procedural skills

Question 1

should the patient wear glasses during a VA test

Answer 1

reading glasses should not be worn but distance glasses should be

Question 2

how to verbalise visual acuity

Answer 2

numerator is the distance of the chart from the patient
denominator is distance at which a normal eye can read that line of the chart
if the patient gets one wrong, subtract this

Question 3

if a patient gets more than 3 wrong

Answer 3

expressed as the previous line plus any numbers they got right on the next line

Question 4

if the patient doesnt get a perfect 6/6

Answer 4

use the pinhole and see if the visual acuity improves
this shows that the patients vision could be improved with glasses

Question 5

if the patient is reading from a chart loser than 6 metres

Answer 5

use the distance that theyre actually looking at the chart at as the numerator

Question 6

if the patient cant read the largest letters on the chart

Answer 6

move the patient to half the distance
and check again
use 3 instead of 6 as the numerator

Question 7

if they still cant read the largest letter at hlaf the distance from the chart

Answer 7

check counting fingers (CF) vision at 1 metre

Question 8

if the patient cant count fingers

Answer 8

check hand wave (HW) vision

Question 9

if they cant see hand movements

Answer 9

check perception of light (PL) vision

Question 10

if they cant see the light

Answer 10

no perception of light (NPL)

Question 11

what should you include when recording the visual acuity

Answer 11

aided or unaided
pinhole or not pinhole
right and left eye

Question 12

slitlamp is used for

Answer 12

examining the anterior section of the eye

Question 13

settings on the slit lamp for a standard examination

Answer 13

slit width 1mm
slit height 8mm
grey light filter (or off for AC)
focus rings on zero f you dont have a refrective error
start with low magnification

Question 14

how to dilate the patients pupils for fundoscopy

Answer 14

mydriatic from such as tropicamide 0.5% or 1% eye drops

Question 15

what should you do before fundoscopy

Answer 15

visual acuity, reflexes and feilds because you wont be able to do these properly once the patients eye are dilated

Question 16

to exmine the patients right eye with fundoscopy

Answer 16

use your right eye with the opthalmoscope in your right hand

Question 17

an absent or dull red reflex indicates

Answer 17

an opacity somewhere - may be in the corena, anterior chamber, lens or vitreous

Question 18

absent red reflex in babies

Answer 18

urgent opthalmology referral - this may be a retinoblastoma

Question 19

quadrants of the eye

Answer 19

infronasal,
infrotemporal
supranasal
supratemporal

Question 20

optic nerve is located

Answer 20

nerve is nasal

Question 21

asssessing the 3 Cs of the optic disc

Answer 21

colour - normal is yellow.
cup
contour - should be well defined

Question 22

abnormal colours of the optic disc

Answer 22

normal is yellow
pale if ischaemic optic neuropathy or GCA
reddish if hyperaemic disc from optic disc swelling

Question 23

abnormality of the countour of the optic disc

Answer 23

should be well defined
blurred or fuzzy = optic disc swelling
if present in both eyes, this is pallioedema caused by raised ICP or malignant hypertension

Question 24

raised intracranial pressure may be caused by

Answer 24

intracranial tumour
idiopathic untracranial hypertension
cerebral abscess
hydrocephalus

Question 25

central pale portion of the optic disc

Answer 25

optic cup

Question 26

abnormalities of the cup

Answer 26

normal cup-disc ratio is 0.3-0.5
if the ratio is above this or there is asymmetry, the patient should be evaluated for glaucoma

Question 27

in patients with diabetes

Answer 27

check for neovascularisation
fine-frilly vessels

Question 28

macula

Answer 28

ask the patient to look directly into the light
should be dark orange or reddish

Question 29

drusen

Answer 29

seen in age related macula degenration

Question 30

haemorrhages and hard exudates

Answer 30

seen in diabates

Question 31

pale white macula with a central cherry red spot

Answer 31

central retinal artery occlusion

Question 32

pigmented occular tumour

Answer 32

choroidal naevus

Question 33

papilloedema is due to

Answer 33

raised intracranial pressure due to a tumour in the brain