Physical Diagnosis I Exam/Quiz II

Brain

The eye is a direct embryological extension of what structure?

Meibomian glands

What provides oils to the tear film of the eye?

Tarsus

What provides a skeleton for the eyelid?

Palpebral

What part of the conjunctiva coats the inside of the eyelids?

Bulbar (ocular)

What part of the conjunctiva coats the outside of the eyelids?

Lacrimal gland-> Canaliculi-> Lacrimal sac-> Lacrimal Duct-> Nasal meatus

What is the pathway a tear follows beginning with the lacrimal gland?

True

T/F- The sclera and cornea are both avascular.

Ciliary body

What produces the aqueous humor of the eye, and contains muscles which control accommodation?

Choroid

What part of the eye is pigmented and richly vascular?

Hyperopic (<20/400)

Infants that are delivered at term have what type of visual acuity?

True

T/F- Peripheral vision is fully developed at birth, but central vision matures later.

6 months

Around what age will infants be able to differentiate colors?

4 years

What age will adult visual acuity be achieved?

Pregnant women

What population will have tears with an increased level of lysozyme, resulting in a greasy sensation?

Last half of pregnancy

When does intraocular pressure fall most notably?

45

What age will the lens become more rigid, and the ciliary muscle become weaker?

CN II (Optic N)

What cranial nerve is tested when testing visual acuity

False (Without glasses first)

When testing the visual acuity (snellen chart) of an individual with corrective lenses, if you test them with and without them, you should record the findings with the corrective lenses first.

False (smallest)

T/F- When testing visual acuity, have the patient start with the largest line they can read.

20/200

Vision that can not be corrected to better than ________ is considered legal blindness.

Pinhole test

What type of test may be used if the visual acuity was recorded at a fraction less than 20/20, to determine if the decrease was a refractive error?

Monocular

What type of diplopia is an optical problem?

Binocular

What type of diplopia is an alignment problem?

False

T/F- Color vision is almost always tested in a routine physical examination.

Red

What color testing may be helpful in determining subtle optic nerve disease, even when visual acuity is normal?

Hypothyroidism

If a patient's eyebrows do not extend beyond the temporal canthus, what may the patient have?

Xanthelasma

What are elevated plaques of cholesterol deposited in macrophages, most commonly in the nasal portion of the eye lids?

Hyperthyroidism

Fasciculations or tremors of a patient's eyelids may be a seen for what condition?

CN III (oculomotor N)

Ptosis may be caused by weakness of the elevator palpebrae superioris, or it may be caused by paresis of which cranial nerve?

Ectropion

When the lower lid is turned outward (away) from the eye, and may result in excessive tearing, it is called what?

Entropion

What condition will the lower lid be turned inward (toward) the eye, in which the eyelashes may cause corneal or conjunctival irritation?

Stye (hordeolum)

What is the acute suppurative inflammation of an eyelash follicle?

Lagophthalmos

What condition consists of the closed eyelids not completely covering the eye?

Pterygium

What is an abnormal growth of conjunctiva that extends over the cornea from the limbus, commonly on the nasal side?

Pterygium

People heavily exposed to ultraviolet light may develop what condition?

CN V (trigeminal N)

What cranial nerve contrals corneal sensitivity?

Arcus Senilis

What is the composition of lipids within the periphery of the cornea, often seen in individuals over 60 years of age?

Lipid disorder

If an arcus senilis is seen before age 40, what may be the cause?

Mydriasis

Pupillary dilation of more than 6mm and failure of the pupils to constrict with light is characteristic of what disorder?

Anisocoria

What is the inequality of pupil size?

Miosis

What is the constriction of pupils to less than 2 mm, and a failure to dilate when in the dark?

True

T/F- Acute uveitis is most commonly unilateral.

Senile hyaline plaque

What is characteristic of a dark, slate gray pigment just anterior to the insertion of the medial rectus on the sclera?

Right

If a patient's affected eye moves rapidly to the right and then slowly drifts leftward, the patient is said to have nystagmus in what direction?

Corneal light reflex

What exam is designed to test the balance of the extra ocular muscles?

Drusen bodies

What are small, discrete spots that are slightly more yellow than the retina, most commonly due to the aging process, and are a precursor for senile macular degeneration?

Amsler grid

What is used to evaluate a patient's central vision when drusen bodies are noted to be increasing in size or number?

Asian

Prominent epicanthal folds are an expected variant in infants of what descent?

Down syndrome

Aside from being a common variant in Asian infants, epicanthal folds can be suggestive of what condition?

Moderate

What grade of retinopathy will first show hemorrhage and cotton-wool spots?

False (should perform)

T/F- You should not perform a corneal light reflex test on infants because their eyes are too sensitive to intense light sources.

Hypertelorism

What is excessively wide spacing between the eyes, which may be associated with craniofacial defects?

Pseudostrabismus

What is the false appearance of strabismus, caused by a flattened nasal bridge or epicentral folds?

Congenital glaucoma

Enlarged corneas in an infant may be suggestive of what condition?

Brush field spots

What condition consists of white specks scattered in a linear pattern around the entire circumference of the iris, and strongly suggests down syndrome?

Graves disease

What is the most common cause of exophthalmos?

Episcleritis

What condition is inflammation of the superficial layers of the sclera anterior to the insertion of the rectus muscles?

Simple

What type of episcleritis often recurs at 1 to 3 month intervals, lasting 7-10 days?

Nodular

What type of episcleritis consists of prolonged attacks of inflammation that are typically painful?

Band kertopathy

What is the deposition of calcium in the superficial cornea, most commonly in patients with chronic corneal disease?

Corneal ulcer

What is a disruption of the corneal epithelium and stroma caused by rheumatologic disorder, often in patients who wear contacts?

Hypoparathyroidism

While central cataracts are generally due to aging, peripheral cataracts may occur in patients with what condition?

Nonproliferative (background) diabetic retinopathy

What type of diabetic retinopathy is characteristic of dot hemorrhages and the presence of hard and soft exudates, which may be caused by the infarction of the nerve layer?

Proliferative Diabetic retinopathy

What type of diabetic retinopathy is characteristic of neovascularization that grow out of the retina toward the vitreous humor, and hemorrhages?

Proliferative Diabetic retinopathy

What type of diabetic retinopathy may be controlled by laser therapy?

Lipemia retinalis

What is a creamy white appearance of the retinal vessels that occurs with excessively high serum triglyceride levels, and doesn't produce vision symptoms?

Retinitis pigmentosa

What condition is an autosomal recessive disorder in which the genetic defect cause cell death, predominantly in the rod photoreceptors?

Retinitis pigmentosa

What condition consists of peripheral bone spicule pigmentations in the advanced stage of this disease?

Glaucoma

What condition is a disease of the optic nerve which kills the nerve cells, usually due to excessive intraocular pressure?

Open angle

What type of glaucoma is caused by decreasing aqueous humor absorption?

Laser therapy

What is the most common cause of chorioretinitis?

Chorioretinitis

What condition may be seen in individuals with a history of histoplasmosis, cytomegalovirus, toxoplasmosis, or congenital rubella infections?

Bitemporal hemianopia

What visual field defect is caused by a lesion, most commonly a pituitary tumor, interrupting the optic chiasm?

Retinoblastoma

What is an embryonic malignant tumor arising from the retina, which manifests with a white "cat eye" reflex on photographs?

Dry

What type of macular degeneration is the gradual breakdown of cells within the macula, and form drusen spots?

Wet

What type of macular degeneration is from new abnormal blood vessels, which leak and scar the retina?

Wet macular degeneration

What is the leading cause of legal blindness in people older than 55 within the United States?

50, 60, 70, 90

At what degree should a patient see an object in their periphery, for brow, nose, chin, and ear in that order?

CN III (Oculomotor N)

What nerve is being tested by the accommodation reflex?

Strabismus

Aside from testing the third cranial nerve, what is the corneal light reflex testing?

Adie pupil

What pupillary defect is an idiopathic unilateral (80%), and is more common in women between ages 30 and 40?

Adie pupil

What condition consists of the affected pupil being dilated all of the time regardless of stimulus?

Argyll Robertson Pupil

What pupillary condition is traditionally associated with tabes dorsalis from neurosyphilis, and consists of the pupils with brisk constriction to accommodation?

Tessellated Fundus

What condition produces a normal fundus (retina) with deeply pigmented choroid interspersed with red from the retina, which gives it a leopard appearance?

CHRPE (congenital hypertrophy RPE)

What retinal condition produces a "bear track" appearance and is benign?

Microaneurysms (dot hemorrhages)

What is the earliest sign of diabetic retinopathy, which is more easily seen under the green light setting on an ophthalmoscope?

Hypertension

What is the most common primary diagnosis in the United States?

Hypertensive retinopathy

What retinal condition is characteristic of arteriovenous nicking, cotton wool spots, exudates and has blood vessels resembling copper wire and silver wire?

True

T/F- Drusen bodies are a risk factor for macular degeneration, but are NOT diagnostic of it.

Leukocoria

What is the appearance of a white retina, where a red reflex would normally occur?

Retinoblastoma

What is the most severe cause of leukocoria, which most commonly occurs in children under age 6?

Cataracts

What is the most common cause of leukocoria overall?

Amblyopia and photograph angle

What types of things are likely to produce pseudoleukocoria?

50

A normal optic cup should cover no more than what percent of the optic disc?

Glaucoma

What condition is due to increased intraocular pressure?

Papilladema

What condition is due to an increased intracranial pressure?

Vitreous detachment

What is likely to produce floating cells (squigglies) in the field of vision?

True

T/F- Most retinal tears occur spontaneously as a result of a posterior vitreous detachment that has put tension on the retina.

Cataract, macular degeneration, diabetic retinopathy, and hypertensive retinopathy

What conditions are likely to cause central visual field deficits?

Glaucoma, retinal detachment, papilledema, retinitis pigmentosa, optic tract lesions, and optic neuritis

What conditions are likely to cause peripheral visual field deficits?