Quiz 1 Flashcards
1
Q
What is the purpose of BIO?
A
To evaluate the peripheral retina in search of “rhegmatogenous” conditions
2
Q
What is a rhegmatogenous condition?
A
Retinal separation associated with a break, hole, or tear in the sensory retina
3
Q
What are the two big advantages of BIO over MO or DO?
A
Quick assessment of entire vitreous and retina
Stereo exam of entire retina and vitreous - large FOV, independent of patient’s refractive effor
4
Q
What are the disadvantages of BIO?
A
Lower magnification that SLE with lenses, as well as direct scope
Requires a dilated pupil
Light is very bright for the patient
5
Q
What is the mag of a 20D lens?
A
About 3X
6
Q
What are the 4 indications for BIO?
A
Part of a comprehensive exam
Complaints of newly onset flashes and floaters
Myopia of greater than 4.00D
Systemic diseases
7
Q
What are the contraindications for BIO?
A
Extremely narrow angles (can’t dilate)
8
Q
What is the relative contraindication for BIO?
A
Down’s Syndrome - sensitivity to tropicamide
9
Q
What is the order of pupil dilation protocols?
A
- Review history for changes
- Optometry vitals - VAs, pupils, EOMs, CF
- SLE of cornea + Van Herick
- IOP
- Gonio - as needed
- Patient education of need, confirm allergies, explain side effects of drops
- Drop instillation
10
Q
What is the mechanism of action for phenylephrine?
A
Sympathomimetic
11
Q
What does phenylephrine cause?
A
Some mydriasis (no cyclo) Vasoconstriction
12
Q
Why isn’t phenylephrine a good dilator on its own?
A
Weak and slow acting
13
Q
What is the usual percentage of phenylephrine used?
A
2.5%
14
Q
When is 10% phenylephrine used?
A
To break synechiae
15
Q
What are common names of phenylephrine?
A
AK-Dilate
Mydfrin
Neo-synephrine
Neofrin
16
Q
What effects can a sympathomimetic drug have on the body?
A
Dizziness Fast, irregular, pounding heartbeat Increased sweating Increased BP Paleness Trembling
17
Q
Why does a sympathomimetic cause high blood pressure?
A
It has vasoconstricting properties that can increase BP bu 10%
18
Q
You should be concerned about using a sympathomimetic drug on a patient with what issue?
A
High BP
19
Q
Patients with which characteristics might make using 0.5% tropicamide more beneficial?
A
Shallow angles
Blue/green eyes
20
Q
Which patients always need 1% tropicamide?
A
Dark brown eyes
Diabetics
21
Q
What is the mechanism of action for tropicamide?
A
Anticholinergic
22
Q
What effects does an anticholinergic drug have on the eye?
A
Blocks the iris sphincter
Blocks the ciliary muscle
23
Q
Which system does an anticholinergic drug block?
A
Parasympathetic
24
Q
What is the “lab dilation cocktail”?
A
Proparacaine
Phenylephrine
Tropicamide
25
What should be recorded when giving drops?
```
Which drop
Which eye
How much
What time
Patient education about the drops
```
26
Increasing the diopteric power of a condensing lens does what to FOV, mag, and working distance?
Increases FOV
Decreases mag
Decreases WD
27
What is the working distance of a 20D lens?
50mm or 5cm
28
A 15D condensing lens gives how much mag?
4X
29
About how big is the FIV with a 20D lens?
8 disc diameters
30
Which side of the lens should be pointed toward the patient?
Side with the silver ring or the more reflective side
31
What is the correct distance from the lens to the examiner?
About 16-20 inches or 50cm
32
What is the critical element in obtaining a BIO view?
Tromboning
33
You should always be ___ degrees from the patients fixation.
180
34
When examining the superior retina, your arms should reach up at what angle?
45 degrees
35
When examining the inferior retina, your arms should reach down at what angle?
30-45 degrees
36
What are the required elements for BIO of the posterior pole?
Dim the rheostat
Sit eye level with patient
OD first, then OS
Make sure the optic nerve moves to a new location with each view
Take hand away before redirecting the patient's gaze
37
If you are having trouble with a temporal views, how should you direct the patient?
Have them turn their head in the opposite direction of their gaze
38
Where is the long ciliary artery found?
Nasally
39
Where is the long ciliary nerve found?
Temporally
40
Where are the short ciliary nerves found?
Superior and inferior
41
What should be recorded when doing a DFE?
Which eye
Anatomical location - by clock position or quadrant
Size and shape
Contour - flat vs elevated
42
Where should you find long posterior ciliary nerves?
3:00 and 9:00 position
43
Where should you find short ciliary nerves?
Between 10:00 and 2:00, as well as between 4:00 and 6:00
44
Where is the vortex ampulla located?
3mm posterior to the ora
45
How many vortex veins stem from the ampulla?
4-6
46
Where are the ampullae located?
1:00, 5:00, 7:00, and 11:00
47
What things must be done before dilating drops are instilled?
```
BP
BCVA
Pupils
EOM
SLE of cornea and angles
Tonometry
```
48
When is tropicamide contraindicated?
Gonio evidence of at risk angles
Iris fixated IOLs
Plateau iris
Hypersensitivity
49
What is the one absolute contraindication to dilation?
Iris fixated IOLs
50
What conditions require caution when dilating?
Hyphema
Pregnancy/lactating
Down's syndrome
51
What orientation are the views given by direct viewing techniques?
Upright
52
What are the two direct viewing techniques that we can use?
DO
| Goldmann 3-mirror Hruby lens
53
What are the characteristics of an indirect view of the fundus?
Inverted, arial image
54
What is the clinical standard for posterior pole examination?
High plus condensing lens with slitlamp
55
What are the advantages of fundus biomicroscopy over DO?
Stereo views
| Variable mag and FOV
56
What is the FOV with a 90D lens?
30-40 degrees
57
What is the working distance with a 90D lens?
7mm
58
Which has a larger FOV, 79D or 90D?
90D
59
What is the working distance of a 78D?
8mm
60
When is a 78D lens preferred over a 90?
For glaucoma suspects and diabetic retinopathy
61
Which has more mag, a 79D or a 90D?
78D
62
The 78D lens has a longer focal length, so the slitlamp must be (closer, farther) from the patient?
Farther
63
The proper working distance allows the back focus of the lens to be fixed where?
Right at the pupil
64
What is the correct set-up for fundus biomicroscopy?
Medium-high illumination, in click
Mag starting with 10X, maybe 16X
Parallelepiped beam with 5-6mm height
Polaroid filter on, aperture 1-3
65
What anatomical landmarks are located in the posterior pole?
Macula
Optic nerve
Superior and inferior vessel arcades
Nasal Vessels
66
If you scan across and reach the outer limit of your lens, what is the corrective measure that you take?
Move the lens in the direction of your scans
67
When the patient is looking up, which direction should you have your lens tilted?
Top down
68
When the patient is looking down, which direction should your lens be tilted?
Bottom up
69
If your patient is looking down and left, and you have an ampulla in view, in which direction is the posterior pole?
Posterior pole will be near the bottom of the lens
70
If your patient is looking down and left, and you have an ampulla in view, in which direction is the ora?
Ora will be toward the top of the lens
71
Which Goldmann mirror is most inclined?
Trapezoid
72
Which Goldmann mirror is least inclined?
D-mirror
73
What are the advantages to 3-mirror fundus exams?
Provides a stable view of the posterior pole
| Provides a magnified view of the peripheral retina
74
When would 3-mirror fundus be performed?
After peripheral retina exam with BIO
75
What are the contraindications for 3-mirror?
Corneal surface disease
Recent eye surgery
Complications of trauma: hyphema, corneal laceration, globe perforation
76
What view does the contact Hruby lens provide?
Direct upright view of the fundus with a larger field of view than the direct scope
77
What view do the rectangular mirror and trapezoid mirror allow?
Views of the retina
78
The D mirror may be used to view what structure with widely dilated pupils?
Pars plana
79
The trapezoid mirror is for viewing what?
Mid-periphery
| Equator to posterior pole
80
The rectangular mirror is for viewing what?
Periphery
| Equator to ora
81
What is the average size of the optic nerve?
1.5mm or 1500 microns
82
When measuring the optic nerve with the slit lamp, what are the conversion factors to use with the 90D and 78D lenses?
1. 33 - 90D
| 1. 2 - 78D
83
A larger than average optic disc is often associated with what?
High myopia
84
What is the order of optic nerve size from large to small among the various races?
African-American
Asian
Hispanic
Caucasian
85
What are the characteristics of a malinserted optic nerve?
Nasal side is indistinct, but temporal is clear
| Tilted along vertical axis
86
A "heaped up" nerve is associated with what?
A tilted disc
87
Tilted disc are tilted along which axis?
Horizontal
88
What things may cause papilledema?
Increased ICP due to brain lesion
Idiopathic intracranial hypertension
Hypertensive crisis
89
What may cause pseudopapilledema?
Congenital disc anomalies like:
Optic nerve head drusen
Congenitally full disc
Malinserted disc
90
What is optic nerve head type I?
Flat nerve heads
C/D 0-0.2
Cupping less than or equal to 1D
91
What is optic nerve head type II?
```
Nerve has sharp temporal rim
Vessels flow over the cup's rim and into the vertical cup's edge
Bifurcation of central vessels visible
C/D from 0.15 - 0.65
1-5D of dupping
```
92
What is ONH type III?
```
Very little to no sharp temporal rim
Vessels follow slope of the cup
Looks somewhat like a saucer
Cupping from 1-3D
Looks like a saucer
```
93
What is ONH type IV?
Little to no sharp temporal rim
Vessels are in the nasal hook
May not see vessel bifurcation
C/D from 0.2-0.7
94
Nasal hooks are commonly seen in which type of patient?
Moderate to hight myopes
95
What is Elschnig type I ONH?
Flat
96
What is Elschnig type II ONH?
Cylindrical
97
What is Elschnig Type III
Sloping
98
What is Elschnig Type IV?
Sloping with hook
99
What is the average C/D for caucasians?
0.4
100
What is the average C/D for asians/latinos?
0.5
101
What is the average C/D for african americans?
0.6
102
When do you get suspicious concerning ON size?
When it is about 0.1 bigger than it should be
103
What are the five R's of glaucoma?
```
Scleral ring
Rim size and color
Retinal nerve fiber layer
Region of peripapillary atrophy
Retinal/optic nerve hemorrhages
```
104
C/D asymmetry is ok if within ___.
0.15
105
What filter is used to better visualize the NFL?
Red-free
106
Where is the NFL thickest?
Vertical poles
107
If fundus veins are too wide, what disease is common?
Diabetes
108
If fundus arteries are too narrow, what disease is common?
Hypertension
109
What is an abnormal A/V ratio?
1/4 - 1/3
110
What are the side effects of tropicamide?
```
Sting
Blurred vision
Photophobia
Decreased sweating
Fast heart rate
```
111
What are the side effects of phenylephrine?
```
Rapid heart rate
Photophobia
Dizziness
Paleness
High BP
Sweating
```
112
How does the image appear when using 3-mirror for a fundus exam?
Inverted, but not reversed
