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AV2 > WEEK 1: Entrance Testing > Flashcards

WEEK 1: Entrance Testing Flashcards

1
Q

<p>What do you need to cover in the patient history?</p>

A

<p>Chief Complaint, Px Ocular History, Patient Medical History, Family History, and conclude with a summary to confirm your understanding</p>

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2
Q

<p>What is acute angle closure glaucoma (ACG)?</p>

A

<p>ACG occurs when the canals are completely blocked causing the IOP to rise quickly. Its an opthalmic emergency if it in conjunction with a headaches</p>

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3
Q

<p>What is the treatment for ACG?</p>

A

<p>Treatment: topical and systemic IOP lowering medications. Primary ACG may require peripheral iridotomies if unresponsive to medical treatment or for prophylaxis.</p>

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4
Q

<p>List the 8 Headache Red flags</p>

A

<p>1. Thunderclap H/A - intense, exploding and hyperacute onset
<br></br> 2. New onset headaches in patients older than 50 or less than 10 years of age

<br></br> 4. New onset H/A in px with a history of cancer
<br></br> 5. New onset H/A in px with a history of HIV infection
Persistent Morning H/A - intense, exploding and hyperacute onset
<br></br> 6. Progressive headache, worsening over weeks
<br></br> 7. Headaches associated with postural changes
<br></br> 8. Aura symptoms that
<br></br> - Last longer than on hour
<br></br> - Include motor weakness
<br></br> - Are different from previous aura
<br></br>Occur for the first time on using oral contraceptive pill</p>

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5
Q

What is the Ishihara Test used for?

A

This is the colour vision test. The first 24 plates are used to differentiate trichromats from monochromats. Used to defects in protans and deutans

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6
Q

What is a common error when testing stereopsis?

A

Allowing patient to tilt head/move closer/point finger

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7
Q

What are you testing for when measuring stereoacuity?

A

Minute intraocular disparity translates into depth.
Causes of reduced stereoacuity: amblyopia, strabismus, high refractive error

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8
Q

What is the normal range for stereoacuity?

A

Normal stereoacuity = 40-60 seconds arc, depending on the test. Wirt circles - 40’’ (some individuals can see up to 70’’ just using monocular cues)

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9
Q

What are some common errors when test Paracentral Confrontation VF testing?

A
  1. Cluttered background
    1. Insufficient occlusion of the eye not being tested
  2. Moving the target too fast
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10
Q

What are you testing when doing Paracentral Confrontation VF testing?

A

Test quadrants comparing the inferior vs superior nasal and temporal fields. Test quadrants comparing the nasal vs temporal superior and inferior fields

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11
Q

What is the purpose of testing Confrontational VF?

A

Gross screening of visual field. May attempt to screen for: (i) Restriction of VF, (ii) Symmetry in hemi-fields (iii) Presence of large scotomas. - Difference along the vertical meridian (nasal vs temporal VF):may indicate neurological disease
Difference along the horizontal meridian (superior vs inferior VF): may disease affecting retinal nerve fibre bundles asymmetrically.

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12
Q

What are some common errors when testing pupil reactions?

A
  1. Room lights too dim to see reaction (tricky with dark irides!)
    1. Swinging the light too fast/slow during RAPD assessment
    2. Blocking the patients view of the fixation target
  2. Forgetting to test pupil reactions prior to dilation
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13
Q

What do abnormal direct and consensual pupil reflexes indicate?

A

Pupil showing abnormal direct response with normal consensual response indicates an afferent pupil-pathway defect

Pupil showing abnormal direct and consensual response indicates efferent pupil-pathway defect. Normal response times: 1 second for initial constriction, 5 seconds for dilation, symmetry between eyes

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14
Q

What are you testing for with the Swinging Flashlight test?

A

Detects unilateral or asymmetric afferent defects (impaired direct response in one eye when compared to the other). Normal response times: 1 second for initial constriction, 5 seconds for dilation, symmetry between eyes

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15
Q

What is normal pupil sizes?

A

Normal pupils size: bright light 3 - 6mm, dim light 4 - 8mm. Normal size reduces with age

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16
Q

What are common error when testing Near Point of Convergence (NPC)?

A
  1. Relying on subject report
    1. Only measuring once
    2. Moving too fast (inaccurate) or too slow (boring for children)
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17
Q

What is the purpose of NPC and the expected results?

A

Measure the closest point px can maintain binocular single vision
- A remote near point of convergence indicates convergence insufficiency (>7cm)
- Normal expected values:
- Break: 3 +/- 4 cm
Recovery: 5 +/- cm

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18
Q

Describe the two testing methods for Amplitude of Accommodation

A

Push up Method
1. Ask the patient to advise you when the letters/target first become blurry
2. Move the target (not too quickly) towards the px
3. Measure the distance at which px indicate blur

Pull away method
1. Ask px to read out the letter as soon as they can identify it
2. Start with the target close to px, slowly move it away from px
3. Measure distance px identified letter correctly

19
Q

What is the purpose of the Amplitude of Accommodation?

A

Purpose: Measure how much accommodation px can generate (monocular and binocular)

Binocular Aa should be 1.00D to 2.00 D greater than monocular values
and generates convergence-induced accommodation

20
Q

What are normal values for Aamp? What can Aamp be indicative off?

A

Age Expected Norms: 18 - (1/3 Age) +/- 2, (Average +/- 2SD) push up method
Pull away method tends to produce lower Aa

Where monocular - binocular Aa, indicates potential accommodative-convergence issues

21
Q

What is the purpose of the Broad H test?

A

Purpose: Check for palsy/under - action/paresis of the EOM
- Broad H pattern used to tracking movement to the 6 diagnostic positions of gaze
- “SRIO - IRSO” indicate which EOMs are involved at specific positions of gaze

22
Q

What are some common errors when performing the cover test?

A
  1. Not being close enough to visualise eye movement
    1. Blocking the patients view of the target
    2. Not covering the eye for long enough
    3. Inappropriate target selection
23
Q

What defects can be found with the lalternating cover test?

A
  • Categorisation of Esophoria vs Exophoria is based on the position the eyes take whilst under cover
  • Observing the movement upon uncovering an eye, we can infer the position the eye took whilst it was under cover.
  • Ortho = eye is directed straight at the target
  • ESO = the eye is turned inward relative to ortho; EXO = the eye is turned outward relative to ortho
    Hyper = the eye is turned upward relative to ortho; Hypo = the eye is turned downward relative to ortho
24
Q

The tip for identifying the type of phoria

A

Watch: The motion of the eye that has just been uncovered.

Think: what position the eye under the occlude had to be in, to cause this movement?
Position under cover
IN= esophoria (observe ‘against’ movement
OUT = exophoria (observe with movement

25
Q

What is the Purpose of the Cover - uncover test?

A

Identifies tropia from phoria, exotropia from esotropia, presence in RE, LE or alternaing, hypertropia from hypotropia

26
Q

What is the purpose of the alternating cover test?

A

○ Identifies esophoria from exophoria
○ Presence of moderate - large vertical phoria
Use of a prism bar with the alternating cover test can assist with measuring the magnitude of the deviation (alternating prism bar cover test)

27
Q

What is the purpose of all cover testing?

A

Purpose:
1. Detect presence of strabismus (excluding microtropia)
2. Estimate magnitude of tropia/phoria (small/moderate/large)
3. Evaluate commitancy (performance in diagnostic positions of gaze)
a. Commitancy - deviation the same in all positions of gaze
Incommitancy - deviation different (smaller/larger) in certain positions of gaze e.g. A- or V- pattern deviations

28
Q

What is the expected acuity for all ages?

A

< 42 months - 6/7.5
>42 months - 65 year - 6/6+
65 - 74years - 6/6 -

29
Q

What are some common facts about migraines

A
  • Migraine: Has with nausea, photophobia, phonophobia, physical activity exacerbates migraine HA
    • Migraines can be categorised by POUND
      • Pulsatile quality
      • One day duration (4 - 72 hr)
      • Unilateral location
      • Nausea/vomiting
        Disabling intensity
30
Q

What questions should you ask to identify ocular emergencies.

A

Flashes/Floaters, Headaches and migraines

31
Q

What does FOLDARQ stand for?

A

Frequency
Onset
Location
Duration
Associated signs and symptoms
Relieving factors
Quality of sensation

32
Q

What is the expected DVA and NVA for a low myope?

A

Reduced distance and normal near

33
Q

What is the expected DVA and NVA for a mod-high myope?

A

Poor distance, normal/reduced near

34
Q

What is the expected DVA and NVA for a low hyperope?

A

Normal distance, normal /reduced near

35
Q

What is the expected DVA and NVA for a mod-high hyperope?

A

Normal/reduced distance, normal/poor near

36
Q

What is the expected DVA and NVA for mod-high astigmatism ?

A

Reduce distance and near

37
Q

What is the expected DVA and NVA for a low myope? With presbyopia

A

Reduced distance, normal/reduce near

38
Q

What is the expected DVA and NVA for a mod-high myope? With presbyopia

A

Poor distance, reduced near

39
Q

What is the expected DVA and NVA for a low hyperope? With presbyopia

A

Reduced distance and poor near

40
Q

What is the expected DVA and NVA for a mod - high myope? With presbyopia

A

Reduced/poor distance and poor near

41
Q

What is the expected DVA and NVA for a mod-high hyperope? With presbyopia

A

Reduced - poor distance and poor near

42
Q

What is the expected VA distance and near for a low hyperope? For presbyope

A

Reduced distance and poor near

43
Q

What is the expected VA distance and near for a mod to high astigmatism ? For presbyope

A

Reduced distance and reduced to poor near

44
Q

What is pounds

A

Pulsation
One day duration
Unilateral
Nausea
Disabling

AV2 (6 decks)

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