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clinical med exam 2 > vision loss > Flashcards

vision loss Flashcards

1
Q

myopia vs hyperopia

A

myopia: nearsighted; hyperopia: farsighted

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2
Q

amblyopia

A

lazy eye

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3
Q

painful vision loss is associated with what condition

A

glaucoma

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4
Q

what is the first thing you should do when starting a physical exam of the eyes

A

visual acuity

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5
Q

the complete eye exam: 8 steps

A
  1. visual acuity
  2. confrontational visual fields
  3. pupils
  4. extraocular movements
  5. external (ptosis)
  6. tonometry
  7. slit lamp (pen light) exam
  8. dilated fundus exam
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6
Q

how do you perform confrontational visual field testing

A

brings a test object from a non-seeing area (such as behind the head) into the field of vision. You will be asked to focus your eyes on a central point—such as the examiner’s nose ,and tell the examiner when you first see the object enter your visual field

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7
Q

how do you check for afferent and efferent pathways of eyes

A

afferent: pupil reactivity
efferent: equal pupil size

  • if you shine the pen light in eye A and nothing happens to eye A; shine the light in eye B to check for consensual constriction. If there is consensual constriction, then the efferent pathway is functional
  • Now shine the light in eye A again and check for consensual constriction. If there is none; the afferent pathway is the problem
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8
Q

what does a relative afferent pupillary defect (RAPD) detect

A

A positive RAPD means there are differences between the two eyes in the afferent pathway due to retinal or optic nerve disease.

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9
Q

how can you test for a relative afferent pupillary defect (RAPD) detect

A

swinging flashlight test

  • In a normal swinging light test (i.e. there is no RAPD) the pupils of both eyes constrict equally regardless of which eye is stimulated by the light. In an abnormal swinging-light test (i.e. there is a RAPD) there is less pupil constriction in the eye with the retinal or optic nerve disease
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10
Q

where does the macula sit in relation to the optic disc

A

temporally

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11
Q

in a dilated fundus exam, what are you looking for

A
  1. nerve (disc edema/pallor; cupping)
  2. macula (heme, exudate; cotton wool spots)
  3. Vessels
  4. periphery (retinal detachement)
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12
Q

what dilating drops can you use for a dilated fundus exam. Name in order of increasing duration of action

A
  1. phenylephrine
  2. tropicamide
  3. cyclopentolate
  4. atropine
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13
Q

what are cataracts

A

any opacity of the crystalline lens

  • age-related
  • congential/traumatic
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14
Q

clinical presentation

  • gradual, chronic, painless loss of vision
  • glare, especially at night
  • PE: decreased visual acuity; yellowing/opalescent changes to the lens
A

Cataracts

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15
Q

management of cataracts

A

ophthalmology referral: if lifestyle is affected

  • glasses
  • surgery (phacoemulsification)
  • prognosis: excellent
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16
Q

what are the 3 primary components of Glaucoma

A
  1. intraocular pressure increase
  2. optic nerve damage
  3. visual field loss
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17
Q

what are the 2 primary subtypes of glaucoma

A
  1. acute angle closure glaucome (emergency)
  2. primary open angle glaucoma
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18
Q

cause of open angle glaucoma

A

decreased aqueous outflow resulting in increased intraocular pressure

19
Q

clinical presentation

  • early symptoms: asymptomatic
  • late: chronic, painless vision loss
    • peripheral first
    • central late
  • PE: increased cup/disc ratio; visual field loss
A

Glaucoma open angle

20
Q

management of glaucoma

A
  1. ophthalmology referral
  • topical anti-ocular hypertensives
  • laser trabeculoplasty
21
Q

what is retinal detachment (RD)

A

seperation of the retinal layer from the underlying choroidal (vascular layer)

22
Q

name the two types of retinal detachment (RD) and the diseases they are associated with

A
  • Rhegmatogenous RD: myopia
  • Tractional RD: Diabetes
23
Q

clinical presentation

  • floaters
  • Photopsias (light flashes)
  • Loss of vision
    • progressive scotoma
    • curtain-like
  • PE:
    • +/- decreased vision
      • may be peripheral only
    • raised, whitish retina
    • posterior vitreous detachement
A

retinal detachment

24
Q

treatment for retinal detachment (RD)

A
  1. ophthalmology referral
  2. Medical: laser retinopexy; air bubble tamponade
  3. Surgical: vitrectomy

* prognosis: variable

25
Q

what is macular degeneration

A

degeneration of photoreceptors and their supporting structures

  • # 1 cause of legal blindness in western world
26
Q

Clinical presentation

  • gradual or acute blurred vision
  • Metamorphopsia (wavy, distorted vision)
  • Central Scotoma (blind spot)
  • PE: +/- decreased vision; Amsler grid distortion
A

age-related macular degeneration (ARMD)

27
Q

distinguish between dry ARMD and wet ARMD

A
  • Dry
    • happens first
    • Drusen, pigment mottling
    • geographic atrophy
  • Wet
    • subretinal fluid, blood, new vessels
28
Q

management of age-related macular degeneration (ARMD)

A
  1. ophthalmology referral
  • vitamins (antioxidants/zinc)/omega 3 FA
  • stop smoking
  • daily amsler grid
  • intravitreal steroid

**prognosis: variable

29
Q

what is the difference between central retinal artery occlusion and central retinal vein occlusion

A

central retinal artery occlusion: embolic

central retinal vein occlusion: thrombotic

30
Q

clinical presentation

  • acute, total, painless loss of vision “black as night”
  • PE: “no light perception,” afferent pupillary defect, whitening of retina, “cherry red spot”
A

central retinal artery occlusion

31
Q

clinical presentation

  • acute, variable, painless loss of vision
  • PE: variable vision; +/- afferent pupillary defect; “blood and thunder” retinal appearence
A

central retinal vein occlusion

32
Q

treatment and prognosis of central retinal artery occlusion and central retinal vein occlusion

A

both: refer to ophthalmology

  • CRAO: poor
  • CRVO: variable
33
Q

clinical presentation

  • asymptomatic
  • PE: systemic HTN; characteristic fundus findings
A

hypertensive retinopathy

34
Q

Give Keith-Wagener-Barker classification of hypertensive retinopathy for Group 1

A
  • arteriolar narrowing
    • “copper wiring”
  • arteriolar sclerosis
    • silver wiring
35
Q

Give Keith-Wagener-Barker classification of hypertensive retinopathy for Group 2

A

(group 1, plus)

  • arteriolar narrowing
    • “copper wiring”
  • arteriolar sclerosis
    • silver wiring
  • A:V crossing changes
    • A:V nicking
36
Q

Give Keith-Wagener-Barker classification of hypertensive retinopathy for Group 3

A

(Group 2, plus)

  • cotton wool spots
  • retinal hemorrhages
  • retinal edema/edudation
    • macular star
37
Q

Give Keith-Wagener-Barker classification of hypertensive retinopathy for Group 4

A

(group 3, plus)

  • disc edema
38
Q

managment for hypertensive retinopathy

A
  • systemic blood pressure control
  • ophthalmology referral if associated with vision loss
39
Q

what is the #1 cause of blindness in western world in patients less than 50 yo

A

diabetic retinopathy

40
Q

name the 2 basic components of diabetic retinopathy

A
  1. non-proliferative/proliferative diabetic retinopathy: progressive retinal ischemia
  2. diabetic macular edema: increased vascular permeability
41
Q

What do non-proliferative and proliferative diabetic retinopathy have in common? What differentiates them?

A
  • Both
    • microaneurysm
    • dot-blot hemorrhages
    • cotton wool spots
    • venous bleeding
  • Proliferative diabetic retinopathy only
    • neovascularization
42
Q

what fundoscopic findings indicate macular edema often seen diabetic retinopathy

A
  1. graying/slight opacification
  2. microaneurysm
  3. hard exudate
43
Q

treatment for diabetic retinopathy

A
  1. blood sugar control
  2. ophthalmology referral

clinical med exam 2 (6 decks)

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