consensual Response?

A

The eye not being stimulated constricts

73
Q

What does the Swinging Flashlight Test measure?

A

How well information is carried from one eye to midbrain compared to how it is carried from other eye

74
Q

How do you record the Swinging Flashlight Test?

A

(-) RAPD: Both eyes constrict normally

+RAPD: one eye gives less (or slower) response than other eye

75
Q

What is the Pupil Testing set up?

A

Patient removes correction, looks at a distance target, and the room is as Dim as possible while still being able to see both pupils

76
Q

If a patient has anisocoria, what should the doctor do next?

A
  1. measure pupil sizes
  2. Do the Pupils Accommodative Test
  3. Evaluate for ptosis
77
Q

How far away should you shine the light into the patient’s eye during pupil testing?

A

5cm

78
Q

How many times do you shine the light in the patient’s eye during pupil testing?

A

3

79
Q

What do the numbers mean when recording Direct and Consensual Pupillary response?

A 
0 = very sluggish
4 = brisk (normal)
80
Q

When do you perform the Near/Accommodative Pupil test?

A

If there is a direct or consensual abnormal reponse

81
Q

What is a Light-Near Dissociation?

A

No pupillary reaction to light but reaction to near stimuli

82
Q

How long do you shine light into a patient’s eye during the swinging flashlight test?

A
  1. 1 second in each eye. Repeat 3x

2. 3 seconds in each eye. Repeat 3x

83
Q

Where do you shine the light during the Swinging Flashlight test?

A

Directly into the fovea (which is slightly temporal to the eye)

84
Q

Every patient should experience a slight ______ during the swinging flashlight test

A

Hippus

85
Q

How do you record the swinging flashlight test?

A
  1. Grade1+: weak initial constriction followed by earlier release
  2. Grade 2+: initial pupillary stall, no change, followed by dilation (escape)
  3. Grade 3+: Immediate pupillary dilation
  4. Grade 4+: No reaction to light
86
Q

(+)RAPD is a _______ not a ________

A

Sign, not a Diagnosis

87
Q

What does PERRLA stand for?

A

Pupils Equal, Round, Responsive to Light and Accomodation

88
Q

What does RAPD stand for?

A

Relative Afferent Pupillary Defect

89
Q

If +RAPD, the doctor must include what information?

A

Which eye is +RAPD as well as the grade

90
Q

What is Adie’s Tonic Pupil?

A

Most common pupillary defect, usually effects women 20 - 40 years old, and near vision is decreased. No ptosis or EOM abnormalities. Parasympathetic system affected.

91
Q

What is CN-III palsy?

A

Fixed Dilated Pupil, Ipsilateral abnormal EOMs, and large Ipsilateral ptosis if complete palsy. An acute, complete CN-III palsy is a medical emergency. Parasympathetic system affected.

92
Q

What is Horner’s Syndrome?

A

Eye does not dilate properly or quickly in dim light, mild ptosis and pain in affected eye. Sympathetic system affected.

93
Q

How do you record Anisocoria?

A

Size (dim/bright) and ptosis / EOM abnormalities (if applicable) ex. OD 6/4, OS 4/3 ptosis OS

94
Q

What are examples of Optic Nerve Disease?

A

Optic Neuritis, Infection (Lyme disease)

95
Q

What are examples of Extensive and Asymmetric Retinal disease?

A

central/branch retinal artery occlusion, retinal detachment

96
Q

True/False. Aniscoria is common in children.

A

False

PPO Midterm 1 (3 decks)

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