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PPO 4 - MIDTERM > MIDTERM > Flashcards

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1
Q

What is another name for a Wide beam?

A

Diffuse Beam

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2
Q

What is another name for a rectangular beam?

A

Parallelpiped

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3
Q

When a pt. comes in with a red eye, you must observe the _________ of the redness

A

Laterality

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4
Q

When observing the red eye, you must document the __________ of the injection.

A

Symmetry

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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

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6
Q

What is the name of the injection when there is redness all over?

A

Diffuse Injection

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7
Q

What is the name of the injection when there is redness in a localized area?

A

Sectoral Injection

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8
Q

What is the name of the injection when there are vessels coming out from the limbus?

A

Ciliary Injection

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9
Q

What are the most superficial vessels in the eye?

A

Conjunctival Vessels

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10
Q

What are the 2nd most superficial vessels in the eye?

A

Episcleral

Note: They have no movement

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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

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12
Q

What is the first type of inspection of injection?

A

Gross Inspection

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13
Q

What is the grading scale of a ptosis?

A

> 0.5mm and more would suggest a ptosis or lid droop

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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

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15
Q

What light source of choice is used to confirm an APD?

A

BIO

Note: The transilluminator has a high level intensity

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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.

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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

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18
Q

You have measured your patients palpebral fissures and notice a difference of 0.6mm. What could this indicate?

A

Ptosis (lid droop)

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19
Q

How is a sinus problem issue associated with an Eye problem?

A

An Eye infection can be present

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20
Q

What type of sinusitis is concurrent with Red eye?

A

Acute Sinusitis

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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

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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

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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

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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

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25
Q

Why is it important to measure pupil size in Light and Dark?

A

Measure Annisocoria (para and symp).

Note: This will allow you to determine whether its physiological or abnormal

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26
Q

What is the clinicial significance of an APD?

A

Check for a lesion of the optic nerve or severe retinal disease

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27
Q

What is the pupillary pathway for the sympathetic system?

A

Signal goes to PN (Pretectal Nucleus), Dilation of pupil and is part of the Afferent response

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28
Q

What is the pupillary pathway for the parasympathetic system?

A

Signal goes to EW (Edinger Westpahl), Constricts pupil and is part of the Efferent response

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29
Q

What does it mean if one pupil constricts more on direct that the other?

A

First warning of APD

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30
Q

What is anisocoria?

A

Pupil sizes are both different from one another

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31
Q

When EVALUATING pupils, what type of light is the best to be used?

A

Brightest

Note: Increases the response to light, thus enhancing the ability to detect an abnormal reaction

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32
Q

When you find an +APD, what will the affected eye see?

A

Dimmer light

Note: Normal eye will NOT constrict to the same amount as the normal eye’s direct response

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33
Q

What is pupillary escape?

A

Pupil will constrict, then re-dilate and stays dilated

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34
Q

What light source of choice is to confirm a APD?

A

BIO > Direct Opt > Transilluminator > Penlight

Note: Must be the brightest portable light source
Slit Lamp is NOT portable

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35
Q

What is a physiological Anisocoria?

A

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

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36
Q

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?

A

Sympathetic

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37
Q

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?

A

Parasympathetic

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38
Q

What is a quick and gross assessment to find the depth of the Anterior Chamber?

A

Shadow Technique

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39
Q

What are two possible grading system for the shadow technique?

A

Graded as either DEEP or SHADOW

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40
Q

When preforming the shadow technique, what is the grading scale?

A 
No Shadow/Grade 4 = "Wide" open angle
Grade 3 = >25% of nasal iris in shadow
Grade 2 = >30% 
Grade 1 = >40%
Grade 0 = >50%
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41
Q

What is a proptosis?

A

Forward displacement of an organ

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42
Q

What is Exopthalmos?

A

Forward displacement of the eye, due to endocrinological dysfunction

Ex. Hyperthroidism

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43
Q

What is the most common cause of unilateral and bilateral exopthalmos?

A

Thyroid Eye Disease

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44
Q

What is usually the measurement for a ptosis?

A

3 mm of the upper lid covers the cornea

Note: 3 mm is the major difference between a ptosis vs. proptosis

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45
Q

You ask your pt. to downgaze and notice the Munson’s V sign, what does this mean?

A

Pt. has Keratoconus

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46
Q

A pt. comes in with abnormally widened palpebral fissures, what is the names of this ocular problem?

A

Dalrymple’s Sign

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47
Q

What is Von Graefe’s sign?

A

Upper lid lag on downgaze

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48
Q

What is the Stellwag’s sign?

A

Incomplete blinking

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49
Q

What is Gifford’s sign?

A

Difficulty in everting the upper eyelid

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50
Q

What is Viguroux sign?

A

Eyelid fullness

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51
Q

What is Mobius Sign?

A

Poor convergence

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52
Q

What is Boston’s sign?

A

Jerky lid lag

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53
Q

What is the avg. and normal findings for a Caucausian using hertel’s exopthalmometer?

A

AVG- 21mm
NR - 11 to 21mm

Note: A difference of 3mm and more is an abnormal finding

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54
Q

What is the avg. and normal findings for an Asian individual using the hertel’s exopthalmometer?

A

AVG - 16 mm
NR - 11 to 21mm

Note: A difference of 3mm and more is an abnormal finding

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55
Q

What is the avg. and normal findings for an African-American individual using the hertel’s exopthalmometer?

A

AVG - 23 mm
NR - 11 to 23 mm

Note: A difference of 3mm and more is an abnormal finding

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56
Q

Why would an Optometrist record the base of the hertel’s exopthalmometer?

A

A reference point, so a repeat of the exam can occur

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57
Q

What type of beam is used for the detection of MGD and Blepharitis?

A

Diffuse/Wide beam

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58
Q

What type of beam is used for Chalazion or a Hordeolum?

A

Diffuse/Wide beam

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59
Q

Evaluation of contact lenses, what type of beam is used?

A

Diffuse/Wide beam

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60
Q

What type of beam would you use for tear film assessment?

A

Diffuse/Wide beam

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61
Q

What are the three types of Direct illumination?

A

Parallelpiped, Optic Section, and Conical Beam

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62
Q

What are the three types of Parallelpiped techniques?

A

Indirect, Retroillumination and Specular Reflection

63
Q

What type of examination does the Paralellpiped do for the cornea, conj, lens, and iris?

A

3D examination

64
Q

What type of image does an Optic section give?

A

2D examination

65
Q

When using the Optic section what are the 5 landmarks you would observe?

A 
Tear film
Epithelium
Bowman's Membrane
Stroma
Endothelium
66
Q

When testing for the Van Herick Angles, what would be the grade for 1/4 of the corneal optic section?

A

Grade 2 (20 degrees)

67
Q

When completing the Van Herick, if you are too far centrally, the angle estimation will be significantly _________?

68
Q

What grades would you preform Gonio?

A

VH angles would be either grade 1 or 2

69
Q

What type of inflammation would you notice, if you saw cells and flare with a conical beam?

A

Iritis (Inflammation of the IRIS)

Uveitis (Inflammation of the Uvea)

70
Q

When using the conicial beam, you notice dust in the light, what could be present?

A

Cells in the AC

71
Q

When using the conical beam, you notice smoke through light, what could be noticed?

72
Q

When looking for Corneal Infiltrates or WBC’s, what is the best type of technique to use?

A

Indirect or Proximal beam

Note: Looking at both side of the beam and not directly at it.

73
Q

What is Retro-illumination?

A

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
Q

When observing the Iris, with Retro-illumination, where do you focus light on and what do you observe?

A

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
Q

What do you study when your using specular reflection?

A

Endothelium, Posterior and Anterior lens capsule

76
Q

What law is constitutive with Snell’s Law?

A 
Specular Reflection
(Angle of Incidence = Angle of Reflection)
77
Q

When using Specular reflection, Slowly scan across the cornea until you see a ________ ________ of the filament

A

dazzling reflection

78
Q

You notice defect and deposits on the corneal endothelium, what type of beam are you using?

A

Specular Reflection

Note: Irregularities and deposits will fail to reflect light and appear DARK

79
Q

What type of illumination technique produces a halo glow of light around the limbus?

A

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
Q

When observing the lens, what angle and height should be the beam?

A

20 degrees and height should be the size of the pupil

81
Q

What is easier to see in younger pt. vs. Old pt. like yourself?

A

Embryonic Nucleus

The darkest region

82
Q

What layer are the Y sutures located?

A

Fetal Nucleus

83
Q

What two types of illumination techniques are used for observing the Anterior Vitreous?

A

Parallelpiped and Retroillumination

84
Q

When pushing into the optically empty retrolental space, known as _______ ________, what is it between of?

A

Berger’s space.

between POSTERIOR CAPSULE and ANTERIOR VITREOUS

85
Q

When examining lids, lashes and conj, what setup on the slit lamp must be present?

A

Polaroid filter is ON
Light @ 30 Degrees
Wide beam
Tall beam

86
Q

What is a loop of Axenfeld and is this a normal finding?

A

Ciliary nerve piercing the sclera.

This is a normal finding

87
Q

What is an Epiblepharon?

A

A normal finding, predominant in asian eye. It is an extra row of skin across the lid margin causing a lower lid crease.

88
Q

What can cause a Subconj. Hemorrhage?

A

Vasovagal

Result of blood thinners (ASA and NSAIDS)

89
Q

What is an Entropion?

A

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
Q

What is a Trichiasis?

A

“misdirected lashes” or lashes that turn in toward the cornea but lid is in correct apposition against the globe

91
Q

What is an Ectropion?

A

when the eye lid not completely on the globe. This can be age-related, congenital, or acquired by different conditions

92
Q

What is Dermatochalasis?

A

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
Q

What is Xanthelasma?

A

when Infiltrates of the eyelid by lipid in the dermis; it is Associated with hyperlipidemia; educate the patient on high cholesterol

94
Q

What is Arcus?

A

white ring around edge of cornea due to high cholesterol. Can be normal in people over 40

95
Q

What is Madarosis?

A

when there is a loss of eyelashes; Most commonly associated with chronic lid disease such as blephritis; chronic infection

96
Q

What is Trichotillomania?

A

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
Q

What is a Blepharitis?

A

Inflammation of the eyelide margin

Note: Anterior = affects the skin and lashes

Posterior = Affects Meibomian Glands

98
Q

What is a Hordeolum?

A

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
Q

What is an MGD?

A

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
Q

What are 6 main reasons we evert the Upper eye lid?

A

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
Q

Where do you place the q-tip when everting the eyelid?

A

Tarsal Plate

Note: Pt. must be looking down

102
Q

What is the name of a Redundant Conj?

A

Conjunctivachalasis

103
Q

What is Chemosis?

A

All around thickened inflammation from swelling of the Conj.

104
Q

What is a Pinguecula?

A
  • 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
Q

What is a Pterygium?

A
  • Thick, fleshy triangular mass of tissue onto NASAL cornea
  • Usually an Iron deposit
  • Stimulated by UV exposure and arid climate
106
Q

What is Stocker’s line?

A

Located at the corneal edge, which shows a promenant brown spot.

107
Q

What is a Nevus?

A

Benign freckle

108
Q

What is a Melanosis?

A

A brown spot on the sclera, usually confined to one area

109
Q

What type of individual are we most concerned about a Malignant nevus?

A

Blue-eyed, Blonde person

110
Q

What is Cogan’s Senile Plaque?

A

A bruise like structure on the sclera, that has the RECTUS muscle grind against and thinning the sclera.
-No clinical significance

111
Q

What are Retention Cysts?

A
  • Common and benign finding of inferior palpebral conjunctiva
  • Thin-walled cysts filled with clear watery fluid in the accessory lacrimal glands of Krause
112
Q

What are concretion?

A

 Small, yellow-white hard spots on superior and/or palpebral conjunctiva

  • Causes chronic inflammation
  • Usually Calcium deposit
113
Q

What type of response do Papillae produce?

A

Vascular response

114
Q

What is the distinct feature of a Papillae?

A

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
Q

What is a follicle?

A

Translucent elevation on the palpebral conjuctiva

116
Q

What is SPK?

A

Superficial Punctate Keratitis

-Corneal surface disorder on the epithelium (do an optic section)

117
Q

What are the etiologies of SPK?

A

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
Q

What is Corneal Neovascularization?

A

When blood vessels grow into the cornea

Note: Use wide beam and indirect

119
Q

What is EKC?

A

Epidemic Keratoconjunctivitis - EXTREMELY CONTAGIOUS

3 symptoms: Sub epithelial infiltrates, follicles and positive lymph

120
Q

What type of illumination should you use for EKC?

121
Q

What is Limbal Girdle of Vogt?

A

Chalky white area on the cornea, which is not 360 degrees

Note: Arcus is 360

122
Q

What is a Corneal Arcus?

A

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
Q

What is Central Corneal Clouding?

A

Result of an RGP.

-Causes a gray area directly in front of the pupil

124
Q

What type of Corneal scar has no effect on vision and you can view it through the Slit Lamp?

125
Q

What type of Corneal scar can you see without a slit lamp and vision is significantly reduced

126
Q

What type of Corneal scar can effected VA and you can view it through the Slit Lamp?

127
Q

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?

A

Cobalt Blue

Eye will glow GREEN

128
Q

What is Fleischer’s ring?

A

A very faint ring that forms on the cornea.

Note: Usually forms around the base of Keratoconus

129
Q

What is corneal striae?

A

Fine whit lines deep in the stroma or Descemet’s membrane

Usually shown as vertical in the cornea

130
Q

What type of filter do you use when your trying to identify blood vessels or sub-conj. hemorrhage?

A

Red-free filter

Note: RBC’s will disappear but pigment cells will remain

131
Q

What is the Tyndall phenomenom?

A

Submicroscopic particles that become visible in a bright light beam if light

132
Q

When observing for Uveitis, you count 5 cells. How would you grade this?

133
Q

When observing Uveitis, you notice more than 5 cells and you can count them within 30 to 60 seconds, how would you grade this?

134
Q

When observing Uveitis, there are too many cells to count and they move slow. How would you grade this?

A

Grade 3

Note: Grade 4, too many to count and barely move

135
Q

When grading flare in the iris, what is the scale?

A

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
Q

What is Keratic Precipitates?

A

WBC’s deposits on the corneal endothelium

Note: Consensual pain reflex, you can suspect Iritis/Uveitis

137
Q

What is the grading scale for Keratic Precipitates?

A

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
Q

What is Persistent Pupillary Membrane?

A

A strand attached to two parts of the of eye, one end must be the IRIS.

Note: Worst type is IRIS to CORNEA

139
Q

What is Hyperphema?

A

RBC’s pooled and settled inferiorly in the anterior chamber

140
Q

What is Mittendorf’s Dot?

A

Remnant of the hyaloid artery, attached to the POSTERIOR SURFACE of the lens

Note: It is nasal to the visual axis

141
Q

What is Epicapsular stars?

A

Small light brown or tan dots on the anterior capsule

142
Q

What is the most common type of Congenital Cataract?

A

Anterior Axial Embryonic

Note: Forms a TWIN BLADE PROPELLER cluster

143
Q

What is a Currulean cataract?

A

Blue dot cataract

Bluish punctate opacities of the peripheral cortex

144
Q

What are the two most common complaints of a Cataract aging lens?

A

Reduced VA and Glare

145
Q

How is Nuclear Sclerosis characterized?

A

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
Q

What is the grading scale for Nuclear Sclerosis?

A

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
Q

As the lens ages, where do vacoules form in the lens?

148
Q

What type of cataract starts in the lens periphery and advances centrally?

A

Cortical

Note: has a spoke like look

149
Q

What is the grading system based on for Cortical Cataracts?

150
Q

What type of Cataract is located in front of the posterior capsule and appears granularly

A

Posterior Subcapsuklar Cataracts (PSC)

Note: Always located in the Visual Axis

151
Q

What is a rosette cataract?

A

Cataract that looks like a flower

152
Q

When a pt. complains about their “cataract coming back” what type of Cataract can this be?

A

Posterior Capsular Opacification

153
Q

What are Elschnig’s Pearls?

A

Look like Vacuoles BUT there isn’t a lens. Thus epi cells are located on the posterior capsular surface

PPO 4 - MIDTERM (1 decks)

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