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PPO 5 > Lecture 1 > Flashcards

Lecture 1 Flashcards

1
Q

what is the purpose of doing Dilation Fundus Exam FDE?

A

to evaluate the peripheral retina to search for ( rhegmatogenous) since it is missed with direct and indirect monocular

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2
Q

what are the advantages of BIO?

A

1- quick assessment of entire retina and vitreous

2- Stereoscopic Examination of the Entire retina and Vitreous

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3
Q

what it means that BIO is a Stereoscopic examination?

A

1- allow a binocular , high resolution view
2- allow a large fov
3- independent of pt. refractive error

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4
Q

what are the disadvantages of BIO ?

A

1- lower mag than SLEx with lenses and direct
2- require dilated pupil
3- the BIO light is very bright

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5
Q

what is the Mag of BIO with 20D lens ? how to increase the mag.?

A

BIO has 3X Mag with 20D lens

the ONLY way to increase the Mag is to change the Diapter lens not getting closer to the patient

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6
Q

what is the distance between the Dr and the lens ? between the lens and the Pt. eye?

A

it is 50cm=16-20 inches from Dr to the lens

it is 50mm from lens to eye

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7
Q

what are the indications for BIO?

A

1- every Pt. with a comprehensive eye exam
2- flashes , floater complaints
3- Myopia >4.00D
4- systematic Diseases

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8
Q

What are the contraindications for BIO ?

A

1- Narrow angle

2- Caution with Down’s syndrome since they are sensitive to Tropicamide

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9
Q

what is the Pupil Dilation Protocols?

A 
1- review history 
2- Acuities = best corrected with trial frame 
3- Pupils , EOMs 
4- SLEx for cornea and angles with VH
5- IOP
6- Gonio
7- Pt education 
8- Instillation of drops
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10
Q

what you should be Caution about if Pt have low BP?

A

Vasovagal Syncope = loss of consciousness caused by transient cerebral hypoperfusion as a result of low HP, HR
symptoms : Nausea, Pale ,
lightheaded, warm

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11
Q

what you should do with Vasovagal ?

A

1- stay calm
2- recline the Pt. wit elevation of their feet
3- while that , take BP, Pulse until return to normal
4- alert the preceptor
5- be careful and support the Pt

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12
Q

What are the three DO NOT with VasoVagal ?

A

1- DO NOT Pt leave until BP, Pulse are back to normal
2- DO NOT let the Pt walk alone if unsteady
3- DO NOT give water

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13
Q

what are the drops you use for dilation ?

A

1-Anesthetic ( Proparacain )
2— Tropicamide 1% or for lighter eyes 0.05% —> Block sphincter( Para symp.) muscle result in dilation
3- Phenylephrine 2.5% will activate the dilator muscle( Sympathetic) mydriasis and vasoconstrictor –> weak Dilator , NOT the standard of care for pupil dilation ( need Tropicamide with it )

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14
Q

what are the two things u need to do before Dialtion ?

A

IOP , VH

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15
Q

what are the properties of Tropacmide ?

A

1- STING make sure eye is numb 1st ,
2- Caution overdose with kids
could cause dry mouth, fast HR, Headaches, drowsiness , redness of skin
3- Blurry Vision at near , Photophobia

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16
Q

what are the properities of Phenylephrine ?

A

ONLY when use 10 %
1- Dizziness , fast HR, increase BP
2- High BP since is it is vasoconstrictor

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17
Q

what are the side effects of dilation ?

A

1- explain that it will be blurry vision at near > distance for 2-6h ( blue eyes stay longer )
2- photophobia
3- Pt may wish to have driver ( Older Hyperopic
4- Cycloplegia may wear off before dilation of Pupil

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18
Q

how to record the dilation ?

A

1- which drop , how much , which eye , when

2- record that u educated the Pt before the dilation

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19
Q

what are the steps to start using the BIO ( binocular Indirect Opthalmoscope ) ?

A

1- make sure u have the BIO comfortable on ur head
2- PD , oculars are properly set before viewing the lens( see the top part of thumb in the middle of the circle )
3- hold the lens in a way that ur fingers not in the way
4- make sure u see single vision
5- make sure u see a red reflex
6- then put the lens close to the eye
7- then Trombone

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20
Q

what happened if you increase the dioptric power of the lens?

A

increase D –>will increase Field of view, DECREASE Mag , decrease WD
(More Diopters= Less Mag)
Change Aperture will change the Mag

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21
Q

which is the lens standard ?

A

20D lens gives the BEST balance between mag and Fov ( field of view )

22
Q

what is the working distance of 20D lens , Pan retinal 2.2=25D, 28D?

A

1- working distance of 20D is 50mm( from the lens to the eye)
2- working distance is 40mm
3- working distance for 28D is 33mm

the lower power lens u use —> the farther aways from the eye the lens should be

23
Q

how changing the Aperture will affect the Mag ?

A 
Change Aperture will change the Mag 
15 D= 4X
20 D = 3X
30 D = 2X
2.2 = 2.5X
24
Q

how field View related to the Mag ?

A

Field View is inversely related to Mag.

25
Q

What are the elements that will change if u INCREASE the Lens D power ?

A 
increase D lens -->
1- Increase the field of view 
2- Decrease the Mag = change aperture will change Mag
15 D= 4X
20 D = 3X
30 D = 2X
2.2 = 2.5X
3- Decrease WD
26
Q

what is the unit used for Field of view ? what is the field of view of 20D lens ? Direct scope

A

1- Disc Diameter is the unit used for field of view
2- 20D =8DD ( Disc Diameter)
3- Direct scope= 2 DD

27
Q

what is the distance between ONH to Macula?

A

it is 2 to 3 DD

28
Q

How you should hold the lens ?

A

1- Grasp the lens between the index finger and Thumb ( silver ring toward the pt)= more reflecting surface
2- the ring, middle , little finger can be used for :
retract the upper lid,
allow stable extension
act as a Pivot ( to tilt the lens)
3- Open arm of V facing u which is the less reflecting surface
4- keep ur eye slightly bent , pull the lens towards u ( keep the light source and pupilalry reflex centered on the lens )
5- Align the Purkinji images
6- keep pulling until–> tromboning

29
Q

how u know ur tromboning ?

A

keep pulling until–> the entire lens is full with a view of fundus–>tromboning
1- true for Posterior pole and midperipher ONLY

30
Q

what you should do each time you have a pt moves their fixation ?

A

Each time you have the patient moves their fixation, you should be moving yourself to maintain a position ~180° from the patient’s fixation

31
Q

what is the set up for superior view ?

A

to view the superior retina –> examiner will be sitting and light on the pt chin, or 45 degree

32
Q

what is the set up for inferior view ?

A

to view the inferior retina –> examiner will be standing , my light ovet the pt head ,or 45 degree

33
Q

what are the BIO goals when filling the lens ?

A

1- keep surface of the lens approximately perpendicular to the light/sight path (by aligning front- & back-surface reflections)
2-keep sight-path & light-beam on a straight line through the center of the lens & the center of the entrance pupil of the patient’s eye.

34
Q

how many peripheral views , and posterior ?

A

8 peripheral , 4 posterior

overlap is the mid-periphral

35
Q

where you should ask the patient if you want to check the superior retina ?

A

ask the patient to look up , and you should come inferiorly (Where the patient is looking is the retina you are studying)

36
Q

What part of the retina are you examining in this picture?she is looking up and to her right

A

Superior temporal

37
Q

If she is looking to her left, then how are you examining “inferior nasal” OD

A

Because you are STANDING and looking down on the retina

38
Q

what are the BIO Pearls ?

A

1- DON’T PULL HARD ON THE LIDS. Pull gently & only enough to get lids and lashes out of your field of view
2“TROMBONE.” If you lose your view, put the lens CLOSE to the eye, find and center the orange “red” reflex, and then smoothly pull the lens back out to fill lens.
3- OK to TOUCH the patient. To keep the lens stable, you MUST support your hand by resting your fingers on the patient’s forehead/cheek.
4-Once you are adept at filling the lens, practice SCANNING (moving).
5- Remember, the field of view is 8 DD. If the vortex veins are centered in the view, the ora serrata will be near one edge of the view in your condensing lens!
6- Have the patient keep their head pointing straight ahead and just move their eyes to the eight positions
7- Troubles with nasal and temporal views  ask patient to turn head opposite to direction of gaze
8- Brighter illumination is required to detect subtle pathology, especially in a dark fundus will not as bright so need a lot of light to see the retina
9- Brown eye , red flex not as bright , dark or orange so make light brighter more

39
Q

why you are seeing double vertical ?

A

the BIO is tilted sideways on your head

40
Q

why you are seeing double horizontal ?

A

incorrect PD

41
Q

what is troubleshooting ?

A

your are getting excessive reflections —> so tilt the lens slightly from perpendicular

42
Q

what are the three retina mapping circles ?

A

1- inner = equater
2- middle Ora serrata
3- outer = ciliary process

43
Q

where is the macula located ?

A

it is temporal and inferior to the optic nerve

44
Q

what is + , circle means in the retinal map ?

A

+ is macula

circle is optic nerve

45
Q

how the image inside the lens look like ?

A

where ever the Pt is looking this is what you are viewing
BUT Image inside the lens is inverted / reversed
SO if you see inside the lens something to your right , it is on the map to the left , up/down

46
Q

where is the short ciliary nerve ?

A

around 10-2 or 5-7 o’cock

47
Q

what does it mean when you see ampullae ?

A

connect the ampullae makes a circle which is the equator

48
Q

if you see something posterior to the equator what does that mean? Anterior to the equator ?

A

posterior to the equator=inside the ring

Anterior to the equator = outside the ring =peripherally = close to ORA

49
Q

what is the different between the nasal ora and temporal ora ?

A

nasal ora has dent process

50
Q

if the pt looking up where is the ora ? if the pt looking down where is the ora ?

A

1- If pt look up Thumb is the ora , finger is close to the equator
2- If pt look down ora finger and equator is to thumb

51
Q

what to record if you see something?

A

1- Which eye or both
2- Anatomical location!! Use clock position or by quadrant
3- Size and shape (size in DD)
4- Contour (flat or elevated

if every thing is normal record: OD and OS separately not as OU
Flat and intact, no holes, no tears, 360o

PPO 5 (1 decks)

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