History taking and examination Flashcards
what are microaneurysms
localised outpouchings of capillaries that leak plasma constituents into the retina
what are dot and blot haemorrhages
arise from bleeding capillaries
what are cotton wool spots
small fluffy white superficial lesions that accumulate from dead nerve cells from ischaemic damage
what is neovascularisation
new vessel formation
what is rubeosis iridis
neovascularisation on the iris
what does pan retinal photocoagulation look like on fundoscopy
punched out appearance widespread over retina
what are drusen and in which condition are they seen
lipid deposits seen at the macula in ARMD
what is AV nipping and in which condition is it seen
compression of venules at sites of arteriovenous crossing
hypertensive retinopathy
how many grades are there in hypertensive retinopathy
1-4
what sign makes hypertensive retinopathy grade 4?
optic disc swelling
what sign can be seen on fundoscopy in glaucoma
cupping of optic disc
ie increased vertical cup:disc ratio
what is papilloedema
optic disc swelling secondary to raised ICP
what is the difference between the terms optic disc swelling and papilloedema
optic disc swelling - any cause
papilloedema - as a result of ^ICP
sign of optic nerve atrophy on fundoscopy
pale optic disc
causes of optic nerve atrophy
glaucoma
inflammation
retinal ischaemia
longstanding papilloedema
signs of CRAO on fundoscopy
pale oedematous retina
cherry red spot at fovea
signs of CRVO on fundoscopy
tortuous veins
haemorrhages
cotton wool spots
optic disc swelling
important points in history to take in visual loss
speed of onset pain extent of loss associated symptoms e.g. flashers and floaters past ocular history PMH
what is the blue light on the ophthalmoscope used for
used to examine the front of the eye with fluroscein drops
what drops should be administered prior to examination with the ophthalmoscope
mydriatic / dilating drops
e.g. tropicamide 1%
if you are examining a patient’s right eye, which eye should you use on the ophthalmoscope
YOUR right eye held with your right hand
what is the first thing you should examine with the ophthalmoscope
red reflex
done with the dial at 0 and standing arms length away
causes of absent red reflex
cataracts
vitreous haemorrhage
retinal detachment
retinoblastoma
after red reflex, what do you dial up your ophthalmoscope to
+10 and come closer to the eye at an angle to observe the external eye structures e.g. cornea, eyelids and lashes
ask the patient to look at the wall behind you
after examination of the external eye, what do you do with your ophthalmoscope
dial back down to 0 to get a better view of the back of the eye
What process should be followed when examining the fundus
6 point process
- disc
- 4 vascular arcades
- macula
what do you assess when looking at the optic disc
cup
colour
contour
what are the 4 vascular arcades
superotemporal
superonasal
inferotemporal
inferonasal
why is the macula examined last
to avoid patient discomfort
when assessing visual fields, glasses can remain on, true or false
false, glasses should be removed
what is the first question to ask in visual field testing
is any part of my face missing
or hold up 2 hands
describe the steps in visual field assessment
ask the patient to cover one eye (and you cover the eye on the same side)
then ask them to use their open eye to look directly at your open eye
assess quadrants by asking the patient to tell you how many fingers you are holding up
using a white headed pin, bring it in from the periphery to central fields diagonally and ask the patient when they can see it
finally examine blindspot with a red pin, hold pin middway and move temporally, report when it disappears and reappears
what is the difference between drusen and exudate
drusen - soft edged pale yellow deposits often occurring in clusters, seen in ARMD
Exudate - well defined deposits, seen in DM and HTN
