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PPO5 > Lecture 4 > Flashcards

Lecture 4 Flashcards

1
Q

what is the magnification of the direct ophthalmoscope?

A

15x - magnification is dependent on patient and examiners refractive error

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2
Q

when is the cobalt blue filter used?

A

with the 20D lens and fluorescein to evaluate the cornea

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3
Q

what does the red-free filter help to identify?

A

hemorrhages, choroidal nevus vs. retinal pigmentation, NFL loss and ON rim tissue

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4
Q

where should your ending point be for direct ophthalmoscopy?

A

about 1.5 to 3mm from eye (middle finger touching cheek) and 15-20 degrees off visual axis

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5
Q

why should you try and keep both eyes open during direct ophthalmoscopy?

A

to reduce the amount of accommodation

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6
Q

what are some limitations of direct ophthalmoscopy?

A

lack of stereopsis, close working distance, refractive error dependent, and dependent on pupil size and lens

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7
Q

what is the diagnostic code for an extended ophthalmoscopy?

A

CPT 92225 (first visit) and 92226 (subsequent visits)

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8
Q

why is extended ophthalmoscopy one of the most audited codes by Medicare?

A

you cannot perform extended ophthalmoscopy and fundus photos in the same visit

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9
Q

how many colors are preferred in extended ophthalmoscopy?

A

4-6 colors and all items must be identified

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10
Q

what are the red colors used for in retinal mapping?

A

light red = attached retina

dark red = retinal arteries, pre-retinal or intraretinal hemorrhages

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11
Q

what is light blue used for in retinal mapping?

A

retinal detachment

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12
Q

what is dark blue used for in retinal mapping?

A

retinal veins, margins of retinal break and lattice is outlined in blue with inside crosslines

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13
Q

what is black used for in retinal mapping?

A

chorioretinal pigmentation

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14
Q

what is yellow used for in retinal mapping?

A

intraretinal or subretinal exudates, CWS

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15
Q

what is brown used for in retinal mapping?

A

nevi, melanomas, choroidal detachments

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16
Q

what is green used for in retinal mapping?

A

vitreous opacities

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17
Q

what is the Gulstrand principle?

A

BIO narrows the users PD - need to place the illuminating/viewing beams within the patients pupillary aperture

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18
Q

if your lens has a full view while looking at the patients superior temporal retina, what area are you actually viewing?

A

mid-periphery the periphery should be an elliptical/oval shape (not filling whole lens)

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19
Q

how do you compensate for elliptical pupils in extreme gazes?

A

slight head tilt (superior/inferior views may require a chin tuck or lift)

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20
Q

if you see something at the edge (not center) of your FOV in the lens, how do you bring it in the center?

A

scan towards it

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21
Q

if the patient is looking up and nasal (OD) - you see the vortex veins in the center of your lens, how do you bring the ora into view?

A

scan/sweep the lens more to the far periphery = ora will be near your thumb

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22
Q

what are “dark” retinal color changes?

A

Nevus, CHRPE, optic nerve choroidal ring, peripapillary atrophy, choroidal pigment changes near ampullae in tigroid and brunette fundi

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23
Q

what are “white” retinal color changes?

A

CWS, infarction/retinal edema, myelination

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24
Q

what are yellow-white retinal color changes?

A

drusen, exudates, emboli

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25
Q

what are “red” retinal color changes?

A

hemorrhages, holes and tears

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26
Q

what are 5 benign peripheral retinal conditions?

A

peripheral (equatorial retinal drusen), honeycomb (reticular degeneration), Pavingstone (degeneration) CHRPE, and post inflammatory scars

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27
Q

what does CHRPE stand for?

A

congenital hypertrophy of RPE

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28
Q

what does benign conditions of the retina mean?

A

they are non-rhegmatogenous conditions - not prone to tearing

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29
Q

what are 3 benign “dark stuff” seen on the retina?

A

pigment crescents, CHRPE/bear tracks, choroidal pigment changes near ampullae

30
Q

what are 3 pathological “dark stuff” seen on the retina?

A

peripapillary atrophy when significant, nevus, and CR scars (chorioretinal)

31
Q

what is an optic nerve choroidal ring?

A

benign condition - choroidal ring 360 or crescents that connect

32
Q

what is peripapillary atrophy “PPA”?

A

potential pathological condition - appears as an irregular, hyper and hypopigmentation zone around the ONH

33
Q

where is PPA most commonly seen and in which types of patients?

A

common on temporal side associated with myopia, glaucoma, and histoplasmosis

34
Q

what is a choroidal nevus?

A

pathological - a flat or slightly elevated grayish-green lesion (disappears with red-free filter) may have overlying drusen and increase in size with age

35
Q

what is a CHRPE (congenital hypertrophy of the RPE)?

A

benign - isolated, distinct edges, dark gray/black areas, anywhere and any size, flat, may be bear tracks

36
Q

what happens to CHRPEs as they age?

A

they can become “halo nevus” - de-pigmented area surrounding the CHRPE (not a true nevus)

37
Q

what causes CR scarring?

A

toxoplasmosis (protozoa) or histoplasmosis (fungi)

38
Q

how do you document anything seen on the retina?

A

gauge size using disc diameters and location using DD from a certain structure - also clock location

39
Q

what does hypoplasia of RPE on a fundus look like?

A

looks like ampulla on blond fundus - RPE drop out near periphery

40
Q

what are cotton wool spots (CWS)?

A

white/fluffy appearance (soft exudates) = results from ischemia/hypoxia of arteriole in NFL bundles

41
Q

where are CWS usually located?

A

within 3-5 DD of the disc (posterior pole) because this is where the NFL is the thickest

42
Q

how long does it take CWS to resolve?

A

6-8 weeks (longer in diabetics)

43
Q

who typically gets CWS?

A

HTN, DM, vein occlusions, vascular diseases (lupus, HIV/AIDS) and interferon therapy (hep C, melanoma/cervical cancers) and MS)

44
Q

what are hard exudates made out of?

A

deposition of lipid and lipoproteins

45
Q

what do hard exudates look like?

A

yellowish, well circumscribed, distinct margins and deep in the retina OPL (does not obscure blood vessels)

46
Q

who typically gets hard exudates?

A

sign of abnormal vascular permeability = diabetic retinopathy, late stage HTN retinopathy and vein occlusions

47
Q

where are drusen located?

A

in bruch’s membrane (will not obscure blood vessels)

48
Q

what may be present if there is “white stuff” on the ONH?

A

it is glial tissue (remnant of hyaloid artery) or myelination of the NFL

49
Q

what does a myelinated nerve fiber layer look like?

A

white, feathery-edged that often obscures retinal vessels usually the optic nerve and peripapillary NFL (may develop in retina away from disc)

50
Q

what is a hollenhorst plaque?

A

a branch retinal artery occlusion - causes an area hypoxia on retina

51
Q

what is a cilioretinal artery?

A

some people have an extra vessel - origin lies in the choroid

52
Q

what is a classic sign of a central retinal artery occlusion?

A

cherry red spot (macula is red because there are no vessels running across it)

53
Q

what are the 4 basic types of hemorrhages?

A

pre-retinal (boat/D shaped), flame/feathered (NFL), dot and blot (round/intraretinal), and sub-retinal

54
Q

what does a BRVO look like?

A

feathery or striated - leaks into the NFL

55
Q

what does a CRVO look like?

A

mostly flame hemorrhages with some large blots

56
Q

what is diabetic macular edema or CMSE?

A

clinically significant macular edema = hard yellow and thickening of the macula

57
Q

what two things can be seen in proliferative (PDR)?

A

neovascularization of the disc (NVD) and neovascularization of the retina (NVE = neovascularization elsewhere)

58
Q

What is seen in this photo?

A

choroidal crescent

59
Q

what is seen in this photo? what cases it?

A

CR scarring - Toxoplasmosis (protozoa)

60
Q

what is in this photo? what causes it?

A

CR scarring - Histoplasmosis (fungi)

61
Q

what is seen in this photo?

A

macular drusen

62
Q

what type of hemorrhage is seen here?

A

D shaped or Boat shaped (pre-retinal)

63
Q

what type of hemorrhage is seen here?

A

Dot and Blot

64
Q

what type of hemorrhage is seen here?

A

subretinal hemorrhage

65
Q

what two landmarks are seen in this photo?

A

ampulla and short posterior ciliary nerve

66
Q

what is seen in this photo?

A

choroidal nevus (will disappear with red-free filter)

67
Q

what is seen in this photo?

A

remnant of hyaloid artery

68
Q

what is seen in this photo?

A

macular edema

69
Q

what is seen in this photo?

A

BRAO = branched retinal artery occlusion

70
Q

what is seen in this photo?

A

hypoplasia of RPE

71
Q

what is seen in this photo?

A

choroidal pigment near ampulla

PPO5 (5 decks)

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