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emma - physical diagnosis > PD - Ophthalmology Exam > Flashcards

PD - Ophthalmology Exam Flashcards

1
Q

Myopia

A

Near-sighted

eye too long, image projected in front of retina

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2
Q

Hyperopia

A

Far-sighted

eye too short, image projected behind retina

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3
Q

Astigmatism

A

an eye with a cornea with differing refractive powers in one meridian compared to another

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4
Q

Accommodation

A

ability of the ciliary muscle to contract causes a change in the shape and power of the lens, allowing the eye to focus at near.

slowly lost thru life.

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5
Q

Miosis

A

pupillary constriction

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6
Q

Mydriasis

A

pupillary dilation

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7
Q

Finding the optic disc

A

At an angle slightly lateral to pt’s line of vision…

Focus on red reflex back to the retina within the pupil using ophthalmoscope. (red-orange reflection from the pupil)

Find a retinal vessel, track back to optic disc. (if vessel is getting smaller, may be leading away from disc)

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8
Q

Steps of the Eye Examination

A
  1. Test Visual Acuity
  2. Test Pupillary Response (pupillary light reflexes)
  3. Inspect lids
  4. Inspect the Conjunctiva and Sclera
  5. Test Extra-Ocular Movement (EOM) and ocular alignment
  6. Test Visual Fields
  7. Inspect the Cornea, Iris, and Anterior Chamber
  8. Check Red Reflex
  9. Perform Retinal Examination
  10. Perform Tonometry
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9
Q

Visual acuity test

A

Distance and near vision (with corrective lenses, if patient uses them)

  • Record each eye individually
  • Record circumstance (i.e., w/ contact lens, wall chart at 20 feet,)

or Count Fingers at x feet, Hand Motions at x feet, Light Perception (if vision very poor)

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10
Q

Common causes of decreased visual acuity

A
  • Refractive disorder
  • Amblyopia: poor vision in an otherwise normal eye, sometimes caused by strabismus
  • Corneal abrasion or infection
  • Age-related macular degeneration or cataract
  • Optic neuritis or ischemic optic neuropathy
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11
Q

anisocoria

A

difference in pupil diameter not greater than 1mm

3% of population

pathologic = indicates disease of the iris, sympathetic nerves (efferent loop,) or CN III

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12
Q

Horner Syndrome

A

Ipsilateral Ptosis, Miosis, and Anhydrosis

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13
Q

Direct Pupillary Response

A

Test miosis with light shined in one eye. (CN II aff, CN III eff)

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14
Q

Consensual Pupillary Response

A

Opposite pupil should constrict with light in one eye

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15
Q

Swinging Flashlight Test

A

Tests for relative AFFERENT pupillary defect (Marcus Gunn pupil) – decreased function of Cranial Nerve II (or retina.)

Shine light in one eye, then shift to other eye (pupils should remain equally constricted)

(if they instead dilate slightly, then there is an afferent pupillary defect)
-affected eye still senses the light and produces pupillary sphincter constriction to some degree, but is reduced.

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16
Q

Accommodation Reflex

A

Ask patient to focus on a distant object (finger) then move it toward their nose.
-Eyes should converge and slightly constrict.

(ciliary muscle also contracts, lens –> convex, but this is not usually visible w/o equipment.)

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17
Q

Why perform the swinging flashlight test?

A

A relative afferent papillary defect is 92-98% sensitive in detecting asymmetrical optic nerve disease (optic neuritis, etc.)

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18
Q

Anisocoria is absent in disease of …

A

CN II (afferent loop) or retina

19
Q

Inspecting lids/surrounding tissues

A
  • Assess for masses, edema, erythema, and asymmetry
  • Inspect lid margins for debris, erythema, discharge
  • Note where upper eyelids crosses the cornea/pupil
  • Evert and inspect under upper eyelid
20
Q

Proptosis

A

Grave’s orbital inflammation or tumor, orbital cellulitis, blunt injury

21
Q

Ptosis

A

CN III palsy, Horner’s, myasthenia gravis, dermatochalasis

22
Q

Swollen lids

A

chalazion, stye, dacryocystitis

23
Q

Tearing

A

dacryocystitis, blepharitis, orbital inflammation, ocular foreign body, allergy

24
Q

Discharge

A

allergic, bacterial, viral or chlamydial conjunctivitis, dacryocystitis, orbital inflammation

25
Q

conjunctiva components (2)

A

Palpebral conjunctiva (inside of the lids)

Bulbar conjunctiva (covers the surface of the eye).

Should be smooth, pink, and moist, without discharge.

26
Q

Superior Rectus (CN III)

A

elevation, (intorsion, adduction); upward gaze

27
Q

Inferior Rectus (CN III)

A

depression, (extorsion, adduction); downward gaze

28
Q

Lateral Rectus (CN VI)

A

abduction; lateral gaze

29
Q

Medial Rectus (CN III)

A

adduction; medial gaze

30
Q

Superior Oblique (CN IV)

A

Intorsion, depression, abduction; downward inward gaze

31
Q

Inferior Oblique (CN III)

A

Extorsion, elevation, abduction; upward outward gaze

32
Q

Ocular Alignment

A

Have patient look ahead and shine light at eyes.

Spot of light reflection should be symmetric.

If cover one eye and light reflex changes on the non-covered eye –> strabismus (lack of coordination between the eyes) w/ covered eye being dominant eye.

33
Q

Confrontational Visual Fields

A

Close one of your eyes and tell pt to look at your open eye

have patient tell you when objects enter/exit their visual field (test by counting fingers in all 4 quadrants)

tests for subtle, focal areas of vision loss (typically indicate more severe pathology)

34
Q

Common causes of visual field abnormalities

A
  • Tumors of optic chiasm
  • CVA or tumor
  • Retinal vascular occlusion
  • Optic neuritis or ischemic optic neuropathy
  • Glaucoma
  • Retinal detachment
35
Q

Areas of denuded corneal epithelium stain ______ after flourescein stain

A

bright green

36
Q

Assessment of anterior chamber depth

A

Shine penlight on cornea from side.

Shadow of iris should not be greater than one-half of the iris on opposite side

37
Q

Examining the optic disc

A
  • Inspect margins
  • Assess color
  • Estimate cup area
  • Look for vertical elongation of cup
  • Look for notches in rim, asymmetry of rim contour
  • Compare to opposite eye
38
Q

Examining the retina

A
  • Red spots: hemorrhages
  • Dot, blot-shaped red spots: deeper intraretinal hemorrhages
  • New vessels: fine, tortuous (diabetes)
  • Soft white, feathery patches: cotton-wool spots (sign of retinal ischemia)
  • Discrete yellow retinal spots: hard exudates, usually cholesterol deposits

assessing for retinal detachment, papilledema

39
Q

Assessing IOP (performing tonometry) directly

A

palpate closed eyelid, the globe should be firm, but slightly giving. A hard globe indicates an elevated IOP.

40
Q

Inspection of cornea and iris steps

A
  1. general inspection
  2. fluorescein stain
  3. anterior chamber depth
41
Q

Presbyopia

A

Reduced accommodation (loss of near vision with old age)

42
Q

optic disc indistinct margins and swelling

A

optic neuritis, papilledema, ischemic optic neuropathy

43
Q

optic disc pallor

A

old optic neuritis or ischemic optic neuropathy

44
Q

cupping

A

glaucoma

emma - physical diagnosis (12 decks)

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