MIDTERM Flashcards
1
Q
What is another name for a Wide beam?
A
Diffuse Beam
2
Q
What is another name for a rectangular beam?
A
Parallelpiped
3
Q
When a pt. comes in with a red eye, you must observe the _________ of the redness
A
Laterality
4
Q
When observing the red eye, you must document the __________ of the injection.
A
Symmetry
5
Q
On a red eye evaluation, when you have pt. look left, right, up and down, you are observing the ________ __ _______.
A
Pattern of Injection
6
Q
What is the name of the injection when there is redness all over?
A
Diffuse Injection
7
Q
What is the name of the injection when there is redness in a localized area?
A
Sectoral Injection
8
Q
What is the name of the injection when there are vessels coming out from the limbus?
A
Ciliary Injection
9
Q
What are the most superficial vessels in the eye?
A
Conjunctival Vessels
10
Q
What are the 2nd most superficial vessels in the eye?
A
Episcleral
Note: They have no movement
11
Q
What is the grading scale on the Efron scale for Conjunctival and Limbal redness.
A
0 - Normal, 1 - Trace, 2 - Mild, 3 - Moderate, 4 - Severe
12
Q
What is the first type of inspection of injection?
A
Gross Inspection
13
Q
What is the grading scale of a ptosis?
A
> 0.5mm and more would suggest a ptosis or lid droop
14
Q
The normal upper lid margin rest about __ mm below the upper limbus.
A
2mm
Note: For the lower lid margin, it would be 1 mm above the lower limbus
15
Q
What light source of choice is used to confirm an APD?
A
BIO
Note: The transilluminator has a high level intensity
16
Q
How is Lymphadenopathy and Red eye connected?
A
Viral Infection
Note: Preauricular lymph nodes are usually swollen and the inferior lids drain into the preauricular lymph nodes.
17
Q
What is the feel of of infected lymph nodes?
A
Firm, Tender, Enlarged and sometimes Warm
Note: If you find a non-tender node, that is usually a sign of malignancy
18
Q
You have measured your patients palpebral fissures and notice a difference of 0.6mm. What could this indicate?
A
Ptosis (lid droop)
19
Q
How is a sinus problem issue associated with an Eye problem?
A
An Eye infection can be present
20
Q
What type of sinusitis is concurrent with Red eye?
A
Acute Sinusitis
21
Q
What type of drug would you recommend to a pt. with , when trying to decrease the inflammation from sinusitis and an eye infection?
A
Psuedophedrine
22
Q
What sinuses are we only able to evaluate?
A
Frontal and Maxillary
Note: Ethmoid cannot, as its an area we cannot access physically
23
Q
What device is commonly used when assessing if a sinus is blocked or not?
A
Transilluminator
Note: If a glow is present, a sinus is open. If there is a glow missing, then there is a blockage
24
Q
What are 4 MAJOR evaluation tests that can be conducted for a red eye?
A
Gross and External observation
Lymphadenopathy
Palpebral Fissure Measurement
Sinuses
25
Why is it important to measure pupil size in Light and Dark?
Measure Annisocoria (para and symp).
Note: This will allow you to determine whether its physiological or abnormal
26
What is the clinicial significance of an APD?
Check for a lesion of the optic nerve or severe retinal disease
27
What is the pupillary pathway for the sympathetic system?
Signal goes to PN (Pretectal Nucleus), Dilation of pupil and is part of the Afferent response
28
What is the pupillary pathway for the parasympathetic system?
Signal goes to EW (Edinger Westpahl), Constricts pupil and is part of the Efferent response
29
What does it mean if one pupil constricts more on direct that the other?
First warning of APD
30
What is anisocoria?
Pupil sizes are both different from one another
31
When EVALUATING pupils, what type of light is the best to be used?
Brightest
| Note: Increases the response to light, thus enhancing the ability to detect an abnormal reaction
32
When you find an +APD, what will the affected eye see?
Dimmer light
Note: Normal eye will NOT constrict to the same amount as the normal eye's direct response
33
What is pupillary escape?
Pupil will constrict, then re-dilate and stays dilated
34
What light source of choice is to confirm a APD?
BIO > Direct Opt > Transilluminator > Penlight
Note: Must be the brightest portable light source
Slit Lamp is NOT portable
35
What is a physiological Anisocoria?
Present if the pupil are not the same size, the difference is small (1mm).
NOTE: The size difference in both dim and light conditions and the difference between the palpebral fissure
36
If you have a pt. with a difference in the size of pupils in DIM conditions, what system would be have this type of problem?
Sympathetic
37
If you have a pt. with a difference in the size of pupils in BRIGHT conditions, what system would be have this type of problem?
Parasympathetic
38
What is a quick and gross assessment to find the depth of the Anterior Chamber?
Shadow Technique
39
What are two possible grading system for the shadow technique?
Graded as either DEEP or SHADOW
40
When preforming the shadow technique, what is the grading scale?
```
No Shadow/Grade 4 = "Wide" open angle
Grade 3 = >25% of nasal iris in shadow
Grade 2 = >30%
Grade 1 = >40%
Grade 0 = >50%
```
41
What is a proptosis?
Forward displacement of an organ
42
What is Exopthalmos?
Forward displacement of the eye, due to endocrinological dysfunction
Ex. Hyperthroidism
43
What is the most common cause of unilateral and bilateral exopthalmos?
Thyroid Eye Disease
44
What is usually the measurement for a ptosis?
3 mm of the upper lid covers the cornea
Note: 3 mm is the major difference between a ptosis vs. proptosis
45
You ask your pt. to downgaze and notice the Munson's V sign, what does this mean?
Pt. has Keratoconus
46
A pt. comes in with abnormally widened palpebral fissures, what is the names of this ocular problem?
Dalrymple's Sign
47
What is Von Graefe's sign?
Upper lid lag on downgaze
48
What is the Stellwag's sign?
Incomplete blinking
49
What is Gifford's sign?
Difficulty in everting the upper eyelid
50
What is Viguroux sign?
Eyelid fullness
51
What is Mobius Sign?
Poor convergence
52
What is Boston's sign?
Jerky lid lag
53
What is the avg. and normal findings for a Caucausian using hertel's exopthalmometer?
AVG- 21mm
NR - 11 to 21mm
Note: A difference of 3mm and more is an abnormal finding
54
What is the avg. and normal findings for an Asian individual using the hertel's exopthalmometer?
AVG - 16 mm
NR - 11 to 21mm
Note: A difference of 3mm and more is an abnormal finding
55
What is the avg. and normal findings for an African-American individual using the hertel's exopthalmometer?
AVG - 23 mm
NR - 11 to 23 mm
Note: A difference of 3mm and more is an abnormal finding
56
Why would an Optometrist record the base of the hertel's exopthalmometer?
A reference point, so a repeat of the exam can occur
57
What type of beam is used for the detection of MGD and Blepharitis?
Diffuse/Wide beam
58
What type of beam is used for Chalazion or a Hordeolum?
Diffuse/Wide beam
59
Evaluation of contact lenses, what type of beam is used?
Diffuse/Wide beam
60
What type of beam would you use for tear film assessment?
Diffuse/Wide beam
61
What are the three types of Direct illumination?
Parallelpiped, Optic Section, and Conical Beam
62
What are the three types of Parallelpiped techniques?
Indirect, Retroillumination and Specular Reflection
63
What type of examination does the Paralellpiped do for the cornea, conj, lens, and iris?
3D examination
64
What type of image does an Optic section give?
2D examination
65
When using the Optic section what are the 5 landmarks you would observe?
```
Tear film
Epithelium
Bowman's Membrane
Stroma
Endothelium
```
66
When testing for the Van Herick Angles, what would be the grade for 1/4 of the corneal optic section?
Grade 2 (20 degrees)
67
When completing the Van Herick, if you are too far centrally, the angle estimation will be significantly _________?
Greater
68
What grades would you preform Gonio?
VH angles would be either grade 1 or 2
69
What type of inflammation would you notice, if you saw cells and flare with a conical beam?
Iritis (Inflammation of the IRIS)
Uveitis (Inflammation of the Uvea)
70
When using the conicial beam, you notice dust in the light, what could be present?
Cells in the AC
71
When using the conical beam, you notice smoke through light, what could be noticed?
Flare
72
When looking for Corneal Infiltrates or WBC's, what is the best type of technique to use?
Indirect or Proximal beam
Note: Looking at both side of the beam and not directly at it.
73
What is Retro-illumination?
Bounce light off background. an example of this would be Using light bouncing off the iris to show you that the spots are dark on the cornea.
74
When observing the Iris, with Retro-illumination, where do you focus light on and what do you observe?
Shine light on the pupil and observe the light bouncing off the retina.
Note: If the iris has an ORANGE glow, that means there is a DEFECT in the Iris
75
What do you study when your using specular reflection?
Endothelium, Posterior and Anterior lens capsule
76
What law is constitutive with Snell's Law?
```
Specular Reflection
(Angle of Incidence = Angle of Reflection)
```
77
When using Specular reflection, Slowly scan across the cornea until you see a ________ ________ of the filament
dazzling reflection
78
You notice defect and deposits on the corneal endothelium, what type of beam are you using?
Specular Reflection
Note: Irregularities and deposits will fail to reflect light and appear DARK
79
What type of illumination technique produces a halo glow of light around the limbus?
Sclerotic Scatter (Total Internal Reflection)
Note: No Mag is used and the pupil is observed with teh NAKED EYE (You are not looking through the slit lamp)
80
When observing the lens, what angle and height should be the beam?
20 degrees and height should be the size of the pupil
81
What is easier to see in younger pt. vs. Old pt. like yourself?
Embryonic Nucleus
| The darkest region
82
What layer are the Y sutures located?
Fetal Nucleus
83
What two types of illumination techniques are used for observing the Anterior Vitreous?
Parallelpiped and Retroillumination
84
When pushing into the optically empty retrolental space, known as _______ ________, what is it between of?
Berger's space.
between POSTERIOR CAPSULE and ANTERIOR VITREOUS
85
When examining lids, lashes and conj, what setup on the slit lamp must be present?
Polaroid filter is ON
Light @ 30 Degrees
Wide beam
Tall beam
86
What is a loop of Axenfeld and is this a normal finding?
Ciliary nerve piercing the sclera.
This is a normal finding
87
What is an Epiblepharon?
A normal finding, predominant in asian eye. It is an extra row of skin across the lid margin causing a lower lid crease.
88
What can cause a Subconj. Hemorrhage?
Vasovagal
Result of blood thinners (ASA and NSAIDS)
89
What is an Entropion?
inversion of lid towards the eye. It can be age-related or congenital. Trichiasis, or eyelashes rubbing the globe is commonly seen with entropion
90
What is a Trichiasis?
"misdirected lashes” or lashes that turn in toward the cornea but lid is in correct apposition against the globe
91
What is an Ectropion?
when the eye lid not completely on the globe. This can be age-related, congenital, or acquired by different conditions
92
What is Dermatochalasis?
When there is excessive upper lid skin. This is age-related; psuedotosis; and can cause superior visual field loss
“derm” as in skin, and “chalasis” sounds like callous.
93
What is Xanthelasma?
when Infiltrates of the eyelid by lipid in the dermis; it is Associated with hyperlipidemia; educate the patient on high cholesterol
94
What is Arcus?
white ring around edge of cornea due to high cholesterol. Can be normal in people over 40
95
What is Madarosis?
when there is a loss of eyelashes; Most commonly associated with chronic lid disease such as blephritis; chronic infection
96
What is Trichotillomania?
when the patient has a loss of lashes or eyebrows do to a psychological condition in which they pluck this out. The eyelashes may be blunted or broken off.
97
What is a Blepharitis?
Inflammation of the eyelide margin
Note: Anterior = affects the skin and lashes
Posterior = Affects Meibomian Glands
98
What is a Hordeolum?
also called a “stye”, occurs when there is an Infected and inflamed Meibomian Glands, Zeiss or Moll glands
Note: Internal infection would affect the Meibomian glands
External infection would affect the glands of Zeiss or Moll
99
What is an MGD?
Meibomian Gland Dysfunction (MGD) is when the patient has clogged glands, red, thickened lid margins and/or capped glands.
NOTE: Inspissation = to undergo thickening or condensing
100
What are 6 main reasons we evert the Upper eye lid?
Allergies, Foreign body, lost contact lens, Hordeolum, Evaluation of a GPC and prospective contact lens pts. prior to contact lens fitting
Note: GPC - Giant Papillary Conjunctivitis - primarily seen in CL wearers
101
Where do you place the q-tip when everting the eyelid?
Tarsal Plate
Note: Pt. must be looking down
102
What is the name of a Redundant Conj?
Conjunctivachalasis
103
What is Chemosis?
All around thickened inflammation from swelling of the Conj.
104
What is a Pinguecula?
- Yellow, slightly elevated mound of tissue
- Benign finding, however may increase dry eye symptoms
- Very common and can be nasal and/or temporal conjunctiva (IP zone: interpalpebral)
105
What is a Pterygium?
- Thick, fleshy triangular mass of tissue onto NASAL cornea
- Usually an Iron deposit
- Stimulated by UV exposure and arid climate
106
What is Stocker's line?
Located at the corneal edge, which shows a promenant brown spot.
107
What is a Nevus?
Benign freckle
108
What is a Melanosis?
A brown spot on the sclera, usually confined to one area
109
What type of individual are we most concerned about a Malignant nevus?
Blue-eyed, Blonde person
110
What is Cogan's Senile Plaque?
A bruise like structure on the sclera, that has the RECTUS muscle grind against and thinning the sclera.
-No clinical significance
111
What are Retention Cysts?
- Common and benign finding of inferior palpebral conjunctiva
- Thin-walled cysts filled with clear watery fluid in the accessory lacrimal glands of Krause
112
What are concretion?
Small, yellow-white hard spots on superior and/or palpebral conjunctiva
- Causes chronic inflammation
- Usually Calcium deposit
113
What type of response do Papillae produce?
Vascular response
114
What is the distinct feature of a Papillae?
The characteristic feature is a single vessel growing in the center of the papillae which cascades down over the edges; look for where the center of it is vascularized
NOTE: Follicles are the translucent version with no vessel in the center
115
What is a follicle?
Translucent elevation on the palpebral conjuctiva
116
What is SPK?
Superficial Punctate Keratitis
| -Corneal surface disorder on the epithelium (do an optic section)
117
What are the etiologies of SPK?
o Associated with: dry, gritty feeling of “there is something in my eye”, photophobia
o Multiple etiologies (origins of the disease): dry eyes, contacts, drug toxicity, trauma, blepharitis, conjunctivitis
118
What is Corneal Neovascularization?
When blood vessels grow into the cornea
Note: Use wide beam and indirect
119
What is EKC?
Epidemic Keratoconjunctivitis - EXTREMELY CONTAGIOUS
3 symptoms: Sub epithelial infiltrates, follicles and positive lymph
120
What type of illumination should you use for EKC?
Indirect
121
What is Limbal Girdle of Vogt?
Chalky white area on the cornea, which is not 360 degrees
Note: Arcus is 360
122
What is a Corneal Arcus?
Usually a hyperlipoproteinemia ring around the limbus of the eye.
o Very common bilateral gray, white, or yellowish circumferential deposits in the peripheral cornea
o “Lucid area usually present between the deposits and the limbus”
o Typically age-related aka “Arcus Senilis
NOTE: If seen in ages 40 and younger, get lipid workup done
123
What is Central Corneal Clouding?
Result of an RGP.
| -Causes a gray area directly in front of the pupil
124
What type of Corneal scar has no effect on vision and you can view it through the Slit Lamp?
Nebular
125
What type of Corneal scar can you see without a slit lamp and vision is significantly reduced
Leukoma
126
What type of Corneal scar can effected VA and you can view it through the Slit Lamp?
Macular
127
When you are trying to assess the cornea and conj. using a Sodium Fluorescein, what type of filter do you use and what color will the eye light up as?
Cobalt Blue
Eye will glow GREEN
128
What is Fleischer's ring?
A very faint ring that forms on the cornea.
Note: Usually forms around the base of Keratoconus
129
What is corneal striae?
Fine whit lines deep in the stroma or Descemet's membrane
Usually shown as vertical in the cornea
130
What type of filter do you use when your trying to identify blood vessels or sub-conj. hemorrhage?
Red-free filter
Note: RBC's will disappear but pigment cells will remain
131
What is the Tyndall phenomenom?
Submicroscopic particles that become visible in a bright light beam if light
132
When observing for Uveitis, you count 5 cells. How would you grade this?
Trace
133
When observing Uveitis, you notice more than 5 cells and you can count them within 30 to 60 seconds, how would you grade this?
Grade 1
134
When observing Uveitis, there are too many cells to count and they move slow. How would you grade this?
Grade 3
Note: Grade 4, too many to count and barely move
135
When grading flare in the iris, what is the scale?
0: optically empty
1: faint
2: moderate (iris detail still clear)
3: marked haze (iris details becoming hazy)
4: intense haze (loss of iris detail) (dense of plasmoid aqueous)
136
What is Keratic Precipitates?
WBC's deposits on the corneal endothelium
Note: Consensual pain reflex, you can suspect Iritis/Uveitis
137
What is the grading scale for Keratic Precipitates?
1 – patient reports pain or increase in pain
2 – patient reports pain AND wincing
3 – patient reports pain AND withdraws from the light
4 – patient reports SEVERE pain AND withdraws
138
What is Persistent Pupillary Membrane?
A strand attached to two parts of the of eye, one end must be the IRIS.
Note: Worst type is IRIS to CORNEA
139
What is Hyperphema?
RBC's pooled and settled inferiorly in the anterior chamber
140
What is Mittendorf's Dot?
Remnant of the hyaloid artery, attached to the POSTERIOR SURFACE of the lens
Note: It is nasal to the visual axis
141
What is Epicapsular stars?
Small light brown or tan dots on the anterior capsule
142
What is the most common type of Congenital Cataract?
Anterior Axial Embryonic
Note: Forms a TWIN BLADE PROPELLER cluster
143
What is a Currulean cataract?
Blue dot cataract
| Bluish punctate opacities of the peripheral cortex
144
What are the two most common complaints of a Cataract aging lens?
Reduced VA and Glare
145
How is Nuclear Sclerosis characterized?
in its early stages by a yellowish hue due to the deposition of urochrome pigment
NOTE: Leads to a MYOPIC SHIFT IN REFRACTION ERROR
146
What is the grading scale for Nuclear Sclerosis?
Trace is when there is a slight yellow color and the patient’s VA is 20-20
Grade One is when there is a yellow color and the patient’s VA is 20-25 to 30
Grade two is when the lens is very yellow and the patient’s VA is 20-30 to 40
Grade three is when the lens is a yellow orange color and the patients VA is 20-50 to 60
Grade four is when the patients lens is an orange brown color, or brunescent, and their VA is 20-80 or worse.
147
As the lens ages, where do vacoules form in the lens?
Cortex
148
What type of cataract starts in the lens periphery and advances centrally?
Cortical
Note: has a spoke like look
149
What is the grading system based on for Cortical Cataracts?
Quadrant.
150
What type of Cataract is located in front of the posterior capsule and appears granularly
Posterior Subcapsuklar Cataracts (PSC)
Note: Always located in the Visual Axis
151
What is a rosette cataract?
Cataract that looks like a flower
152
When a pt. complains about their "cataract coming back" what type of Cataract can this be?
Posterior Capsular Opacification
153
What are Elschnig's Pearls?
Look like Vacuoles BUT there isn't a lens. Thus epi cells are located on the posterior capsular surface
