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MD1 PCP > Ophthalmology Exam > Flashcards

Ophthalmology Exam Flashcards

1
Q

What are the main components?

A 
Visual acuity
Visual fields
Eye movements
Pupillary reaction
Fundoscopy
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2
Q

What is a layman’s term for visual acuity?

A

Eyesight

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3
Q

What is visual acuity?

A

Clarity of person’s vision

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4
Q

What is visual acuity measured using?

A

Snellan chart

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5
Q

What does testing visual acuity involve?

A

How well person can identify letters from standard distance

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6
Q

What is the standard distance of measurement for visual acuity?

A

6 m

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7
Q

In what order should visual acuity be measured?

A

Unaided
With pinhole
With glasses

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8
Q

Are the eyes tested together in visual acuity?

A

No, they’re tested separately

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9
Q

What should you remember when the patient is covering their eye?

A

Hand/paper should be at angle parallel and next to nose to block out all possible light

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10
Q

What are the instructions to the patient for visual acuity?

A 
Stand 6 m away from chart
Cover 1 eye
Read letters aloud
Don't squint to read them
Encourage them to continue reading if they get stuck
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11
Q

What denotes a person’s visual acuity?

A

Row with smallest letters person can accurately read

If get half or more of row correct, that row is included

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12
Q

How is visual acuity recorded?

A

Eg: 6/18 +2

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13
Q

What is normal vision?

A

6/6

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14
Q

What reflects abnormal vision?

A

Denominator greater than 6

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15
Q

What can you do if the person cannot read the biggest letter on the chart?

A

Count number of fingers held in front of them (CF); if not >
See hand movements (HM); if not >
Perceive any light (LP); if not >
No light perception (NLP) > blind in that eye

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16
Q

What does a pinhole test for?

A

Refractive problems - usually with lens

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17
Q

What does it mean if a person’s acuity improves with a pinhole?

A

Probably refractive error

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18
Q

Is visual acuity a specific test?

A

No

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19
Q

What is the layman’s term for visual field?

A

Peripheral vision

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20
Q

What is a visual field?

A

Extent of peripheral vision while looking at target straight in front of them

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21
Q

What can cause defects in visual fields?

A

Lesions in any point in the visual pathway

22
Q

Generally, what visual field does a lesion behind the optic chiasm affect?

A

Visual fields of both eyes

23
Q

What visual field does a pathology of the eye or optic nerve affect?

A

Visual field of one eye

24
Q

What does your visual field have to be to measure a patient’s?

A

Normal

Mirror exactly

25
Q

How do you position yourself and the patient for a visual field test?

A

Sit in front of patient at same level

26
Q

What do you instruct the patient to do when testing their visual field?

A

Close and cover one eye (you close your own eye directly opposite)
Look at your eye with open one
Place hand about halfway between the two of you
Wiggle fingers in from periphery from 8 points > like Union Jack
Ask patient to inform you when they can see movement
Compare this to when you see your hand yourself
Repeat for other eye

27
Q

Is this way of testing the visual field specifically diagnostic?

A

No, it’s a screening test

If abnormality detected, more detailed mapping required

28
Q

What is unilateral blindness?

A

Loss of visual field of one entire eye

29
Q

Where is the lesion in unilateral blindness?

A

Optic nerve

30
Q

What is bitemporal hemianopia?

A

Loss of temporal visual fields of both eyes

31
Q

Where is the lesion in bitemporal hemianopia?

A

Optic chiasm

32
Q

What is homonymous hemianopia?

A

Loss of nasal visual field in one eye and temporal visual field in other

33
Q

Where is the lesion in homonymous hemianopia?

A

After optic chiasm; eg: optic radiation

34
Q

Which cranial nerves innervate the extraocular muscles?

A

CN III
CN IV
CN VI

35
Q

Which nerve controls the superior oblique?

A

CN IV

36
Q

How does the superior oblique move the eyeball?

A

Down and medially

37
Q

Which nerve controls the lateral rectus?

A

CN VI

38
Q

How does the lateral rectus move the eyeball?

A

Laterally

39
Q

Which muscles does CN III control?

A

Superior rectus
Inferior rectus
Medial rectus
Inferior oblique

40
Q

What is the muscle that elevates the eye?

A

Levator palpebrae superioris

41
Q

What are the functions of CN III in the eye?

A

Control 4 extraocular muscles
Elevate eyelid
Constrict pupil

42
Q

What will an oculomotor nerve palsy cause?

A

Ptosis
Severe ocular movement limitation
Dilated pupil

43
Q

How do you test eye movements in a patient?

A 
Sit opposite patient
Ask them to keep head still
Ask them to follow tip of finger/pen with their eyes
Draw out H
- Start laterally
- Move up
- Move down
- Move medially
- Move laterally
- Move up
- Move down
Move slowly
Move to extremes of gaze
Observe both eyes
44
Q

What are you looking for when you test eye movements?

A

Symmetrical movements
No limitation of movement
No double vision

45
Q

In what light conditions should you test the pupillary response?

A

Dimly lit room

46
Q

What is involved in the examination of the pupils?

A

Sit in front of patient
Observe pupils for shape and symmetry
- Note if equal
Using strong torch, shine light into one eye
Pupil should constrict = direct response
Shine light again into same eye
Other pupil should constrict = consensual response
Repeat in other eye
If either pupil fails to constrict to light, check if constricts to accommodation = look far away > focus on near object > pupil should constrict
Swinging flashlight test

47
Q

What is the swinging flashlight test?

A

Compares right and left pupillary responses
When swinging light from right eye to left, left pupil should restrict as light reaches it
Same should happen when you swing light back to right eye

48
Q

What does it mean if a pupil dilates in response to light in the swinging torch test?

A

Retinal or optic nerve disease

Called relative afferent pupillary defect (RAPD)

49
Q

How is the fundus examined?

A

Done through pupils that have been dilated with mydriatic drops
If not possible achieve pupil dilation by darkening room
Use ophthalmoscope to examine person’s eye with your same eye
Ask patient to look ahead
Shine light of ophthalmoscope into eye and examine fundus
Move head in all points of the Union Jack to see entire fundus

50
Q

Which muscles elevate and depress the eye when it is abducted?

A 
Elevator = superior rectus
Depressor = inferior rectus
51
Q

Which muscles elevate and depress the eye when it is adducted?

A 
Elevator = inferior oblique
Depressor = superior oblique

MD1 PCP (43 decks)

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