Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Peds Fall 2020 > Lecture 6 > Flashcards

Lecture 6 Flashcards

1
Q

Purpose of NRA/PRA

A

To measure fusional convergence and divergence. Also looks at accommodation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Normal NRA and PRA values

A

NRA +2.00

PRA -2.37

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Harmon distance

A

Comfortable reading distance from middle knuckle to elbow.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Lag means you are focusing ___ the target

Lead means you are focusing ___ the target

A

Lag: behind
Lead: in front

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

FCC purpose

A

To determine the lab of accommodation or add subjectively

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Near ret purpose

A

To determine the need for a near vision correction/add over the distance rx.
Ojective info on accommodation done binocularly.

Ex: MEM, NOTT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Benefit to using spot ret

A

Allows for more light to enter retina. Better color, brightness, observe 2 meridians at the same time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

MEM is objective correlate to

A

FCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

MEM

  • Distance?
  • Tell patient to do what?
  • What does Dr do?
  • Expect what?
  • Concerns:
A
  • At harmons distance/16 inches
  • Tell patient to read cards with both eyes open, wearing appropriate rx
  • Dr estimates Diopter value of motion.
  • Expect +0.25 to +0.75
  • Unequal reflexes, lag reader than +0.75 or against motion, indicating that we need to add minus.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Bell retinoscopy procedure

A

Pt wears appropriate rx.
Start with target and retinoscope at 50 cm. Keep ret still and move the target closer (wolff wand) and then further away from patient.
No lenses added!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Bell ret. See with motion. Do what?

A

With motion = add plus. Move closer to make neutral.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Bell ret. See against motion. Do what?

A

Against motion = add minus. Move further away to make neutral.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How to determine lag doing bell ret?

A

Compare accommodation response to accommodation stimulus.

The response is the distance the ret is from the patient (50cm, -2.00D)

The stimulus is the distance the target is from the patient when it is neutral. This changes.

The difference between the AR and AS is the lag.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Normal values for bell ret

A

Lag of +0.25 to +0.75
~16 inches, 40 cm. -2.50
Ret at 50 cm, -2.00

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Book ret procedure

A

While patient reads with appropriate rx, observe the reflex in each eye.
Look at motion, color, brightness and symmetry.
Start with easy material (2 grade levels below) then more difficult.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

During book ret, how does the color of the reflex change as the reading difficulty increases?

A

White –> pink –> Red as difficulty increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

During book ret, how does the brightness of the reflex change as the reading difficulty increases?

A

Bright –> Dull as difficulty increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

During book ret, how does the direction of the reflex change as the reading difficulty increases?

A

Low with motion (low plus) to large with motion (high plus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Nott procedure

A

Can do this in phoropter
Patient wears appropriate RX
place near card at 40 cm
The examiner moves the RET closer or father until neutrality is reached.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Difference between bell ret and nott

A

Bell ret: Move wolff wand target. Keep ret in same place.
Nott: Move ret. Keep target in the same place.

In both cases, there are no changes in lenses! Take difference between stimulus of ret and stimulus of target to find lag.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Nott. Notice with movement, what does this mean?

A

Means you (and the ret) need to move further away from the target. The pt has a lag.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Nott. Notice against movement. What does that mean?

A

Means you and the ret need to move closer to the patient (in between patient and target) The patient has a lead.

23
Q

Relationship between accommodative stimulus (moving target) and response (ret)

A

Non linear. As the stimulus increases, the response can’t keep up.

24
Q

Stress point

A

As the target moves toward a patient, they react the stress of the near target with a physiologic response= change in brightness. A quick dull, then re-brightness.

25
Q

Stress point procedure

A

Ret held at 50cm. Have the patient look at a target that you move closer to them. Look for a change in reflex BRIGHTNESS, not motion. Brightness will quickly dull then re-brighten.

26
Q

Stress point. What happens if you give the patient plus lenses?

A

The plus lenses shift the stress point closer to the patient. They can fixate on nearer targets without stress.

27
Q

Expected stress point for children and adults

A

Children: 4 inches closer than harmon distance
Adults: 6 inches from face

28
Q

What does it mean if you have a high lag

A
  • Eso
  • Over minused
  • Esos want plus so they can relax accommodation. Will have a higher NRA than PRAq
29
Q

What does it mean if you have a low lag/lead

A
  • Exo

- Over plused

30
Q

“just look” technique

A

Compare both eyes, stability of reflex, what happens when you move target?

Neutralization is not part of the technique.

31
Q

Color development- what colors can children see first?

A

Black and white
Infant: red from white
1 month: Blue/green from gray
3 months: Yellow/blue/green from gray

32
Q

If you are testing color vision for congenital defects, can you do mono or bino?

A

Ok to test OU

33
Q

HRR test

-Benefits

A

Allows you to quantify defect

  • Protan/deutan Mild, medium, strong
  • Tritan medium or strong
34
Q

HRR. What happens if the child misses any of the 6 screening plates?

A

Do entire book. and fill out page based on what child says.

35
Q

Ishihara color vision test

A

Has numbers. Plates determines red/green defect. Last plates can differentiate proton from deutan.
Tells if they are strong or mild.

36
Q

D-15 test

A

Requires child to figure out the pattern of similar colors. Harder test.
Determines protan from deutan from tritan.

Will have child order them and then you will order them in the circle. Based on the pattern, you can determine their color vision defect.

37
Q

Computer color vision benefits

A

Can motor changes over time.

Tests to look at how cones are operating by wavelength.

38
Q

Pupil testing on infants

A

Infants have mitotic, sluggish pupils.

39
Q

VF testing on infants/toddler, preschoolers and school age

A

Infants/toddler: Have them fixate on central target. Bring target from the periphery, child shoaled observe it. Make sure the peripheral target is non-auditory or you won’t know if they responded to the visual or sound cues.

Preschooler: Count fingers
School age: Count fingers, add

40
Q

When to do automated visual field on children?

A

__

41
Q

What class of drug has a risk of increasing IOP

A

Steroids

42
Q

IOP gold standard

A

Goldmann

43
Q

Anterior seg assesments

A
  • Slit lamp. Have child sit in parent’s lap or use portable.
  • Direct opthalmoscope to look at cornea, sclera, iris.
  • Shadow test for open angle
  • IOP
44
Q

Neuro assessments

A

Color vision, stereo, pupils, cover test.

45
Q

3 types of anesthetics and what are their uses

A

Proparacaine, tetracaine, benoxinate

Used to increase absorption of subsequent drops- softens cornea.

46
Q

If pt is allergic to a “-cain”, what anesthetic drop should you use

A

Benoxinate

47
Q

Side effects of anesthetics

A

Irregular heart beat, dizzy, shortness of breath, nausea, lid swelling.

48
Q

Cyclo percentages for infants and 1 year +

A

infants- 0.5%

1 year- 1%

49
Q

Adverse side effects for cyclo

A

*Drowsy
*seizure
Ataxia- mimics being drunk
Restlessness
Hallucinations
Hypersensitivity in down syndrome

50
Q

When to use atropine 1%

A

Prob uveitis.

51
Q

Atropine side effects

A

Sympathetic like side effects
Tachy, dry mouth, flushing, confusion

Hot as a hare, mad as a hatter, red as a beat, dry as a b one.

52
Q

What class of drugs in is phenylephrine

A

Alpha 1 agonist- causes vasoconstriction and mydriasis.

Side effects: tachycardia, Bp changes

53
Q

Length;
Atropine
Cyclo
Tropicamide

A

Atropine- weeks
Cyclo- 1 day
Tropicamide- 4 to 6

Peds Fall 2020 (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions