Lecture 3: Fundus Biomicroscopy and Fundus Findings part 2

Question 1

“Distinct Margins” is referring to the:

A) disc
B) cup
C) macula
D) Ora Serrata

Answer 1

A) disc

Question 2

A malinserted disc is tilted along its ____ axis. and is often associated with a _____ ____

Answer 2

vertical, scleral cresent (disc appears to be tilted upward nasally, and nasal rim can be “heaped up” with temp depressed)

Question 3

With a tilted disc, the _____ axis itself is tlted. The disc appears to be tilted _____ ____

Answer 3

vertical, downward nasal

Question 4

Describe the Elschnig classification of ONH for each of the 4 types.

Answer 4

1) Type 1=flat cross sectional
2) Type 2=cylinder cross sectional
3) Type3=a sloping cross sectional
4) Type 4=a sloping with hook cross sectional

Question 5

Describe the “ISNT” rule

Answer 5

This is for a healthy optic nerve. inferior with be thickest and temporal will be thinnest. Inferior>Superior>Nasal>Temporal

Question 6

In glaucoma, the vertical C/D _____ faster than horizontal and _____ follow the “ISNT” rule

Answer 6

increases, doesn’t

Question 7

Average C/D for caucasians is ____
Average C/D for asain/latino is ____
Average C/D for African-Americans is ____

Answer 7

caucausians=0.4 (0.3+/-0.2)
Asain/latino=0.5
African-Americans=0.6 (0.5+/-0.15)
(suspicious when C/D is 0.1 larger than normal expectation)
*30% of normals have 0.1 difference
*4% of normals have 0.2 difference

Question 8

Which 3 cup to disc scenarios are abnormal and suspicious of glaucoma? (pick 3)

A) average to small
B) average to average
C) large to small
D) large to average

Answer 8

A) average to small
C) large to small
D) large to average

Question 9

(T or F) A large cup to disc ratio can be a sign of glaucoma, however 2% of normals have a C/D ratio of 0.7 or more

Answer 9

True

Question 10

(T or F) The nerve fiber layer should look dark

Answer 10

False, dark wedge shaped NFL is a loss of NFL

Question 11

Normal arterial light reflex (ALR) is ____ or ____

Answer 11

1/3 or 1/4 (ratio of reflected light width to width of the artery)

Question 12

Normal artery vein (A/V) ratio is ____ or ____

Answer 12

2/3 or 3/4

Question 13

Choose the correct statement:

A) veins are 25% smaller than arteries
B) arteries are 25% smaller than veins
C) A healthy person’s arteries will be the same size as their veins
D) A healthy A/V ratio is 1:10

Answer 13

B) arteries are 25% smaller than veins

also, artieries are lighter and veins are darker

Question 14

There are ___ pairs of vessels in each quadrant of the posterior pole

Answer 14

4

Question 15

The ____ vessels arc around the macular area

Answer 15

temporal

Question 16

Veins too wide, think _____. Arteries too narrow, think_____

Answer 16

diabetes, HTN

Question 17

The A/V estimation should be made after the ____ bifurcation and before the ____ bifurcation

Answer 17

1st, 3rd

Question 18

As the walls of the artery thickens, ____ light is allowed to pass thru the artery and ____ is reflected back.

A) more, more
B) less, less
C) more, less
D) less, more

Answer 18

D) less, more

Question 19

ALR _____ with arteriosclerosis and HTN

Answer 19

increases

Question 20

“nicking” or “pinching” of the vein is abnormal and could be a sign of _____

Answer 20

high cholesterol (arteriolar sclerosis)

Question 21

Tortuous vessels look crooked/winding/wiggly. This could be either congenital or pathological. However:

A) if both arteries and veins are wiggly, then its most likely congenital
B) if arteries are more wiggly than veins its most likely congenital
C) if veins are more wiggly than arteries, its most likely congenital

Answer 21

A) if both arteries and veins are wiggly, then its most likely congenital

Question 22

(T or F) An albino has no RPE layer

Answer 22

true (albino’s have no macualr pigment)

Question 23

Tigrid is a blotchy striped pattern found in the posterior retina and is most common in:

A) African-Americans
B) Caucasians
C) Asians
D) Columbians

Answer 23

C) Asians

Question 24

When viewing the macular area, you are looking for what 5 things?

Answer 24

1) even pigmentation 2) +FLR 3) “red stuff”=hemorrhages 4) “white stuff”=drusen 5) “dark stuff”=pigmented lesions

Question 25

Which is constitutes as “reduced acuity”?

A) 20/25
B) 20/40
C) 20/80
D) 20/200

Answer 25

A) 20/25 (really, its all of them) anything worse than 20/20 is considered “reduced acuity”

Question 26

The FLR is the Foveal Light Reflex that shines back at you when you shine your light onto the fovea. Where is the FLR actually focused?

Answer 26

In the vitreous (as a result of the shape of the retina and the depression in the fovea). The fovea acts like a concave mirror which gathers light from the ophthamloscope and focuses it slightly in front of the retina as a point of light.