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Physical Assessment > Phys Exam 3 > Flashcards

Phys Exam 3 Flashcards

1
Q

Palpebral fissure?

A

Elliptical open space between eyelids.

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2
Q

Lower lid margin, at limbus, borders between cornea and sclera.

A

◦Canthus: corner of eye, angle where lids meet

◦Inner canthus: caruncle is small fleshy mass containing sebaceous glands

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3
Q

Tarsal plates

A

contain meibomian glands, which are modified sebaceous glands that secrete an oily lubricating material onto lids

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4
Q

Conjunctiva

A

Transparent protective covering of the eye

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5
Q

Cornea

A

covers and protects the iris and pupil

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6
Q

Lacrimal apparatus

A
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7
Q

What are the numbered parts of the eye?

A
  1. Upper eyelid
  2. Palpebral fissure
  3. Lateral canthus
  4. Lower eyelid
  5. Pupil
  6. Iris
  7. Sclera
  8. Medial Canthus
  9. Caruncle
  10. Limbus (between cornea and sclera)
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8
Q

How many muscles attach the eye to the orbit and direct to point of interest?

A

Six

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9
Q

What is conjugate movement?

A

Eached coordinated muscle (AKA yoked) move with one another ensuring the two eyes move. When they move the axes always remain parallel.

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10
Q

What are the four straight muscles?

A

Superior, inferior, lateral, and medial rectus

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11
Q

What are the two slanting muscles?

A

Superior. and inferior.

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12
Q

What is cranial nerve VI?

A

Abducens nerve, innervates lateral rectus muscles, which abducts eye.

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13
Q

What is cranial nerve IV?

A

Trochlear nerve, innervates superior oblique muscle

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14
Q

Label

A
  1. Bony orbit
  2. orbicularis oculi m.
  3. palpebral conjuctiva
  4. Bulbar conjunctiva
  5. posterior chamber
  6. anterior chamber
  7. cornea
  8. Tarsal plate
  9. meibomian glands
  10. sclera
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15
Q

What is cranial nerve III?

A

It is the oculomotor nerve that innervates all the rest of the muscles.

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16
Q

Label each muscle and the cranial nerve that controls it.

A
  1. inferior oblique, CN III
  2. superior rectus, CN III
  3. lateral rectus, CN VI
  4. inferior rectus, CN III
  5. superior oblique, CN IV
  6. medial rectus, CN III
  7. inferior oblique, CN III
  8. superior rectus, CN III
  9. lateral rectus, CN VI
  10. inferior rectus, CN III
  11. superior oblique, CN IV
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17
Q

Label

A
  1. superior rectus
  2. optic nerve
  3. lateral rectus
  4. inferior oblique
  5. inferior rectus
  6. medial rectus
  7. superior oblique (passing through trochlea)
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18
Q

Label

A
  1. Vitreous body
  2. Retina
  3. Choroid
  4. Sclera
  5. Macula
  6. Optic disc
  7. Retinal vessels
  8. Inferior rectus muscle
  9. Cillary body
  10. Posterior chamber
  11. Anterior chamber
  12. Lens
  13. Iris adn pupil
  14. Cornea
  15. Superior rectus muscles
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19
Q

What is the sclera?

A

A tough, white, protective covering.

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20
Q

What is the cornea?

A

part of the refracting media of the eye, it bends incoming light rays so they will be focused on inner retina.

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21
Q

What nerve stimulates blinking?

A

CN VII

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22
Q

What is the corneal reflex?

A

When the eye comes into contact with a wisp or cotton, stimulating a blink in both eyes.

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23
Q

What is the choroid?

A

Has dark pigment to prevent light from reflecting internally and is heavily vascularized to deliver blood to retina.

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24
Q

What is the iris and its function?

A

It functions as a diaphragm, varying in bright light to accomodate for near vision. It’s function is the muscles fibers of the iris contract in bright light to accommodate for near vision. The when light is dim, they will dilate for far vision.

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25
Q

What is the pupil?

A

It is round and regular. Size is determined by balance between PSNS and sympathetic chains of autonomic nervous system.

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26
Q

What is the lens?

A

Biconvex disc located just posterior to the pupil. It is transparent and serves as a refracting medium, keeping a viewed object in continued focus on the retina

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27
Q

How do you determine intraocular pressure?

A

Determined by balance between amount of aqueous produced and resistance to outflow.

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28
Q

What is the retina?

A

The visual receptive layer of the eye where light waves change into nerve impulses.

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29
Q

What retinal structures can be seen through an ophthalmoscope?

A

Optic disc, retinal vessels, general background, and macula.

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30
Q

What is the optic nerve?

A

AKA optic papilla, fibers from the retina coverage to form the optic nerve. Located on the nasal side of the retina. Color varies from creamy yellow orange to pink, it’s round/oval in shape.

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31
Q

What is the retinal vessel?

A

Normally included a paired artery and vein extending to each quadrant.

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32
Q

What is the macula?

A

Located on temporal side fundus. Slightly darker pigmented region surrounding fovea centralis, area of sharpest and keenest vision.

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33
Q

What is the pupillary light reflex?

A

Normal constriction of pupil when a bright light shines on the retina. It is a subcortical reflex that we cannot control. Sensory afferent link is CN II and motor afferent path is CN III.

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34
Q

What is the fixation?

A

Is a reflex direction of the eye toward an object attacting our attention. The image is fixed in the center of the visual field, the fovea centralis. This can be affected by drugs, alcohol, fatigue, and inattention (so… me… LOL)

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35
Q

What is accommodation?

A

Adaption of the eye for near vision. Occurs by increasing the curvature of the lens through muscle of the cilary body. Can observe pupillary constriction.

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36
Q

True or False, the infant does not have a macula at birth?

A

True. The infant’s macula will not mature until about 8 months.

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37
Q

At what age do infants establish binocularity?

A

3 to 4 months. They then can fixate on a single image with both eyes simultaneously.

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38
Q

True or False, the lens is flat at birth?

A

False, the lens is spherical and gets flatter as we age.

39
Q

What is the consistency of the lens from birth and then in old age?

A

Soft plastic then rigid glass.

40
Q

What is presbyopia?

A

When the lens loses elasticity, and it becomes hard and glasslike. This leads to difficulty with accommidation.

41
Q

When does cataracts usual begin developing?

A

It begins around age 70. Fibers of the lens will thicken and yellow?

42
Q

When does visual acuity begin to diminish?

A

It starts after 50, and more so after 70.

43
Q

What are the four most common causes of decreased visual functioning in older adults?

A

Cataracts, glaucome, age-related macular degeneration, and diabetic retinopathy.

Diabetic retinpathy is most common cause of blindness in adults ages 25-74.

44
Q

What are the two types of glaucoma?

A

Open and closed angle.

45
Q

What is the most common cause of blindness worldwide?

A

Cataracts. Est. 80% are preventable or curable with surgery.

46
Q

Which ethnicity is most likely to develop glaucoma?

A

African americans are 3-6 times more likely to get it than Caucasian americans. Primary glaucoma is leading cause of blindness in African Americans and Hispanics.

47
Q

What age and ethnicity is age-related macular degeneration common in?

A

It is seen in adults over the age of 75. It is most prevelant in Caucasians.

48
Q

Risk factors for macular degeneration?

A

Family history, smoking, hyperopia, light iris color, HTN, hypercholesterolemia, and female gender.

49
Q

What is visual impairment?

A

When you cannot see the letters on the eye chart at 20/50? VI will be doubled by 2050. Highest numbers are in causasian women and older. adults. CONCEPTUAL CONCERN: Safety.

Groups that are having higher VI are african americans and hispanics.

50
Q

Subjective date for the eyes.

A

Vision diffuculty (decreased acuity, blurring, blind spots)

Pain

Strabismus (cross eyed), diplopia

Redness, swelling

Watering, discharge

Hist. of ocular problems

Use of glasses or contacts

Patient-centered care

51
Q

Vision difficulty questions?

A

Diff. seeing or any blurring? Blind spots? Come on suddenly or slowly? One or both eyes?

Is it constant?

Objects appear out of focus or cloudy?

Any halos, rainbows, rings around objects?

Does your blind spot move as you shft your gaze? Any loss of periph vision?

Any night blindness?

52
Q

Questions relating to eye pain?

A

Any eye pain and describe?

Come on suddenly?

Quality of pain?

A foreign body sensation? Or deep aching? Or headache in your brow area?

53
Q

Questions for past history of ocular problems?

A

History of injury or eye surgery? Any history of allergies?

54
Q

How to assess glaucoma?

A

Have you been tested for glaucoma, if yes what were the results?

Any family history of glaucoma?

55
Q

How to assess the use of contacts or glasses?

A

Do you wear them, if yes do they work for you?

Last time prescription was checked/changed?

If you wear contacts, are there any problems such as pain, photophobia, watering, or swelling?

How do you clean your contacts? How long do you wear them? Do you remove them for certain activities?

56
Q

Patient centered care questions?

A

Last vision test? Test for color vision? (Using glasses annual exam, no correction every 2-3y)

Any envirnmental conditions at home or work that can affect eyes? If yes, wearing protective goggles?

Medications you’re taking, if yes are they systemic or topical? Any specific to the eyes? (prednisone may cause cataracts or increased intraocular pressure)

Do you smoke? (assoc. w/AMD, cataract, diabetic retinopathy, and eye inflamm)

If you have vison loss how do you cope? (Large print books, audio tape of books, braille?)

Do you maintain your living environment?

Do you fear complete loss of vision?

57
Q

History for infants and children?

A

Vaginal infections in mother at delivery? (Herpes and gonorrhea have risk of eye disease for newborn)

With age of child, which developmental milestones of vision has the parent noted?

Routine testing at school?

Is the parent aware of safety measures to protect child’s eyes from trauma? Do they inspect toys?

Have you taught child safe care of sharp objects and how to carry and use them?

58
Q

Additional history for aging adults?

A

Have you noticied any visual difficulty with climbing stairs or driving? Any problem with night vision? (Loss of depth perception, contrast sensitivity, peripheral or central vision may occur?)

Last time you were tested for glaucoma? (60-65 people need annual exam.)

Any aching pain around the eyes? Any loss of peripheral vision?

If you have glaucoma, how do you manage your eyedrops?

History of cataracts? Any loss or progressive blurring of vision?

Do your eyes ever feel dry or burning? What do you do for this?

Any decrease in usual activities, such as reading or sewing?

59
Q

Objective data for the eyes?

A

Snellen eye chart, an opaque card or occluder (to cover eye), if the pt wears glasses/contacts have them keep them on for the test.

60
Q

How to test near vision?

A

Do with handheld vision screener with various sizes of print (Jaeger card).

Hold card in good light about 35cm (14in) from the eye: distance equals prit on 20ft chart.

Test each eye separately, with glasses on.

Normal results are 14/14. (presbyopia is decrease of accomm and is shown when they move card further away.)

Can use a newpaper or magazine if no screening card is available.

61
Q

How to perform the confrontation test:

A

Gross measure of peripheral vision; compares the person’s peripheral vision with yours.

  1. Position yourself at eye level with the person about 2ft away.
  2. Direct the person to cover one eye with an opaque card and with the other eye look straight at you.
  3. Cover your own eye opposite to the person’s covered one; you are testing the uncovered eye.
  4. Holdl pencil or your finger as target midline between you and the person, slowly advance it in from periphery in several directions.
  5. Ask the person to say “now” as target is first seen; this should be just as you see the object also.
  6. Est. angle between anteroposterior axis of eye and peripheral axis where object is first seen. (Norm results are apx 50 degrees upward, 90 temporal, 70 down, and 60 nasal.

Sensitivity can be increased by combining wiggling finger with moving red target.

62
Q

What is the Hirschberg test?

A

AKA corneal light reflex.

Assesses parallel alignment of eye axes by shining a light toward the person’s eyes.

Direct the person to stare straight ahead as you hold the light about 30cm (12in away)

Note reflection of light on corneas; should be in exactly same spot on each eye.

63
Q

What are abnormal findings within the eyebrows?

A

Unequal or absent movement with nerve damage.

Scaling with seborrhea (improper fxn of the oil glands, will see greasy, waxy scales on eye).

64
Q

Abnormal findings of the eyelids and lashes?

A

Lid lag in hyperthyroidism.

Incomplete closure creates risk for corneal damage.

Ptosis (drooping of upper lid)

Periorbital edema, lesions.

Ectropion (lower eyelid rolls outward) and entropion (rolls inward)

65
Q

Abnormal findings of the eyeballs?

A

Exophthalmos (protruding eyes) and enophthalmos (sunken eyes)

66
Q

How to assess sclera and conjunctiva?

A

Have person look up, use your thumbs, slide lower lids down along orbital rim, being careful to not push against eyeball.

*be aware of ethnic variations (African americans occasionally have a gray-blue or muddy color to the sclera. In dark skinned people you may see small brown macules in the sclera)

67
Q

How to assess the lacrimal apparatus?

A

Ask the person to look down; with thumbs. slide outer part of upper lid up along bony orbit to expose under lid; inspect for any redness or swelling.

Can assess excessive tearing by pressing on the lacrimal sac just inside the lower oribital rim (not against side of the nose). Pressure should slightly lower lid but no other response should occur.

68
Q

True or False, arcus senilis is not common in older adults.

A

False, it is common. It is normal in the aging person and is a gray or white arc visible above and below the outer part of the cornea.

69
Q

What color is the fundus of the eye normally?

A

Color varies from light red to dark brown-red. No lesions should be noted.

70
Q

How to inspect the macula?

A

Inspected by the funduscopic exam. Bright light can cause watering , discomfort, and pupillary constriction.

Can be darker than the fundus but even and homogeneous.

Clumped pigment may occur with aging.

71
Q

Why is the eye exam deferred at birth?

A

Its deferred due to edema of lids from birth trauma or from instillation of silver nitrate at birth.

We should examine the eyes within a few days of birth and at every well-child exam after.

72
Q

True or false, neonates blink in response to light?

A

True

73
Q

True or false, blink and pupillary light reflex indicates an infant can see?

A

False, cannot confirm until later.

74
Q

At birth to 2w what can an infant see?

A

Will not open eyes after exposure to bright light. Increased alertness to object. Infant may fixate on an object.

75
Q

What can the infant see at 2-4w?

A

Infant can fixate on an object.

76
Q

What can the infant see at 1m?

A

Can fixate and follow llight or a bright toy.

77
Q

What can the infant see at 3-4m?

A

Can fixate, follow, and reach for a toy.

78
Q

What can the infant see at 6-10m?

A

Infant can fixate and follow toy in all directions.

79
Q

Visual tests for infants a children?

A

Allen test, picture cards, screens children from 2.5. years, 2y, and 11 months (respectively).

Use picture chart or Snellen E chart for preschooler from age 3 to 6; a child should reach 20/20 acuity by 6/7y.

80
Q

When can you perform the confrontation test on a child?

A

Older than 3.

81
Q

What is color blindness?

A

It is an inherited recessive x-linked trait affecting 8% of white males and 4% of african americans. It’s very rare in females.

82
Q

True or false, we test for strabismus in early childhood.

A

True. This is done by the corneal light test reflex and cover test.

83
Q

True or false, we should influence the opening of a neonates eyes?

A

False, it can increase contraction of the orbicularis oculi muscle.

84
Q

What is an epicanthal fold?

A

An excess skinfold extending over inner corner of eye, partly or totally overlapping inner canthus. Common in Asians and 20% of Whites. In non asians usually disappears by 10 years of age.

While present, epicanthal folds give false apearance of malalignment, termed pseudostrabismus, yet corneal light reflex is normal.

85
Q

Conjunctiva and sclera in infants?

A

Newborn may have transient chemical conjunctivitis from instillation of silver nitrate; appears w/in 1 hour and lasts not more 24h hours after birth.

Sclera should be white and clear, although it may have a blue tint as a result of thinness at birth; lacrimal glands are not functional at birth

86
Q

Iris and pupils in newborns?

A

Normall blue or slate gray in-light skinned newborns and brown in dark-skinned infants. By 6-9m permanent color differentiated.

87
Q

What ocular changes occur in the older adult?

A

Eyebrows may show loss of outer one third to one half of hair because of the decrease in hair follicles. Remaining hair is coarse.

As a result of atrophy of elastic tissue, skin around eyes may show wrinkles or crow’s feet.; upper lid may be elongated as to the rest on lashes, resulting in pseudoptosis.

Decreased lacrimal apparatus may lead to dry looking eyes and pt may report burning sensation.

Fat may heniate resulting in buldging lower lid and inner third of upper lid.

Cornea may look cloudy with age.

88
Q
A
89
Q

What is Xanthelasma?

A

Soft, raised yellow plaques occuring on lids at inner canthus. They occur aroud the 5th decade of life. No pathological significance. Common in women.

90
Q

True or false, lens lose transparency in the older adult.

A

True. They become opaque.

91
Q

What is a hordeolum?

A

It is a stye. It is a localized staph infection and can affect hair follicle along lid margin.

Typically are painful, red, and swollen.

It is contagious especially when you rub your eye.

Treat: warm compresses, topical antibiotic treatment, steriods.

92
Q

What is a hyphema?

A

Blood within the aqueos fluid of the anterior chamber.

93
Q
A

Physical Assessment (3 decks)

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