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GM Phys Di > Unit 4 - Eyes > Flashcards

Unit 4 - Eyes Flashcards

1
Q

What is the outer fibrous layer of the internal eye

A

Sclera posteriorly and cornea anteriorly

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2
Q

What is the middle layer of the eye

A

Choroid posteriorly and ciliary body/iris anteriorly

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3
Q

What is the inner layer of the internal eye

A

The retina

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4
Q

What are the 5 major structurs of the internal eye

A

Slcera, cornea, iris, lens, retina

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5
Q

Is the sclera vacular?

A

No it is avascular

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6
Q

What is the scleras purpose

A

Supports internal eye structures

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7
Q

Cornea is continuuous with the ____ anteriorly

A

Sclera

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8
Q

What part of the internal eye is the sensory innervation for pain

A

The cornea

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9
Q

What is the major part of the refractive power of the eye

A

The cornea

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10
Q

What do the iris, ciliary body, and choroids comprise

A

The uveal tract

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11
Q

What produces aqueous humore and contains the muscles controlling accomodation

A

The ciliary body

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12
Q

What of the internal eye is a pigmented, richly vascular layer that supplies oxygen to the outer layer of the retina

A

The choroid

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13
Q

Where is the lens located

A

Immediately behind the iris

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14
Q

How is the lens supported

A

Circumferentially by fibers arising from the ciliary body

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15
Q

What changes the thickness of the lens

A

Contraction/relaxation of the ciliary body

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16
Q

What is the sensory network of the eye

A

The retina

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17
Q

How does the retina work

A

Transforms light impulses into electrical impulses

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18
Q

What part of the brain interprets impulses as visual objects from the retina

A

The cortex

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19
Q

When does the eye form

A

During first 8 weeks of gestation - can be malformed due to drug ingestion/infection

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20
Q

When is lacrimal drainage complete

A

At birth

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21
Q

When does the lacrimal gland begin to produce full volume of tears

A

By 2-3 weeks

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22
Q

______ depends on nervous system maturation and occurs over time

A

Vision development

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23
Q

What is term infants vision like

A

Hyperopic [20/400]

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24
Q

When is peripheral vision fully developed compared to central vison

A

At birth, central develops later

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25
Q

When is binocular vision development complete

A

By 3-4 months

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26
Q

When is vision developed sufficiently so that the infant can differentiate colors

A

By 6 months

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27
Q

The glob of the eye grow as the childs ____ grow

A

Head an brain

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28
Q

Adult visual acuity is acheived by what age

A

4 years of age

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29
Q

What changes are common in pregnant womens eye

A

Hypersensitivity and changes in refractory power

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30
Q

Tears in a pregnant woman can contain an increased level of ____ resuting in what

A

Lysozyme; results in greasy sensation and perhaps blurred vision for contact lens wearers

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31
Q

Where does edema and thickening occur in pregnant women

A

Corneal

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32
Q

What type of retinopathy can happen in pregnant women

A

Diabetic retinopathy

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33
Q

What type of pressure falls in pregnant womens eyes

A

Intraocular pressure

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34
Q

What can occur/resolve spontaneously in pregnant women

A

Subconjunctival hemorrhages

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35
Q

What is the major physiologic eye change that occurs with aging

A

Progressive weakening of accomodation (focusing power) known as presbyopia

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36
Q

Loss of lens ____ and ___ formation can happen in older adults

A

Clarity; cataract

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37
Q

What visual exam detects and defines important neurological or ocular disease

A

Visual field testing

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38
Q

When is the visual acuity exam recorded

A

Beginning of eye exam

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39
Q

What visual exam gives valuable clinical info about disease or their processes

A

Pupillary exam

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40
Q

What is the order of visual examination

A

Visual acuity, visual field testing, pupillary exam, ophthalmoscopy

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41
Q

What color should the conjunctiva of the eye be

A

Should be pink at the lid margins

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42
Q

What is the acronym PERRLA for

A

The pupil of the eye, pupils are equal, round, reactive to light and accomodation

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43
Q

What does the pinhole occluder test for

A

Visual acuity improvement

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44
Q

What is standard for near vision testing

A

Rosenbaum near vision card

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45
Q

What is the test for color vision

A

Ishihara

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46
Q

What motion does the superior oblique do

A

Medial and downward movement

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47
Q

What motion does the inferior oblique perform

A

Medial and upward

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48
Q

What is innervated by the trochlear nerve

A

The superior oblique

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49
Q

What is innervated by the abducens nerve

A

The lateral recuts

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50
Q

What can you find with peripheral field tests that were previously undetected

A

Occipital strokes and optic chiasmal tumors (pituitary or suprasellar masses)

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51
Q

What light reflex causes the pupil to constrict with light stimulus

A

Direct light reflex

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52
Q

What light reflex causes opposite/contralateral pupil to consrict with light stimulus

A

Indirect/consensual light reflex

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53
Q

What light reflex shows light reflected in both pupils equally

A

Corneal light reflex

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54
Q

What is a normal variant characterized by a physiological difference in muscular tone between right and left pupils but doesnt change with illumination

A

Physiological anisocoria

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55
Q

What happens when the pupil of an affected eye is smaller (miotic); patient has ipsilateral ptosis and anhidrosis;difference varies with illumination

A

Horners syndrome

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56
Q

What abnormal pupil rsponse constricts only response to accomodation but not in response to light

A

Argyl robertson

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57
Q

What abnormal pupil response is seen in tertiary syphillis, diabetics, alcoholics neoplasm, infx, and is ALWAYS pathological

A

Argyll robertson

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58
Q

What abnormal pupil response is a. Tonic pupil that fails to constrict in response to both light and accomodation eventually may constrict but is sluggish and is ALWAYS benign

A

Adies pupil

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59
Q

What is an afferent pupillary defect also called

A

Marcus gunn pupill

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60
Q

What is marcus gunn pupil

A

Has normal efferent system, but abnormal afferent pathway,

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61
Q

What is the mc cause of marcus gunn pupil

A

Optic neuritis, also assymmetric optic neuropathy

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62
Q

What are causes of optic neuritis

A

Demyelinating diseases, infx, sinus infx, drugs, radiation therapy

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63
Q

What is a cobalt aperature filter for

A

To evaluate small lesions, corneal abrasions, foreign bodies

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64
Q

What is a red free filter aperature used for

A

Highlights hemorrhages

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65
Q

What pathology has an opaque gray ring at the periphery of the cornea just within sclerocorneal junction

A

Arcus cornealis

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66
Q

Who frequently gets arcus cornealis

A

Elderly

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67
Q

What causes arcus cornealis

A

From fatty granules in or hyaline degeneration of lamellae and cells of cornea

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68
Q

What is another name for a hordeolum

A

A stye

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69
Q

What is an inflammation of the lash follicle

A

Hordeolum

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70
Q

What pathology has a plugged meibomian gland

A

Chalazion

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71
Q

How do you tell the difference between the hordeolum and chalazion

A

Hordeolum is painful, chalazion is non tender

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72
Q

What pathology has inflammation of eyelids, hard to manage due to recurrence and what are the 2 types

A

Blepharitis (anterior = outer lid bacteria) (posterior = inner lid caused by oil or meibomian)

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73
Q

What pathology has a yellowish flat plaque that occurs near inner canthus of eyelid mc on upper lid and can be soft or semi hard, frequently symmetrical

A

Xanthelasma

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74
Q

How many xanthelasma occur with elevated plasma levels

A

50%

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75
Q

What can cause xanthelasma

A

High plasma lipid levels, altered lipoprotien composition

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76
Q

Who frequently gets xanthelasma

A

Frequently occur in patients with type 2 hyperlipidemia

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77
Q

What pathology is a wedge shaped growth lateral to the iris that can cover iris

A

Pterygium

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78
Q

What are two abnormal growths on the surface of the eyes

A

Pinguecula and pterygium

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79
Q

Where are cases of pterygum and pinguecula usually seen im the world

A

Warm dry climates

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80
Q

What is cats eye called

A

Coloboma

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81
Q

What is a white reflex that indicates something is changing the normal color of the retina (decreased BS) or that something is obstructing the normal reflex

A

Leukocoria

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82
Q

What causes leukocoria

A

Mc congenital cataract

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83
Q

What is the most serious cause of the leukocoria

A

Retinoblastoma

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84
Q

What pathology is a condition that affects normal use of the eyes and visual development

A

Amblyopia

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85
Q

What are 3 major causes of amblyopia

A

Strabismus, unequal focus, cloudiness of the eye tissues

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86
Q

What is the mc cause of blindness in individuals under the age of 65

A

Diabetic retinopathy

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87
Q

What is the risk factor for diabetic retinopathy

A

Duration of the diabetes, 90% in those with the disease more than 15 years

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88
Q

What is the most common form of diabetic retinopathy

A

Nonproliferative diabetic retinopathy

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89
Q

Who is more common to get NDR

A

Type 1 diabetes = 100%, type 2 = 60%

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90
Q

What pathology is characterized by growth of new vessels on the surface of the retina

A

Proliferative diabetic retinopathy

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91
Q

What pathology has progressive loss of vision, fine-severe loops of new vessels growing in optic disc, leak causeing retinal edema

A

Proliferative diabetic retinapathy

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92
Q

What pathology has small yellowish areas of coloration in the retina and occur due to swelling of surface of retina (microinfarcts)

A

Cotton wool spots

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93
Q

What are the mc causes of cotton wool spots

A

Diabetes and high bp

94
Q

What is often the earliest recognizable clinical sign of diabetic retinopathy

A

Microaneurysms

95
Q

What pathology has small round dark red dots on the retinal surface that are less than the diameter of the optic veins

A

Microaneurysms

96
Q

What happens to microaneurysms as the degree of retinal involvement progresses

A

They increase in number

97
Q

What pathology resembles bundles of straw and may be round/flame shaped

A

Hemorrhages

98
Q

What indicates an increasingly ischemic retina

A

Hemorrhages

99
Q

As the number of _____ increase the retinal vessels become more damaged and leaky, leading to exudation of fluid, lipid, and proteins

A

Hemorrhages

100
Q

What pathology has bright reflective white or cream colored lesions on the retina

A

Exudates

101
Q

What do exudates on the retina indicate

A

Vessel permeability and increased risk of retinal edema

102
Q

If exudate swelling occurs on macula what hapens

A

Vision may be lost

103
Q

Who is more likely to have hypertensive retinopathy

A

AA patients with only hypertensive retinopathy that is asymptomatic

104
Q

All the findings of hypertensive retinopathy stem from hypertension induced changes in what

A

Retinal microvasculature

105
Q

Hypertension leadss to lying down of what in the tunica intima of mediaum and large arteries

A

Cholesterol

106
Q

Hypertensive retinopathy leads to decreassd lumen size of vessels and focal closure giving rise to what

A

Hemorrhages and cotton also related to increase in ICP

107
Q

What is the normal arteriovenous ratio

A

3;5 to 2;3

108
Q

The site of crossinng the arteriole and vein share a common what

A

Adventitial sheath

109
Q

What causes a compression of the underlying lumen resulting in AV nicking or a tapering of a venule

A

Vascular sclerosis

110
Q

What is the most common reason for AV nicking

A

Prolonged systemic hypertension

111
Q

What are round yellow deposits that form within a layer under the retina that cause vision to be effected when forming in the macula

A

Drusen bodies

112
Q

The increased pressure of glaucoma leads to what

A

Destruction of optic nerve fibers and visual field deficits

113
Q

Ophthalmological exam of glaucoma reveals what

A

Cupping of the optic disk

114
Q

What is common when there is traction on the retina by viterous gel

A

Retinal tears

115
Q

What is posterior vitrous detachment

A

With aging vitreous humor detaches from the retina and can cause floaters in the eye

116
Q

What layers are associated with retinal dettachement

A

Sensory and pigmented layers

117
Q

Retinal detachment is considered an _____ because it can cause permanent visual damage

A

Ocular emergency

118
Q

What type of retinal detachment is common in nearsightend that have undergone eye surgery or have experience serious eye injury

A

Sensory layers and fluid seeps underneath the retina

119
Q

What is the 2nd most commmon type of retinal detachment

A

When strands of vitreous or scar tissue create traction on retina

120
Q

Patients with diabetes are more likley to experience whatt type of retinal detachement

A

2nd kind where scar tissue creates traction

121
Q

Whatt is the 3rd type of retinal detachment

A

Fluid collects underneath layers causing separation

122
Q

How are 1st and 3rd retinal detach different

A

1st involves sensory layer breaking

123
Q

What retinal detachment occurs in conjunction with another disease that affects the eyes

A

3rd

124
Q

What symptoms have light flashes, wavy/watery vision, shower of floaters, sudden decrease in vision

A

Retinal detachment

125
Q

What is an optic disc swelling secondary to eleveated ICP

A

Papilledema

126
Q

Papilledema is almost always present as a ______ phenomenon and may develop over hours to weeks

A

Bilateral

127
Q

The disk swelling of papilledema is result of what

A

Axoplasmic flow stasis with intra axonal edema in optic disc

128
Q

How much larger is the pan optic ophthalmascope than traditional

A

Pan optic = 25, 5 degrees is traditional

129
Q

The panoptic has a larger field of view and therefore what shows five times larger

A

The fundus is five times larger

130
Q

What is used for detecting strabismus

A

Strabismoscope

131
Q

Photoscreening is used to detect what

A

Amblyopia (lazy eye) and strabismus is children

132
Q

What else is photoscreening used for other than amblyopia and stabismus

A

Obtain images of pupillary reflexes and red reflexes

133
Q

The snellen chart is used for a screening examination of ___ vision

A

Far vision

134
Q

Visual acuity is recorded as a what

A

Fraction with numerator of 20

135
Q

The larger the denominator in visual acuity equals what

A

Poorer the vision

136
Q

Measurement other than 20/20 indicates what

A

Either refractive error or an optic disorder

137
Q

If a patient is able to read some but not all the letters of the next smaller line indicate this by what

A

You adding number of letters read correctly on that line (20/25 +2) meaning thet can read all letters of 20/25 line and also 2 of the letters of the 20/20 line

138
Q

What is used for young children 3-5 years old unable to read letters/use snellen chart

A

The tumbing e or HOTV

139
Q

What does the LEA or LH symbols chart use

A

Four optotypes (circle square apple house)

140
Q

What eye test consists of six pairs of cards with different accuities

A

The broken wheel test

141
Q

What test is where the child identifies the card that has the broken wheels on a pictured car

A

Broken wheels card test

142
Q

To assess for near vision what charts are used

A

Rosenbaum or Jaeger charge

143
Q

A screening test for use with individuals at risk of macular degeneration is provided with the _____

A

Amsler grid

144
Q

What monitors about 10 degrees of central vision and is used when retinal drusen bodies are seen during examination or when strong family history of macular degeneration

A

Amsler grid

145
Q

What is a grid of straight lines that has a black dot that acts as fixation point

A

Amsler grid

146
Q

What provides oils to the tear film in the eye

A

Meibomian glands

147
Q

What distributes tears over the surface of the eye,limits amount of light entering, and protects from foreign bodies

A

The eyelid

148
Q

What conjunctiva coats the inside and outside of the eyelids

A

Palpebral conjunctiva = inside, bulbar (ocular) conjuctiva = outer

149
Q

What protects the anterior surface of the eye with the exception of the cornea and the surface of the eyelid contacting the glob

A

The bulbar conjunctiva

150
Q

What is a biconvex transparent structure located immediately behind the iris

A

The lens

151
Q

What changes the thickness of the lens permitting images of varied distances to be focused on the retina?

A

Thee ciliary body (contraction or relaxation)

152
Q

When is accurate binocular vision acheived

A

When an image is fused on the retina by the cornea and the lens

153
Q

Fibers located on the ______ decussate in the optic chiasm

A

Nasal retina

154
Q

Accurate binocular vision requires the synchronous functioning of the what

A

Extra-ocular muscles

155
Q

What is one of thee earliest visual responses of an infant

A

The mothers face

156
Q

Lacrimal drainage is complete at when

A

At the time of term birth

157
Q

By 3 to 4 months of age ____ vision development is complete

A

Binocular vision

158
Q

When are the eyes developed enough to differentiate colors

A

By 6th months

159
Q

Young children become less ____ with growth

A

Hyperopic

160
Q

Adult visual acuity is achieved at about how old

A

4 years of age

161
Q

What types of changes can eyes undergo in pregnant women

A

Hypersensitivity (change refractive power), tears increased lysozyme (greasy/blurred vision), mild corneal edema

162
Q

Does intraocular fall or rise in pregnancy

A

Intraocular pressure falls notably during latter half of pregnancy

163
Q

What is the major physiologic eye change that occurs with aging

A

Progressive weakening of accommodation (focusing power) = presbyopia

164
Q

When does the lens become more rigid usually and the ciliary muscle becomes weaker

A

Age 45

165
Q

Old fibers of the lens are compressed _____ forming denser ____ region that may cause what to happen

A

Centrally; central region; cause loss of clarity of the lens contributing to cataract formation

166
Q

What cranial nerve is tested for small visual details and is essentially a measurement of central vision

A

CN 2

167
Q

In the eye exam the smaller the fraction indicates what

A

The worse the vision

168
Q

When do you perform a pinhole test

A

If visual acuity is recorded at a fraction less than 20/20

169
Q

Expect improvement in visual acuity by at least one line on the chart if ______ is responsible for diminished acuity

A

Refractive power

170
Q

Monocular diplopia is a ______ problem, binocular diplopia is an _____ problem

A

Optical; alignment

171
Q

Measurement of near vision should also be tested in each eye separately with handheld card such as what

A

The rosenbaum pocket vision screener

172
Q

What fields are you testing in peripheral field vision test

A

Nasal, temporal, superior, inferior fields

173
Q

_____ most likely to produce confrontation abnormalities include stroke, retinal detachement, optic neuropathy, pituitary tumor compression at the optic chiasm, and central retinal vascular occlusion

A

Lesions

174
Q

What is the order you carry out external exam of the eyes

A

Begin with appendages and move inward

175
Q

If patients eyebrows are coarse or do not extend beyond temporal canthus, the patient may have what

A

Hypothyroidism

176
Q

What is an elevated plaque of cholesterol deposited in macrophages most commonly in the nasal portion of the upper or lower lid

A

Xanthelasma

177
Q

When examining a patient you have them lightly close their eyes and notice tremors what does this indicate

A

Hyperthyroidism

178
Q

If one superior eyelid covers more of the iris than the other or extends over the pupil then ____ of that lid is present

A

Ptosis

179
Q

Ptosis indicates a ____ or _____ weakness of the ____ muscle or a paresis of a branch of the ____ CN

A

Congenital or acquired; levator muscle; 3rd CN

180
Q

When the lower lid is turned away from the eye it is called what

A

Ectropion

181
Q

When the lid is turned inward toward the globe the condition is known as what

A

Entropion

182
Q

In the case of entropion the lids eyelashes can cause what

A

Corneal/conjuctiva irritation, increasing secondary infection chances reports of foreign body sensation

183
Q

An acuute suppurative inflammation of the follicle of an eyelas can cause an erythamatous or yellow lump called what

A

Hordeolum caused by staph

184
Q

What usually causes blepharitis

A

Bacterial infection, seborrhea, psoriasis, roascease, allergic response

185
Q

If closed eyelids do not completely cover the globe then it is a condition called what and results in what

A

Lagophthalmos cornea can become dried/infx

186
Q

Pain on palpation of closed eye is consistent with what

A

Scleritis, orbital cellulitis, and cavernous sinus thrombosis

187
Q

An eye that feels very firm and resists palption can indicate what

A

Severe glaucoma or retrobulbar tumor

188
Q

An erythematous or cobblestone appearance especially on the ____ conjunctiva may indicate an _____

A

Tarsal conjunctiva; allergic/infectious conjunctivitis

189
Q

Subconjunctival hemorrhages can occuur spontaneously during what

A

Labor/pregnancy

190
Q

A pterygium is more common in people heavily exposed to what

A

UV light

191
Q

Corneal sensitivity is controlled by CN ____ and is tested by touching whisp of cotton to the cornea

A

CN V

192
Q

Decreased corneal sensation is often associated with what

A

Diabetes, herpes simplex and herpes zoster viral infx, after trigeminal neuralgia surgery

193
Q

Blinking after corneal sensitivity test indicates what sensory CN are intact

A

CN 5 and motor fibers of CN 7

194
Q

If arcus senilis is present before age 40 what can this indicate

A

Lipid disorder

195
Q

What is a pupillary constriction to less than 2 mm

A

Miosis

196
Q

The miotic pupil fails to do what

A

Dialate in the dark

197
Q

What can cause miosis

A

Drugs like morphine or glaucoma meds

198
Q

Pupillary dilation of more than 6mm an failure of pupils to constrict with light characterization of what

A

Mydriasis

199
Q

Mydriasis is an accompaniement of a what

A

A coma or eye drops

200
Q

What is an inequality of pupillary size and is common variation but can occur in other disease states

A

Aniscoria

201
Q

If a pupil continues to dilate rather than constrict then what is present

A

Afferent pupillary defect or marcis gunn pupil

202
Q

Bilateral, miotic, iregularly shaped pupils that fail to constrict with light but retain constriction with convergence are what

A

Argyll robertson pupil

203
Q

A failure to respond to direct light but retaining constriction during accomodation is sometimes seen in patients with what

A

Diabetes/syphilis

204
Q

What happens that causes sclera to become pigmented and appear either yellow or green

A

Liver or hemolytic disease

205
Q

What appears as a dark slate gray pigment just anterior to the insertion of the medial recuts muscle

A

Senile hyaline plaque

206
Q

What do you use to test the balance of the extraocular muscles

A

Corneal light reflex

207
Q

What can cause no initial red reflex

A

Improper placement, cataract, hemorrhage into vitreous humor

208
Q

If your patient is myopic you will use what lens

A

Minus (red) lens

209
Q

If a patient is hyperopic or lacks a lens (aphakic) you will use what ophthalmascope lens

A

You will need a plus lense

210
Q

Characteristics during a ophthalmologic exam inclduing narrowing of vessels, increased vascular toruosity, copper wiring, arteriovenous nicking and retinal hemorrhage indicate what

A

HTN

211
Q

Prominent epicanthal folds are expected in asian infants but can be suggestive of what

A

Down syndrome/ other congenital anomolies

212
Q

Wide spacing of the eyes is known as what

A

Hypertelorism

213
Q

What is the false appearance of strabismus

A

Pseudostrabismus

214
Q

Brushfield spots strongly suggest what

A

Down syndrome

215
Q

The anticipated visual acuity for children 3-5 is what

A

20/40

216
Q

The anticipated visual acuity for children aged 6 and older is what

A

20/30 or better

217
Q

What can help differentiate chronic htn and PIH in pregnant women

A

Retinal examinations

218
Q

Vascular tortuosity, angiosclerosis, hemorrhage, and exudates may be seen in patients with what

A

Long standing history of HTN

219
Q

Segmental arteriolar narrowing with wet, glistening appearance indicative of edem is in a patient with what

A

PIH

220
Q

What is inflammation of the superficial layers of the sclera anterior to the insterion of the rectus muscles

A

Episcleritis

221
Q

What is a deposition of calcium in the superficial cornea

A

Band keratopathy

222
Q

What is a disruption of corneal epithelium and stroma

A

Corneal ulcer

223
Q

What is it when both eyes do not focus on an object simultaneously but can focus with either eye

A

Strabismus e

224
Q

What is it when there is interruption of sympathetic nerve innervation to the eye

A

Horner syndrome

225
Q

What is it when there is dot hemorrhages or microaneurysms and the presence of hard/soft exudates

A

Non proliferative diabetic retinopathy

226
Q

What is it with development of new vessels as result of anoxic stimulaiton

A

Proliferative diabetic retinopathy

227
Q

What is it when there is a creamy white appearance of retinal vessels that occurs with excessively high serum triglyceride levels

A

Lipemia retinalis

228
Q

What is an autosomal recessive disorder in which genetic defects cause cell death predominantly in the rod photoreceptors

A

Retinitis pigmentosa

229
Q

What is a disease of the optic nerve where the nerve cells die usually due to high intraocular pressure

A

Glaucoma

230
Q

What is an inflammatory process involving both choroid and the retina

A

Chorioretintitis

231
Q

What is disruption of normal progression of retinal vascular development in preterm infant

A

Retinopathy of prematurity

232
Q

What is it when part of the retina degenerates

A

Macular degeneration

GM Phys Di (3 decks)

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