Information to know Flashcards
Uses acetylcholine as main neuro-transmitter
Parasympathetic system
*Stimulates the parasympathetic nervous system
Parasympathomimetics
*Mimics effects of acetylcholine: Constricts pupils, slows down HR, Dilates blood vessels, Activates digestion
Parasympathomimetics
Pilocarpine is an example of….
Parasympathomimetics
Blocks action of parasympathetic systems
Parasympatholytics
Cyclopentolate is an example of…….
Parasympatholytics
Parasympathomimetics and parasympatholytics are used for what system?
Parasympatheic System
Calm system
Parasympathetic
Flight or flight system
Sympathetic System
Exerts effect on a- and B- adrenergenic receptors
Sympathetic System
This system’s main neurotransmitters are Epinehprine and Norepinephrine
Sympathetic System
*Stimulates the sympatheic nervous system
Sympathomimetics
* question are tricky-know the affects on pupils and what dilation drops do*
*Meds that stimulate the sympathetic nervous system, Dilate pupils, Increase HR, Inhibit digestion.
Sympathomimetics
*Atropine is an example of
Sympathomimetics
Inhibit sympathetic system, reduces BP
Sympatholytics
Sympathomimetics and Sympatholytics are under which system?
Sympathetic System
Peripheral nervous systems is under the
Central Nervous System
Somatic Nervous System and Autonomic Nervous System is under….
Peripheral Nervous System
Parasympathetic and Sympathetic systems is under….
Autonomic Nervous System
Beta Receptors and Alpha Receptors are part of what system?
Sympathetic System
This system controls Vegetative functions “Relax & Renew”
Parasympathetic
This system allows body to function under stress “Fight or Flight”
Sympathetic
What does R-O-Y-G-B-I-V stand for
Red, orange, yellow, green, blue, indigo, violet
Roygbiv (start with the longest and end with the shortest)
*What is the normal visible spectrum?
400nm-700nm
What color has the longest visible spectrum?
Red
What color has the shortest visible spectrum?
Violet
The distance between two similar points (peak to peak)
Wavelength
Number of peaks that pass a fixed point every second
Frequency
Maximum height of a peak measured from the midline
Amplitude
Speed at which light travels through space or a transparent medium
Velocity
Goldmann Visual Fields:
Error: Lid, lens rim artifacts
How do you remedy?
Tape lid, ensure lens near to eye, remove lens when testing beyond central 30 degrees.
Goldmann Visual Fields:
Error: Poor fixation
How do you remedy?
Monitor fixation, don’t tire patient with long test
Goldmann Visual Fields:
Error: Patient’s head tilted or moving off chin rest
How do you remedy?
Check positioning
Goldmann Visual Fields:
Error: Patient not understanding instructions
How do you remedy?
After explaining test, ask if pt has questions
Goldmann Visual Fields:
Error: Pt responding too slow
How do you remedy?
Common with older or senile pt
slow down test object
Goldmann Visual Fields:
Error: Moving target too slowly or too fast
How do you remedy?
Be aware of your pace
Goldmann Visual Fields:
Error: Marking chart inaccurately
How do you remedy?
Crucial
Goldmann Visual Fields:
Error: Poor adjustment of perimeter
How do you remedy?
Follow set protocols, prepare instrument carefully
What are the types of automated visual field tests?
Threshold, Suprathreshold, Short wave Automated (SWOP), SITA (SITA fast, SITA Standard)-Screening test
Which Automated Visual Field test does this describe?
*Relative term, mathematical approximation
*Requires multiple tests of the same points of varying intensities of stimuli
*Represents the level a stimulus can be seen 50% of the time
*Both Static and Kinetic used
*VF’s from kinetic and static perimetry cannot be directly or consistently compared
Threshold
Which Automated Visual Field test does this describe?
*Stimuli presented at intensities statistically calculated to be above the patients’
*If the stimuli are seen, we assume that no significant defect exists
* Goldmann, Humphrey & Octopus use
Suprathreshold
Which Automated Visual Field test does this describe?
*Bright yellow background
*Isolates and measures blue cone function (thought to be damaged first in glaucoma)
*Fast
*Good for suspects
Short Wave Automated (SWOP)
Which Automated Visual Field test does this describe?
*Faster-50%-70% less test time
*Incorporated & analyzes pt’s responses to decrease test time
*No trials for false positives
*Monitor decibel graph to catch high readings for false positives
SITA
What could cause Central K edema with CL use?
Insufficient O2
How do you correct Insufficient O2 with CL use?
Blend junctions of CL curve better, flatten peripheral curve, reduce diameter, reduce diameter of OZ, fenestrating lens
CL: Cause of K abrasion
Insufficient O2 or lens too flat or too loose
Cure for K Abrasion with CL use
Increase CL diameter, OZ, reduece edge thickenss, steepen OZ or peripheral curve, increase BC
CL: Cause of 3 o’clock & 9 o’clock staining
Dryness, Improper Removal
Cure for dryness with CL use
Smaller, thinner CL, tears, blinking exercises
Cure for Improper Removal of CL
Reinstruct pt
CL: Cause of Zig Zag/Irregular Staining
FB bodies under lens
CL: Cause of Arc staining
Poor insertion technique, Sharp juncture lines between central posterior curve and intermediate or peripheral curve
CL:
Cure for Poor insertion technique
Reinstruct pt
CL: Cure for Sharp juncture lines between central posterior curve and intermediate or peripheral curve
Better blended lens
CL: Cause of Bubbles
Too steep
CL: Cure for CL being to steep
flatter lens
CL: Cause of flare/streaming lights at night
optic zone too small
CL: cure for optical zone being too small
Larger CL or OZ
CL: Cause of Blurring of VA in daylight
Lens Rides too high
-High minus
-Small lens/tight lids
CL: Cause of Gravitating too low after blink
Too heavy/high plus
Too thin at edge
CL: how to remedy too thin at edge on CL
Redesign lens
CL: Cause of Lens displaces nasally or temporally
Abnormally centered K
Preparing for Fluorescein Angiogram:
What size syringe of dye is used?
10ml
Preparing for Fluorescein Angiogram: Setup-
If container must be broken up you will need….
Filter Needle
Preparing for Fluorescein Angiogram: Setup-
Butterfly infusion set with tubing and ____G, __” needle
21, 3/4
Preparing for Fluorescein Angiogram: Setup-
What items are needed for set up for Fluorescein Angiogram?
10 ml Syringe of dye
Filter needle if container must be broken open
Butterfly infusion set with tubing and 21 G, 3/4” needle
Alcohol wipes
Tourniquet
Band Aids
Tape (for taping butterfly in place)
2x2’s
Emergency kit
These are possible side effect of what?
Yellow-Orange urine x 24-48 hrs (common)
Yellow staining of mucous membranes x 24-48 hrs(common)
Sneezing
Uticaria (hives)-usually within 1st hr
Tongue and lip paresthesia
Nausea (15%) (common), vomiting 92%)
Dizziness, fainting-have smelling salts available
Allergic respiratory reaction
Anaphlactic Shock
Cardiac arrest
Local tissue necrosis (very rare)
Fluorescein Angiography
Fluorescein Angiography:
What should you have available in case of Allergic respiratory reaction?
Have emergency airway resuscitation supplies available
Fluorescein Angiography:
What should be on hand for dizziness, fainting?
have smelling salts available
Fluorescein Angiography:
What should you have on hand in case reaction is anaphylactic shock?
IV epi, anti histimines, airway maintenance, transfer to emergency medical facility
Fluorescein Angiography:
What are some contraindications with Fluorescein Angiography?
Previous hx of fluorescein reaction
If pt reports multiple allergies and has never had FA before, be on alert
Pregnancy
Important to document reaction, no matter how minor
Fluorescein Angiography: If pt has Previous hx of fluorescein reaction……..
Ophthalmologist decide whether to proceed depending on severity
If diagnosis and treatment are obvious (Risks vs Benefits)-Ophthalmologists’
What are the steps to take for Fluorescein Angiogram?
- Explain Procedure to Pt, Answer questions 2. Obtain Informed consent (most important) 3. name plate (if not digital) 4. Control Photos Green filter (red free) a. documents autofluorescence 5. Setting vary, typically lowest flash 6. Increase power for FA, Align 7. Setting vary, definitely higher than red-free 8. Recheck focus and alignment with the green filter 9. Set timer to zero and remove green filter 10. Put exciter and barrier filters in place 11. injection 12. Have everything aligned and in focus before injection begins 13. Position patient on chin rest 14. Let injector know when you’re ready. If you’re injecting, confirm needle is in vein by drawing back blood. Inject just a small amount of dye first. 15. Begin timing device when you tell injector ‘go’ or you begin injecting 16. inject Fluorescein at rate of 1 cc per sec. 17. injector should say ‘in’ when injection is complete 18. Take photo to record time of injection 19. Begin photographing approx 1 photo per sec for first minute ( you can’t take too many photos) 20. After re-circulation photos remove butterfly and compress injection site. Pt can relax 21. Take late phase photos 10 min post injection.
FA Imaging Artifacts:
Illumincaiton artifacts, blurring of image
Media opacities
FA Imaging Artifacts:
Reduces light causing uneven illumination
Poor pupillary dilation
FA Imaging Artifacts:
Degrades retinal fluorescence
Excess topical fluorescein
FA Imaging Artifacts:
Loss of field definition
Poor patient cooperation
FA Imaging Artifacts:
Reduces amount of dye in retinal vessels and causes patient discomfort
Leakage of dye out of vein
FA Imaging Artifacts:
Adjust what setting to compensate for high refractive errors?
Resolution, Image Brightness, and Myopic lens settings
*With Retinoscopy do you seek with or against motion?
With motion
Retinoscopy:
Follow __________ to neutrality
With motion
Retinoscopy:
Maintain you working______
distance
Retinoscopy:
Stay aligned with patient’s __________
visual axis
Retinoscopy:
Watch center of________
pupil
Retinoscopy:
Sweep side to side perpendicular to _______________
orientation of streak
Retinoscopy:
If you are in doubt whether you’re at neutrality or not you should……..
Add minus so see ‘with’ motion and gradually add one click of plus at a time til the with motion is no longer visible and center of pupil fills with light.
Retinoscopy:
When you think you are at neutrality… if you move in a little you should see…..
with motion
Retinoscopy:
When you think think you’re at neutrality if you move back a little you should see
against motion
*Retinoscopy:
If you see with motion the focal point is ________ you.
Behind
*Retinoscopy:
If you see against motion the focal point is ___________of you
In front
Retinoscopy:
If you see neutrality ___________________________
You are at the focal point
What are some common aseptic technique errors with masks?
Not covering mouth and nose
tied too loosely
hair loose from cap
What are some common aseptic technique errors with scrubs?
Fingernails longer than 1 mm beyond nail bed
Runoff dripping down arms /hands
Too short scrub time
Not developing systemic scrub/missing area
Splashing clothes (strikethrough on sterile gown)
What are some common aseptic technique errors with Drying
Using wet section of towel to dry hand
Allowing towel to touch non sterile clothing
What are some common aseptic technique errors with Gowning
Allowing gown to come in contact with nonsterile items or hands
What are some common aseptic technique errors with gloves
Touching outer portion of glove with bare hand
Undetected perforations in gown
Holding hands against body while waiting
What are some common aseptic technique errors with skin prep
Going back and forth rather than in circular fashion
Not prepping lashes, lid margin or brows
Allowing even traces of soap to come in contact with quarternary ammonium compounds (ie Zephiran) thus neutralizing it.
The surgical scrub:
Always scrub from…
the finders UP
What should you begin with when doing a surgical scrub?
with nails
When doing surgical scrub you should use what to clean nails
nail cleaner and brush
When doing surgical scrub, scrub each side of the finger and treat each finger as a ____
four sided object
After scrubbing fingers with surgical scrub you should then….
Scrub each side of the hands treating it as a four-sided object
After scrubbing hands doing a surgical scrub you should then…..
Scrub the wrists, the arms and 2” past the elbows
When doing a surgical scrub, keep hands tilted ______at all times
upwards
Surgical scrub:
Rinse from _______to_____
fingertips to elbows
Surgical scrub:
never allow water to __________
Drip back down to hands
Surgical scrub:
Rinse all_____from under fingernails, in folds of knuckles
subds
If you accidentally touch anything during or after you’ve done a surgical scrub you must______
start over
What are the 3 main types of slit lamp illumination?
Direct
Indirect
Diffuse
What are 4 types of Tonometry?
Shiotz
Goldmann
NonContact
Tonopen
What principle is used with Schiotz
Indentation
What principle is used in Goldmann tonometry?
Applanation Principle
What principle does Non Contact tonometry use?
Indentation Principle
What principle does Tonopen use?
Combination of applanation and indentation principles
Tonometry: True or False
A force or weight will indent or sink into a soft eye further than into a hard eye.
True
Tonometry:
Which tonometry method must you refer to a scale on the tonometer and then a conversion table to determine IOP?
Schiotz
These are advantages of which tonometry method?
Reliable, simple mechanics
Inexpensive to buy and maintain
Calibration easy to check
Use on restricted pts
Can sterize for use in OR
Schiotz
These are disadvantages of which tonometry method?
Pt apprehension
Anesthesia required
Need good pt cooperation
Risk of corneal abrasion
Rarely delegated
Must disassemble and clean after each use
Displaces significant aqueous
Schiotz
What principle is decribed?
The pressure inside a thin-walled sphere=the force necessary to flatten its surface divided by the area of flattening
Imbert-Fink Principle
These are advantages of which tonometry method?
Reference standard for accuracy
Rarely needs recalibrated
Displaces little aqueous, repeated readings accurate
Relatively inexpensive to buy and maintain
Compact
Hand held models available
No electronics, reliable
Goldmann
The following are disadvantages of which tonometry method:
Requires topical anesthetic
Poor results with edematous cornea
Patient must be able to be positioned at slit lamp
Must send to factory for calibration
Influenced by external pressure
Risk of corneal abrasion
Subjective
Goldmann
These are advantages of which tonometry method:
Accurate compared with Golmann (if <30mm)
No anesthetic required
Displaces little aqueous
Easily delegated by Dr.
No risk of K abrasion
Quick
Can measure through contact lenses
Non Contact tonometry
The following are disadvantages of what tonometry method:
Some patients apprehensive
Expensive
Large, bulky
Must send to factory for calibration
Multiple readings required
Non Contact Tonometry
These are advantages of which tonometry method:
Most accurate method for scarred or edematous corneas
Quick
Minimal corneal disruption
Easy to use with patients who can’t sit upright or hold steady
Portable, light weight
Tonopen
These are disadvantages of which tonometry method:
Accuracy questionable
Factory calibration
Expensive to buy, operate and maintain
Displaces significant aqueuous
Influenced by external pressure
Tonopen
How do you clean and disinfect Goldmann Tonometer?
Remove measuring prisms carefully from holder
Wipe prisms clean before rinsing for 30-60 seconds in running cold water
Disinfect with Hydrogen Peroxide for 10 minutes (3% aqueous solution) or Sodium Hypochlorite (household bleach) for 10 minutes (10% aqueous solution)
Rinse thoroughly with running cold water (Note:rinsing time in water not to exceed 60 minutes)
Dry with one way tissue clean and soft
Store in container clean and dry
What cleaner is used to clean Goldmann tonometry prism tip?
Hydrogen peroxide or Sodium Hypochlorite
What is the break down of phakic axial length measurements using immersion technique? (PCAPRS)
Probe, Cornea, Anterior lens, posterior lens, retina, sclera, then the space past this is orbital fat
*EOM innervation Mnemonic
SO4, LR6, III
What fluorescein angiography phase is present when fluorescein dye is indicated in the arteries and choroid only?
Arterial
What fluorescein angiography phase is present when there is a full filling of larger veins?
Late venous
What is the term for mid-phase fluorescein angiography?
Venous phase
What fluorescein angiography phase is present when there are no white areas of leakage seen and diminution of fluorescein in all retinal blood vessels is indicated?
Late
What is the earliest phase of retinal circulation in fluorescein angiography?
Arterial phase
What is the primary purpose of using epinephrine for glaucoma?
Increase aqueous outflow
What fluorescein angiography phase is present when capillaries fluoresce?
Early venous
**What does PCAPRS stand for in A scan
(**Know what effect old RD and tumors have on the spikes and what and what it looks like when hits retina)
Probe/cornea/anterior lens/posterior lens/retina/sclera
Goldman tonometry
** if mires are oval in OD and round in OS this means….
I answered OD has higher astigmatism ** I do not know if I was right.
