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PDX II Test 1
Test 1
189
Anatomy
Graduate
02/06/2012

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Cards

Term
What are the objectives for developing and maintaining bionocular vision?
Definition
Foveal centration and lens accommodation. To be able to fix the fovea centralis in each eye on the same target.
Term
The Fovea centralis si about how big?
Definition
1.5 mm in diameter.
Term
What are the first things required to develop dinocular vision?
Definition
Learning to use EOMs and ciliary muscles.
Term
Yoked eye movement and yoked vergence movements present by what age?
Definition
yoked/ conjugate eye movments by about 4 months. Yoked vergence by about 6 months.
Term
What is the bilateral lens accomodation needed for?
Definition
Near vision.
Term
What is the primary processing center for visual info in the brain?
Definition
Lateral geniculate nuclei in the thalamus.
Term
How is binocular vision established with cortical mapping?
Definition
These pathways are activity-driven sorting process.
Term
Complete / total deprivation of vision from one eye early in life will cause what to happen?
Definition
It prevents side-to-side balance from developing and the non-deprived eye will assume control of nearly all cortical cells.
Term
What is emmetropia and amblyopia?
Definition
Emmetropia- perfect vision. Amblyopia- Lazy eye.
Term
What is important in developing depth perception?
Definition
Normal retinal correspondence (NRC).
Term
Convergence insufficiency can cause what?
Definition
Eyestrain headaches.
Term
What is convergence insufficiency?
Definition
Inability to maintain binocular alignment on near objects.
Term
When will Convergence insufficency be uncommon?
Definition
In children under 10. More common in adolescents and young adults.
Term
Convergence insufficiency is associated with what?
Definition
Prolonged periods of reading and computer use.
Term
What happens with convergence insufficiency?
Definition
One eye usually deviates outward during convergence on a near object.
Term
Besides eyestrain headaches what can convergence insufficiency cause?
Definition
Blurred vision for near objects, diplopia (double vision).
Term
What is a treatment for convergence insufficiency?
Definition
Lifestyle changes.
Term
What is a potential problem with convergence insufficiency?
Definition
The patient may be asymptomatic and may learn to suppress vision from the eye that deviates during near vision.
Term
What % of children experience some type of vision problems?
Definition
5-10%.
Term
What % of children with vision problems show eye misalignment?
Definition
1-4%.
Term
Of the children with eye misalignment problems what % will develop amblyopia?
Definition
40%.
Term
What is the big question to ask when children have convergence insufficiency?
Definition
Is the misalignment constant, intermittent, or alternating.
Term
What is Amblyopia and what is anisometropia?
Definition
Amblyopia- Lay eye. Anisometropia- Not in the same measure of light the 2 eyes have an unequal refractive power/ unequality.
Term
What type of vision are infants born with?
Definition
Farsightedness.
Term
Amblyopia most often manifests when?
Definition
Between 6 months - 2 years.
Term
Amblyopia will most often be uni or bi lateral?
Definition
Unilateral.
Term
What is the leading cause of monocular vision loss in those 20-70?
Definition
Amblyopia.
Term
What is the likely outcome of constant, intermittent or alternating deviations?
Definition
Constant- amblyopia/ vision loss. Intermittent or alternating- less likely to result in amblyopia.
Term
Most of the factors that lead to amblyopia involve what?
Definition
Suppression of vision usually in one eye.
Term
What is strabismus?
Definition
Latin for squinting, but is a generic term used for eyes that are not properly alligned with each other, and will not describe the circumstance under which the deviation occurs.
Term
What is Phoria?
Definition
Latin for bearing, but is refering to a latent(it is there, but cant really be tell that it is there) deviation that occurs only when one eye is covered.
Term
Phoria is common in who?
Definition
Children under 5 years of age.
Term
What is tropia?
Definition
Latin for turning, but refers to a manifest(well seen) deviation that occurs when both eyes are open and uncovered.
Term
What type of tropias will and will not result in amblyopia?
Definition
Constant- are more likely. Intermittent and alternating are less likely.
Term
How is the screening for phoria done?
Definition
Cover-uncover test.
Term
What will surgery for eye deviation be like?
Definition
Sometimes takes about 3 surgeries to fix.
Term
What can prolonged or unsupervised patching cause?
Definition
Amblyopia.
Term
What are the most common types of deviations?
Definition
Medial.
Term
Medial deviations are aka?
Definition
Esotropias.
Term
Esodeviations account for what % of ocular deviations?
Definition
50%.
Term
After medial (esotropias) what are the second most common eye deviations and they are aka?
Definition
Lateral deviations aka exotropias.
Term
Exodeviations are often ____.
Definition
Hereditary.
Term
Constant exodeviation could be caused by what?
Definition
CN III damage.
Term
Vertical eye deviations are often accompanied by what?
Definition
Characterisitic head tilt.
Term
Vertical eye deviations are associated with what (besides characterisitic head tilt)?
Definition
CN IV paresis.
Term
What % of males and females will have vision problems after whiplash accidents?
Definition
males- 11.5%. Females- 13%.
Term
What % of males and females will have dizziness/ unsteadiness after whiplash accidents?
Definition
males- 41.4%. Females- 48.3%.
Term
What is the test done for visual acuity?
Definition
Snellen chart.
Term
What is the snellen chart test of visual acuity like?
Definition
A rough estimate.
Term
What is the easiest and hardest letters to read on the snellen chart?
Definition
Easiset is L and hardest is B.
Term
How is visual acuity determined from a snellen chart test?
Definition
The smallest line on which the patient can distinguish more than one-half the letters is the visual acuity.
Term
What is legal blindness?
Definition
A distant vision of 20/200 or less in the better eye when the best possible correction has been applied and or a visual field that subtends an angle of less than 20 degrees.
Term
Why is the near visual acuity not routinely assessed in a screening exam?
Definition
This exam is notoriously imprecise.
Term
What is presbyopia?
Definition
Old vision. Age-related loss of elasticity in the lense that leads to a far-sightedness for near vision.
Term
Presbyopia is an inability to _____?
Definition
Accommodate and leads to far-sightedness for near vision.
Term
What % of refraction occurs in the cornea and what % happens in the lens?
Definition
80% in the cornea. 20% in the lens.
Term
How common is true emmetropia?
Definition
rare.
Term
What is myopia and yperopia?
Definition
Myopia- near-sightedness. Hyperopia- far-sightedness.
Term
What is the difference of refractive myopia and axial myopia?
Definition
Refractive- lense is too great. Axial- eyeball is too long.
Term
What is the difference of refractive and axial hyperopia?
Definition
Refractive- lense is insufficient. Axial- eyeball is too short.
Term
What type of error is more common refractive or axial?
Definition
Refractive.
Term
Axial errors are more likely to have what?
Definition
Complications.
Term
What is astigmatism?
Definition
Unequal refraction in different meridians of the eyeball that cause difficulties in seeing fine detail.
Term
Astigmatisms affect what % of people?
Definition
1 in 3 people.
Term
What is more common a regular or irregular astigmatism?
Definition
Regular is much more common.
Term
What should be done when testing peripheral vision with the confrontation method?
Definition
Make eye contact with patient.
Term
What is the difference between negative and positive defects?
Definition
Negative- objective blind spots so patient sees nothing. Positive- perceived blind spots so patient sees flashes of light.
Term
What is a hemianopia and a quadrantinopia?
Definition
Hemianopia- blindness in one half of the visual field of noe or both eyes. Quadrantinopia- Blindness in one quarter on the visual field of one or both eyes.
Term
A lesion to the midline optic chiasm will cause what type of problem with vision?
Definition
Bitemporal hemianopia this leads to a loss of peripheral vision since it is bilateral.
Term
A bitemporal hemianopia is commonly caused by what?
Definition
Pituitary tumor.
Term
A lesion to the right optic radiation will cause what type of problem with vision?
Definition
Left homonymous hemianopia. Which will be a loss of vision in the left visual field in both eyes.
Term
A lesion in the optic radiation is commonly caused by what?
Definition
Vertebrobasilar artery insufficiency.
Term
When might a patient not be awar that they have a homonymous hemianopia caused by a lesion to the optic radiation?
Definition
If macular vision is preserved.
Term
What is a scotoma, scotomata?
Definition
scotoma- blind island. Scotomata- blind islands.
Term
Scatomas can by what type of visual problems?
Definition
Positive or negative.
Term
What is the cause of floaters in the vision?
Definition
Vitreous substance between the lense and retina can become detached and this is called posterior virteous detachment PVD.
Term
When should floaters be taken very serious?
Definition
Sudden shower of floaters, new light flashes, a veil or curtain obstructing your vision should be refered to the ER.
Term
Sudden showers of floaters is a warning of what?
Definition
Retinal detachment and this is one of the 3 most time sensitive opthalmic emergincies.
Term
What are the first components of the eye exam?
Definition
PERRLA. P-pupils, E-equal size, R-round, R-reactive to, L-light, A-accomidates to near vision.
Term
What is the second component of the eye exam?
Definition
Corneal reflection test. Assesses the alignemtn of the eyes in the neutral position.
Term
What is the third component of the eye exam?
Definition
Cardinal field of gaze. This is done in neutral position and in conjugate pursuit movements of paired EOMS.
Term
What is EOMs?
Definition
Exraocular muscle movements.
Term
What is Ptosis?
Definition
Drooping of the upper eyelid.
Term
With ptosis what is the question that should be asked?
Definition
Is it of new onset or an existing problem.
Term
What are the 2 general types of ptosis?
Definition
Congenital and acquired.
Term
What are the 2 causes of congenital ptosis and which one is most common?
Definition
1. Localiezed myogenic dysgenesis and this is the most common. 2. Congenital horners syndrome or congential CN III palsy.
Term
Wich cause of congenital ptosis will there be abnormalities in pupil size?
Definition
Just congenital horners syndrome or congenitla CN III palsy.
Term
What are the 3 causes of acquired ptosis?
Definition
1. Acquired aponeurotic ptosis- from aging, surgery or inflammation. 2. acquired horners syndrome or acquired CN III palsy. 3. Acquired myogenic ptosis.
Term
Of the causes of acquired ptosis which one(s) will cause abnormal pupils?
Definition
Just horners and CN III palsy.
Term
What should be done with lumps on the eye lid?
Definition
squeexing them is ill-advised.
Term
What is acquired myogenic ptosis?
Definition
acquired weakness of the superior rectus and or medial rectus muscles with concurrent weakness of the levator palpebrae supeioris is common.
Term
What are 2 ways to say abnormalites in the shape of the pupil?
Definition
Pupillary dyscoria, coloboma.
Term
What is synechia?
Definition
Adhesion of the iris to the cornea or the lense.
Term
Synechia are uncommon complications of what?
Definition
Acute iritis.
Term
Acute iritis is often confused with what?
Definition
Conjunctivitis aka pink eye.
Term
What is anisocoria?
Definition
an inequality in pupil size.
Term
How common is anisocoria?
Definition
seen in up to 20% of the population.
Term
What is the pupilary refelx like with anisocoria?
Definition
It is intact.
Term
What drugs are used to dialate the pupils?
Definition
Mydriatic agents.
Term
What is adie's tonic pupil/ adies pupillotonia?
Definition
Sluggish and delayed reactions of the pupil.
Term
What is associated with argyll robertson pupil?
Definition
Tabes dorsalis, and syphilis.
Term
If there is a picture on the midterm of eyes with different pupil sizes which one will be the affected or problem pupil the large or small one?
Definition
The one that is bloodshot.
Term
What is acute iritis?
Definition
A painful, aching, bloodshot eye and small pupil.
Term
What is acute glaucoma?
Definition
a very painful, bloodshot eye and a large pupil.
Term
Which condition is a true medical emergency acute iritis or acute glaucoma?
Definition
Acute glaucoma.
Term
What is the key difference between conjunctivitis vs. acute iritis/ glaucoma?
Definition
pink eye is not an intra-ocular inflammation and does not change pupil size or shape.
Term
Do you need good vision to have a direct and a consensual pupil response to light?
Definition
No you can even be blind and have both direct and consensual pupil responses to light.
Term
What is hippus?
Definition
Normal variant in the pupillary reaction to light.
Term
What is miosis of the eye?
Definition
Excessive constrictino of the pupil. This is abnormal when the pupil will not dilate in the dark.
Term
What is mydriasis?
Definition
Excessive dilation of the pupil. This is abnormal when the pupil will not constrict in bright light.
Term
What is the second step in an eye exam after PERRLA?
Definition
Assessing ocular alignment in the primary (neutral position).
Term
How is the assessment of ocular alignment in a neutral position done?
Definition
Have patient stare at an object and look for the corenal reflection.
Term
Will the corneal reflex test determine if there is a phoria?
Definition
No. A phoria is an eye deviation that occurs only when one eye is closed or covered.
Term
What % of population will have some degree of eye deviation?
Definition
1-4%.
Term
What is the third step in the eye exam (after PERRLA and ocular alignment)?
Definition
Cardinal field of gaze.
Term
What is concomitant strabismus? AKA?
Definition
Abnormal cardinal gaze, A noticeable deviation of the eye. AKA non-parylitic strabismus.
Term
Will concomitant strabismus involve muscle weakness?
Definition
No.
Term
What 3 things will a concomitnat strabismus imply?
Definition
abnormal origin or insertion of a muscle. Abnormallity in muscle length. Abnormallity associated amblyopia.
Term
What is non-concomitant strabismus?
Definition
Abnormla cardinal gaze with paralysis and or restrictions to movement of the extra-ocular muscles.
Term
When will the worst deviation and double vision occur with extraocular muscle palsy?
Definition
When the patient looks in the direction of the weak muscle.
Term
What will it suggest when the patient looks in the direction of a weak muscle with extraocular muscle palsy?
Definition
Lesion of the cranial nerve nucleus, the cranial nerve, the neuromuscular junction, or the muscle itself.
Term
CN III palsy is aka?
Definition
Oculomotor palsy.
Term
CN IV palsy is aka?
Definition
trochlear palsy.
Term
CN VI palsy is aka?
Definition
Abducens palsy.
Term
Kera refers to what?
Definition
Cornea.
Term
What is ectropion and endtropion?
Definition
Ectropion- eversion of the eyelid margin. Endtropion- inversion of the eyelid margin.
Term
How will ectropion happen?
Definition
Acquired- age related or paralytic like bells palsy
Term
What are the complications of ectropion?
Definition
inadequate tear drainage which leads to excessive tearing.
Term
Bleph means what?
Definition
eye lid.
Term
What are the 2 types of blepharitis?
Definition
Anterior- an inflammation around the eyelashes and follicles. Posterior- involves the meibomian gland.
Term
Posterior blepharitis is aka?
Definition
Internal hordeolum.
Term
Hordeolums will be what?
Definition
H for hurt or painful.
Term
What is an external hordeolum?
Definition
A stye, a painful inflammation of an eyelash follice.
Term
What are external hordeolums like?
Definition
Painful self-limiting, usually don’t result in problems, recurrences are common.
Term
What is an internal hordeolum?
Definition
A painful meibomian gland.
Term
What are the internal hordeolums like?
Definition
self limiting, can result in compliations and recurrences are common.
Term
What is a chalzaion?
Definition
Painless retention cysts associated with the meibomian gland.
Term
What should be considered with a recurrent chalazia?
Definition
sebaceous carcinoma, squamous cell carcinoma, microcystic adnexal carcinoma or TB.
Term
What is xantheisma?
Definition
Subcutaneous lipid deposition and it is the most common cutaneous xanthoma.
Term
What is the possible correlation with xanthelasma's?
Definition
elevated plasma lipid levels in 50% of people.
Term
Dacryo refers to what?
Definition
Lacrimal.
Term
What is dacryoadenitis?
Definition
Painful inflammation and swelling of the lacrimal gland.
Term
What is keratoconjunctivitis sicca and what is it aka?
Definition
aka KS and it is dry eyes due to insufficient tear production.
Term
What is sjogren syndrome?
Definition
Dry mouth dry eye.
Term
What is dacryocystitis?
Definition
Infection of the lacrimal sac.
Term
Where is the palpebral conjunctiva?
Definition
It lines the inner surface of the eyelids.
Term
Where is the conjunctiva at?
Definition
The transparent modified mucous membrane of the eye.
Term
What is the cornea?
Definition
A transparent multi-layered avascular structure of the eye.
Term
What will provide 85% of the refractive power of the eye?
Definition
The cornea.
Term
What is the pain like for the conjunctiva and the cornea?
Definition
Conjunctiva- much less pain-sensitive than the cornea- which is VERY pain sensitive.
Term
What is found in the iridocorneal angle?
Definition
The canal of schlemm.
Term
What is the normal intra-ocular pressure?
Definition
14-20 mmHg.
Term
What is pinguecula and pterygium?
Definition
Pinguecula- elevated, benign, yellow fibrovascular connective tissue mass. Pterygium- a benign, fleshy wing like fibrovascular connective tissue growth.
Term
Injection means what?
Definition
Bloodshot eyes.
Term
What is worse conjunctiva injection or ciliary injection?
Definition
Conjunctiva not so bad, but ciliary is bad.
Term
What are the general signs and symptoms of conjunctivitis?
Definition
red eye, discomfort, discharge, not overtly painful, not photophobic, vision unchanged, pupillary reactions are normal.
Term
What is the most important clinical feature of acute allergic conjunctivitis?
Definition
Ocular itching.
Term
What else is possible with acute allergic conjunctivitis?
Definition
Lymphoid follicular response.
Term
What is a lymphoid follicular response?
Definition
Bumbs of lymphoid tissue aggregate in the palpebral conjunctiva giving it a cobblestone appearance.
Term
Pink eye is aka?
Definition
Adenoviral conjunctivitis.
Term
Adenoviral conjunctivitis is the most common cause of what?
Definition
Viral conjunctivitis.
Term
What is pink eye like?
Definition
sudden onset and can last 2-4 weeks with redness, mild itching, tearing, chemosis, and pseudomembranous.
Term
What is the clinical concern with adenoviral conjunctiva?
Definition
differentiating it from conjunctivitis due to herpes simplex infection.
Term
What are the common pathogens that cause acute bacterial conjunctivitis?
Definition
Staphylococcus pneumoniae and haemophilus influenza.
Term
What is the stronges perdictor that one might have an acute bacterial conjunctivitis?
Definition
Awakening with one or both eyes glued shut. Also a mucopurulent discharge that crusts on eyelashes.
Term
What is the clinical concern with acute bacterial conjunctivitis?
Definition
The concern would be if the infection was caused by bacteria that is very aggressive to the conjunctivia like N. Gonorrhoeae or chlamydia.
Term
What are signs of corneal diseases?
Definition
Localized pain, photophobia, reduced visual acutiy, lacrimation, blepharospasm (spasm of the eyelids), iridescent vision, and ciliary injection.
Term
What is the most important (for the test) sign of corneal disease and what is it?
Definition
Iridescent vision. Breaking down of halo into light specturms.
Term
How will adenovirus, herpes simplex, and chlamydia affect the cornea?
Definition
Adenovirus- rarely results in complications. Herpes and chlamydia often result in complications.
Term
Adenviral keratoconjunctivitis manifests how?
Definition
minimal pain, some photophobia, pre-auricular lymphadenopathy, lymphoid follicular response.
Term
What type of herpes simplex virus affects the ocular area?
Definition
HSV-1. HSV-1 is genital infection.
Term
What are the important patient presentations with HSV-1?
Definition
Vesicular eruptions on eyelids or face (like chicken pox), Photophobia, blurred vision.
Term
What is the most common cause of blindness in the USA and the world?
Definition
USA- HSV-1 keratitis. World- Chlamydial keratitis.
Term
Why is chlamydial keratitis the most common cause of blindness in the world?
Definition
Poor sanittation and poor public heatlth.
Term
What type of medical emergency will chlamydial keratitis be?
Definition
A ophthalmologic emergency since the cornea may rapidly lead to perforation of the cornea.
Term
What is Episcleritis?
Definition
Inflammation of the Episcleral tissue found between the conjunctiva and the sclera.
Term
What is scleritis?
Definition
Diffuse or localized inflammation of the anterior sclera with necrosis.
Term
What is a common cause of scleritis?
Definition
48% are associated with autoimmune disorders.
Term
What is scleritis like?
Definition
Almost always painful.
Term
What is anterior uveitis?
Definition
Inflammation of the anterior chamber.
Term
What are the classic indications of anterior uveitis?
Definition
Direct eye pain, redness, small pupil that reacts poorly to light.
Term
What type of medical emergency is anterior uveitis?
Definition
A true medical urgency not a true medical emergency.
Term
What is angle-closure glaucoma like?
Definition
a less common type of glaucoma and is usually unilateral and symptoms are present form onset of angle closure.
Term
What are the diagnostic critera for a angle-closure glaucoma?
Definition
at leaste 2 of these; ocular pain, intermittent blurring of vision with halos, nausea/vomiting. At leaste 3 of these; nonreactive pupil in mid-dilation, ciliary injection, corneal epithelial edema, intraocular pressure that is > 21 mm Hg, a shallow anterior chamber.
Term
What type of a medical emergency is acute angle-closure glaucoma?
Definition
A true medical emergency that can result in permanent vision loss in a matter of hours.
Term
What is a subconjunctival hemorrhage?
Definition
Rupture of conjunctival and or episcleral blood vessels, with bleeding inot the potential space between the conjunctiva and sclera.
Term
What causes a subconjunctival hemorrhage?
Definition
Trauma, may be idiopathic, may be due to coughing, vomiting, straining, etc.
Term
What happens to someone with subconjunctival hemorrhage?
Definition
Usually asymptomatic and resolves completely within 2 weeks.
Term
What is traumatic hyphema?
Definition
Accumulation of blood in the anterior chamber following trauma to the eye.
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