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PPO4 > Midterm Exam > Flashcards

Midterm Exam Flashcards

1
Q

How do you check the direct/consensual pupil reflex?

A

direct: shine light into eye for 2sec (5-6cm)
consensual: shine light into 1 eye while looking at the other for 2sec (5-6cm)

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2
Q

How do you check for an APD?

A

shine light into one eye for 3sec, rapidly move to other eye for 3sec and repeat

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3
Q

What is the clinical significance of an APD?

A

asymmetry in the afferent pathway

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4
Q

What is anisocoria? and when is it normal vs. abnormal?

A

Different pupil sizes. Normal = within 1mm (illumination level shouldn’t change amount)
Abnormal = more than 1mm

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5
Q

What is the pathway for the sympathetic pupil response?

A

mydriasis/dilation (iris dilator)

and anisocoria will be greater in dim illumination

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6
Q

What is the pathway for the parasympathetic pupil response?

A

miosis/pupil constriction (iris sphincter) and anisocoria will be greater in light illumination

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7
Q

What are the 3 ways to control amount of illumination?

A

height, width, and intensity of beam

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8
Q

What are the 2 most common illumination techniques?

A

wide beam and direct

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9
Q

How do you grade the bulbar conjunctiva?

A

0-4: 0=normal, 1=trace, 2=mild, 3=moderate, 4=severe

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10
Q

Which vessels are moveable with eyelid friction?

A

conjunctival vessels

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11
Q

what is the layer of vessels deep to the conjunctival vessels?

A

episcleral (do not move)

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12
Q

What is considered a ptosis?

A

if the palpebral fissure differs by more than 0.5mm

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13
Q

what is the normal position of the upper lid margin?

A

2mm below the upper limbus

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14
Q

what is the normal position of the lower lid margin?

A

about 1mm above the lower limbus

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15
Q

What is Munson’s sign?

A

a V-shaped dent of the lower lid produced by the conic cornea in downgaze (keratoconus)

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16
Q

What are the 3 most common TED lid signs?

A

Dalrymple’s sign, Von Graefe’s sign, and Stellwag’s sign

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17
Q

What is Dalrymple’s sign?

A

abnormally widened palpebral fissures, “pseudoptosis” (surprised look)

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18
Q

What is Von Graefe’s sign?

A

lid lag in down gaze, lag of upper eyelid in following the globe when patient looks down (sclera is continuously seen)

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19
Q

What is Stellwag’s sign?

A

infrequent or incomplete blinking

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20
Q

What is Gifford’s sign?

A

difficulty in everting upper lid

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21
Q

What is Vigouroux sign?

A

eyelid fullness or swelling (upper and/or lower)

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22
Q

What is Mobius sign?

A

poor convergence

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23
Q

What is Boston’s sign?

A

“jerky” lid lag

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24
Q

What is the best light source to evaluate pupils with?

A

transilluminator (direct, BIO, and slit lamp may also be used)

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25
Q

If you don’t have a slit lamp, what can you use to check gross angle assessment?

A

20D lens with a transilluminator or shadow technique

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26
Q

How do you grade the shadow technique?

A

4=wide open or no shadow, 3=25% of nasal iris in shadow, 2=30%, 1=40% and 0=50% or more

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27
Q

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

A

thyroid eye disease (TED)

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28
Q

What do you use to measure exophthalmos?

A

Hertel exophthalmometer

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29
Q

What happens if the inner arcs are too far medial at orbital rim? or too far lateral?

A

too far medial = erroneously low

too far lateral = erroneously high

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30
Q

What difference between the exophthalmometer is considered abnormal?

A

difference of 2mm or more between the eyes (or an increase of 2mm or more over time)

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31
Q

What are the average readings for exophthalmometer for caucasian, african american and asian males?

A

21, 23, and 16mm

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32
Q

Name the 5 landmarks of the optic section

A

Pre corneal tear film, epithelium, bowman’s membrane, stroma, descemet’s membrane/endothelium

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33
Q

What are the “grainy” specs seen in the middle of the beam of an optic section?

A

keratocytes (corneal fibroblasts) - flattened cells that lie between and occasionally within the lamellae

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34
Q

What are the “layers” of the cornea seen in the optic section?

A

tears, epithelium, bowman’s layer, stroma, endothelium

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35
Q

Why is an optic section important?

A

it determines the depth and location of a defect (cornea or lens) - provides a 2D “slice” of tissue

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36
Q

What is the critical angle required for an accurate optic section of the cornea? Why is this angle “critical”?

A

60 degrees - if angle is too small the optic section collapses - limiting the information about the layers

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37
Q

What is the correct illumination technique (beam) used with the Van Herick?

A

Optic section at the corneal side of the limbus

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38
Q

According to VH measurements, which angle grade will “probably” close if dilated?

A

grades 1 and 2

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39
Q

Which VH grade strongly suggests the need for “gonioscopy” prior to dilation?

A

Grade 1

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40
Q

Where must you place the light for accurate angle estimations?

A

60 degrees

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41
Q

When is a wide beam used?

A

general observation and overview - lids, lashes, conjunctiva

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42
Q

What is the purpose of a parallelepiped beam?

A

provides a 3D examination of the cornea, conjunctiva, lens, iris - most effective at detecting tissue abnormalities

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43
Q

What is the set-up for a parallelepiped beam?

A

width (2-4mm), angle (20-45: depends on structure), med-high intensity, 10-16x

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44
Q

How does the angle change with more anterior structures?

A

the more anterior structure = wider angle (more posterior = smaller angle)

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45
Q

What is the set-up for an optic section?

A

very narrow beam (>1mm), tall (8mm), cornea = 60 degrees and lens = 20-30 degrees, med-high intensity, 16x

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46
Q

What happens if you are too far centrally doing a Van Herick?

A

the angle estimation will be artifically greater (will seem more open)

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47
Q

How do you grade a VH?

A

4=1:1 or higher, 3= 1/2-1/4:1, 2= 1/4:1 and 1= <1/4:1

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48
Q

When is a conical section used?

A

to examine the anterior chamber

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49
Q

What is the set-up for a conical section?

A

uses a parallelepiped beam but needs to be 1x3mm, angle is 30-45, max intensity, 25x, and need to dark adapt 30sec

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50
Q

What is indirect illumination used for?

A

produces a “softer” illumination to give better detection and definition - observation of cornea, lens and retina

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51
Q

What is the set-up for indirect illumination?

A

parallelepiped beam, 20-30 angle, med intensity, and 10-16x

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52
Q

What 2 other techniques does indirect utilize at the same time?

A

direct and retro-illumination

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53
Q

What is specular reflection used for?

A

corneal endothelium (only way to see this), anterior and posterior lens capsules

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54
Q

What is the optical principle that applies to specular reflection?

A

Snell’s law: light is reflected directly into only 1 ocular

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55
Q

What is the set-up for specular reflection?

A

parallelepiped beam, cornea = 20-45 and lens= 20-30, 16-25x, med-high illumination

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56
Q

When is sclerotic scatter used?

A

to view corneal edema

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57
Q

What is the set-up for sclerotic scatter?

A

parallelepiped beam, angle 45-60, tall height - look outside oculars with naked eye

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58
Q

How does sclerotic scatter work?

A

utilizes total internal reflection of the cornea

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59
Q

What is an epiblepharon?

A

extra horizontal row of skin across lid margin (common in children and asians)

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60
Q

What is xanthelasma?

A

infiltrates of the eyelid caused by lipid in the dermis - hyperlipidemia (small yellow/white bumps)

61
Q

What is arcus?

A

a white ring around the peripheral cornea - cholesterol deposits

62
Q

What is trichiasis?

A

eyelashes turned inwards - rub the cornea

63
Q

What is madarosis?

A

decrease in number or complete loss of lashes - due to chronic lid disease (blepharitis)

64
Q

What is trichotillomania?

A

condition where people pull out hair/lashes often when stressed and not aware of action (lashes are blunt/broken off)

65
Q

What glands are infected/inflamed with an internal hordeolum or “stye”?

A

meibomian glands

66
Q

What glands are infected/inflamed with an external hordeolum?

A

Zeiss and moll glands

67
Q

What are reasons to evert the upper eyelid?

A

all new CL wearers, allergies, FB, lost CL, hordeolum, GPC, red eye cases

68
Q

How do you grade blepharitis, MGD, and papillary conjunctivitis (bumps)?

A

grade 0=normal, 1=trace, 2=mild, 3=moderate, 4=severe

69
Q

What is a loop of axenfeld?

A

posterior ciliary nerve piercing the sclera (ends before limbs)

70
Q

What is the set-up to scan the conjunctiva (bulbar and palpebral)?

A

10x, wide diffuse beam, medium illumination, Polaroid filter on, 30 degrees

71
Q

What are the different illumination techniques used to study the lens and anterior vitreous?

A

lens = direct (parallelepiped and optic section), specular, and retro-illumination
anterior vitreous = direct (parallelepiped) retro-illumination

72
Q

What is the significant difference between performing an optic section of the lens vs. cornea?

A

cornea is at 60 degrees and lens is at 20-30 degrees (lens is more internal = smaller angle)

73
Q

Why do more external structures need wider angles?

A

allows for viewing depth without the distraction from reflections from upper layers and can see behind the surface (direct/indirect/retro simultaneously)

74
Q

What is the set-up to scan the iris?

A

16x, parallelepiped, med illumination, angle 20-30

75
Q

What changes do you make after scanning the iris to scan the lens?

A

reduce vertical height to 5mm and reduce angle to 10-20 (un-dilated pupil= smaller angle)

76
Q

What technique do you use to identify the anterior and posterior lens capsules?

A

specular reflection

77
Q

What are the layers seen in the lens?

A

anterior capsule, cortex, adult nucleus, fetal nucleus, and embryonic nucleus

78
Q

Which layer contains the Y sutures?

A

the fetal nucleus

79
Q

What is the set-up to scan the anterior vitreous?

A

16-25x, thin parallelepiped beam, high illumination, 10-20 degrees

80
Q

What causes a nevus of Ota?

A

unilateral proliferation of melanocytes following distribution of CN V1 and V2

81
Q

What does a nevus of Ota look like?

A

facial and/or ocular slate-blue pigmentation = benign

82
Q

What is Cogan’s senile plaque?

A

benign finding in elderly = thinned areas of sclera (bilateral - temporal and nasal)

83
Q

What causes senile plaques?

A

horizontal recti muscles rubbing against sclera over time

84
Q

What is conjunctivochalasis or redundant conjunctiva?

A

redundant or loose non-edematous conjunctiva which creates folds that billow over lid margin

85
Q

Where is redundant conjunctiva usually located?

A

infra-temporal conjunctiva but can spread to superior bulbar

86
Q

What is a pinguecula?

A

benign finding = yellow, slightly elevated bulbar conjunctiva thickening

87
Q

What causes a pinguecula and where is it normally found?

A

nasal and/or temporal (IP zone) and results from a lifetime exposure to UV and elements

88
Q

What is a pterygium?

A

thick, fleshy triangular mass of tissue on nasal conjunctiva

89
Q

What are retention cysts?

A

common benign findings of interior palpebral conjunctiva - thin walled cysts with clear watery fluid (Krause glands)

90
Q

What are concretions?

A

small, yellow-white hard bumps on palpebral conjunctiva (superior and inferior)

91
Q

What causes concretions and when are they an issue?

A

idiopathic or result of chronic inflammation/dryness; if they become larger or calcify

92
Q

What causes papillae?

A

vascular response - associated with an allergic reaction, bacterial infection, CL GPC

93
Q

What do papillae look like?

A

reddish vascular tufts, varying in diameter - have a single vessel in center

94
Q

What causes follicles?

A

normal in children, abnormal associated with viral infections (adenoviral, herpes simplex), drug toxicity (hypersensitivity)

95
Q

What do follicles look like?

A

translucent elevations (pale mounds) of infiltrate of varying diameter - avascular centers

96
Q

What is superficial punctate keratitis (SPK)?

A

a corneal surface disorder - breakdown and damage to epithelium

97
Q

What are the symptoms of SPK?

A

dry, gritty, photophobia

98
Q

what causes SPK?

A

dry eyes, CL, drug toxicity, trauma, blepharitis, conjunctivitis

99
Q

What are sub-epithelial infiltrates (SEI)?

A

not benign - white blood cells have entered the cornea (detect with indirect)

100
Q

What is limbal girdle of vogt?

A

chalky appearance and raised degeneration around limbus (no clear area between limbus and cornea –> arcus does)

101
Q

What 2 types of scars need to be viewed with the slit lamp?

A

nebular and macular

102
Q

what type of scar can be seen without the slit lamp?

A

leukoma

103
Q

which type of scar has no effect on VA?

A

nebular

104
Q

How do macular and leukoma scars affect vision?

A 
macular = VA is effected
leukoma = significantly reduced
105
Q

Why would a cobalt blue filter be used?

A

aid NaFL assessment of cornea and conjunctiva - dry eye evals, GPC, RGP CL, iron deposits in cornea

106
Q

What is a Hudson-Stahli line?

A

iron deposition line in corneal epithelium (benign = age-related) between lower pupil margin and inferior limbus

107
Q

What is Fleischer’s ring?

A

iron deposits that form around the base of the “cone” in keratoconus

108
Q

What are corneal striae (vogt’s striae)?

A

keratoconus patients or over-wearing CL - fine white vertical lines in stroma or descemet’s membrane

109
Q

What is the best technique to view vogt’s striae?

A

parallelepiped beam and moderate magnification

110
Q

What is PPM (persistent pupillary membrane)?

A

remnants of anterior portion of tunica vasculosa lentis

111
Q

what are the 4 types of PPM?

A

iris to iris, iris to floating, iris to lens, iris to cornea

112
Q

How common is PPM?

A

17-32% of population has PPM

113
Q

What are the “cells” seen in the anterior chamber?

A

usually WBCs, sometimes RBCs or pigment cells

114
Q

What is the direction of current in the anterior chamber?

A

up to warm lens and down to cold cornea

115
Q

what is the “flare” seen in the anterior chamber?

A

fibrinous exudate

116
Q

What are the symptoms of cells and flare?

A

variable pain, photophobia, red-eye, intraocular inflammation

117
Q

What causes cells and flare in AC?

A

due to breakdown in blood aqueous barrier by inflammation (uveitis, iritis)

118
Q

What is Tyndall phenomenon?

A

sub-mircoscopic particles become visible in bright beam of light against the dark background of the pupil

119
Q

How do you grade cells?

A

0= 0 cells, trace = 1-5, 1+ = 6-15, 2+ = 16-25, 3+ = 26-50, 4+ = 50+

120
Q

How do you grade flare?

A

0, trace = none, 1+ = faint, 2+ = moderate (iris detail +), 3+ = marked (iris hazy), 4+ = intense (fibrin/plastic aqueous)

121
Q

What is a hyphema?

A

RBC or pigment cells pooled and settle inferiorly in AC

122
Q

How do you know if the cells in a hyphema are RBCs or pigment cells?

A

use a red-free (green) filter = RBCs will disappear because they will absorb the green light –> then it is pigment

123
Q

What are the 2 ways to examine the lens?

A

frontal view with retro-illumination (cataract extend relative to visual axis)
parallelepiped or optic section (cross-sectional)

124
Q

What is a mittendorf’s dot?

A

normal - always nasal to visual axis: embryological remnant of hyloid artery on posterior surface of lens

125
Q

what are episcleral stars?

A

small light brown or tan (despite iris color) dots on anterior capsule (single or multiple) = remnants of tunica vasculosa lentis

126
Q

What are the 5 types of congenital cataracts?

A

anterior axial embryonic, anterior/posterior polar, sutural, pulverulent, and currulean

127
Q

what are anterior axial embryonic cataracts?

A

(25% of population) opacities in a propeller shape anterior to embryonic nucleus (no VA reduction)

128
Q

what are anterior and posterior polar cataracts?

A

opacity on the visual axis (reduction in VA depends on size) *need an optic section to know which layer it is on

129
Q

what is a sutural cataract?

A

opacity is around the Y suture (rarely affects VA)

130
Q

what is a pulverulent (dust-like) cataract?

A

ring/disc shaped opacities in embryonic nucleus

  • retroilluminate when dilated, if cataract blocks orange glow, it will affect vision
  • cause glare at night and not able to get perfect 20/20 vision
131
Q

what is a currulean (blue dot) cataract?

A

small bluish punctate opacity of peripheral cortex (doesn’t affect VA)

132
Q

What are the 6 types of age-related cataracts?

A

nuclear sclerosis (NS), cortical, posterior sub-capsular (PSC), traumatic, secondary, and posterior capsular opacification (PCO)

133
Q

Where do the first changes of a nuclear cataract occur?

A

at embryonic nucleus - appears hazy and less distinct –> then begins to appear yellow

134
Q

Why do patients with NS complain of reduced VA?

A

NS leads to a myopic shift in refractive error

135
Q

How do you grade NS cataracts based on color?

A

trace = slight yellow, 1 = yellow, 2 = very yellow, 3 = yellow-orange, 4 = orange/brown

136
Q

How do you grade NS cataracts based on BVA?

A

trace = 20/20, 1 = 20/25-30, 2 = 20/30-40, 3 = 20/50 - 60, 4 = 20/80 or worse

137
Q

what are lens vacuoles?

A

as the lens ages - one of the early signs of change is in cortex with appearance of one or more shiny droplets of clear fluid

138
Q

Where are lens vacuoles located?

A

under the capsule in mid-cortex or near adult nucleus

139
Q

What can lens vacuoles lead to in cortical cataracts?

A

if fluid forces between individual lamellae in lens = lamellar separation and leads to dark areas in cortical cataract

140
Q

What are cortical cataracts?

A

opacity is found in anterior, posterior or equatorial portion of cortex = spoke like appearance in periphery

141
Q

How do you grade cortical cataracts?

A

on how many quadrants they are in (1-4) *must view as dilated pupil

142
Q

What is the fastest growing age-related cataract?

A

posterior sub-capsular (PSC)

143
Q

What is a PSC?

A

located in front of posterior capsule - appears granular or plaque like with specular reflection (starts in center)

144
Q

How is VA affected with PSC?

A

opacity is on visual axis - decreased VA (near worse) with glare –> typically vision is most affected when pupil is miotic

145
Q

What causes a PSC?

A

age-related, steroid therapy, diabetes

146
Q

How do you grade of PSC?

A

based on density of amount seen in retro-illumination while pupil is dilated (1-4)

147
Q

What is a traumatic cataract?

A

caused by direct penetrating injury, blunt force trauma = rosette cataract on visual axis

148
Q

what causes a secondary cataract?

A

drug induced from steroids, systemic disease, chronic anterior uveitis

149
Q

What is a posterior capsular opacification (PCO)?

A

proliferation of equatorial lens epithelial cells along posterior capsule surface after cataract surgery (appearance of soap bubbles or grapes) = need YAG

PPO4 (1 decks)

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