Term
| Know the techniques used when performing a fundoscopic exam |
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Definition
"*begin with the lens diopter set at 0
*regardless of your dominant hand, use your right hand and right eye to examine the patient's right eye, and vice versa, to avoid bumping noses and getting uncomfortably close
*start with the opthalmoscope about 15 in from the patient's eye and find the red reflex, then steady the patient's head by placing your thumb over his/her opposite eyebrow, then move in towards the patient's eye at a 15degree angle lateral from the nose
*locate the optic disc - follow a blood vessel centrally, following the arrows that the vessels make as they branch
*adjust the lens to focus the optic disc clearly
* examine the optic disc, the retina, the macula and the fovea
* examine the anterior structures of the lens and vitreous by adjusting the lens to a diopter between +10 and +12" |
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Term
| Know the anatomy and findings in a patient with a normal fundoscopic exam |
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Definition
"*optic disc findings
-sharp, well defined edges, though may be somewhat blurred on nasal side
-yellowish-orange in color, may be rimmed by pigmented or whitish crescents
-central physiologic cup - diameter should be less than half the disc diameter. cup may not be present, and may be sightly displaced towards the temporal side
*retinal findings
-examine the retinal arteries (light red, smaller, and bright light reflex) and retinal veins (dark red, larger, absent/diminished bright light reflex)
-follow the retinal vessels peripherally in four directions from the pupils
-venous pulsations as they emerge from the disc may or my not be present in a normal exam
*move laterally from the optic disc, telling the patient to focus on the light beam, to find the fovea and surrounding macula
-there will be a tiny bright light reflection in the center of the fovea, and a shimmering reflection in the macula. both reflections diminish with age. " |
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Term
| Know the anatomic location and function of the optic nerve, optic disc, and macula |
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Definition
| the optic nerve (CN II) travels from the optic disc, where all of the sensory nerve fibers from rods and cones converge at the optic disc, and it carries visual input from the retina to the optic chiasma, where it meets the optic nerve from the opposite side. the macula is located laterally to the optic disc, and it is a less vascular, highly pigmented area of the retina which accounts for visual acuity. at the center of the macula is the fovea, which consists of densely packed cones. the retinal vasculature arches from the optic disc above and below the macula. |
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Term
| Know the physical exam findings in a patient with homomymous and temporal hemianopsias |
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Definition
"*homonymous hemianopsia - will not be able to see one half (either left or right) of the visual field with either eye individually or with both eyes open
-this is caused by a lesion in the optic tract, posterior to the chiasm
*bitemporal hemianopsia - ""tunnel vision"" with one eye closed, patient will have reduced or absent vision in the ipsilateral (temporal) field. (right eye with left eye closed - loss of right visual field)
-this is caused by a lesion in the optic chiasm
" |
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Term
| know the physical exam findings and significance in patients with scotomas |
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Definition
| Scotoma: partial visual field defect with area of preserved vision around it. Exam: Can be detected by confrontation testing (patient will not be able to see some areas of normal visual field). Amsler Grid: ask patient to color in grid where the lines disappear. Scotomas are caused by any lesion from the eye to the brain. Ex: central, cecocentral, arcuate (often glaucoma) and temporal scotomas (optic nerve lesion), bitemporal hemianopsia (optic chiasm lesion - can be pituitary tumor), homonymous hemianopsia (after optic chiasm) [stolen from sarah - we had the same question] |
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Term
| know the definitions and significance of cottom wool spots, ocular hemorrhage, papilledema |
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Definition
"Cotton wool spots: yellow-white fluffy spots on the retina that are due to retinal nerve infarcts and accumulation of axonal debris. Causes include diabetes, HTN most commonly among many others
Ocular hemorrhage: these hemorrhage have many presentations on fundiscopic exam including flame, boat, and dot. The likely causes are usually diabetes (dot), HTN or vein occlusion (flame), and increase in ICP (boat).
Papilledema: optic disc swelling that is cause by increase in intracranial pressure. Most often bilateral presentation.
" |
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Term
| know the definitions and signifiance of horizontal, rotatoinal, unilateral, and verticl nystagmus |
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Definition
"Nystagmus: defined by the direction of the quick eye movement (saccade) which, physiologically, is the opposite of the VOR direction.
Horizontal nystagmus: Also called gaze nystagmus. This is includes a fast saccade back to midline with lateral gazes. Often indicative of a cerebral lesion. The fast saccade is towards the side of the lesion. If it is due to a vestibular apparatus lesion, the saccade is away from the lesion.
Rotational nystagmus: This occurs after a period of rotation (thus it is often called post-rotational nystagmus). If you spin around in a chair to the left, the direction of VOR would be to the right and nystagmus is to the left. So when you stop spinning, there is still a left beating nystagmus.
Unilateral nystagmus: according to what I found, this is extremely rare and there is doubt if it actually exists of if one eye ‘s movement is just more subtle than the other. I couldn’t find much credible info on this.
Vertical nystagmus: Can be downbeat or upbeat. Downbeat is highly suggestive of an Arnold-Chiari malformation. Upbeat is often due to the posterior semicircular canal having a higher tone than the anterior canal or due to lesions of brainstem tracts.
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Term
| know the definitions and physiology that lead to miosis and mydriasis |
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Definition
"Miosis: constricted pupils. This is due to parasympathetic input via CN3 to the iris sphincter muscle. Can also be due to loss of sympathetic input (Horner’s syndrome). Also a side effect of many drugs.
Mydriasis: dilation of the pupils mediated by alpha1 sympathetic input. Can be due to overactive sympathetic input or underactive parasympathetic input. Also a side effect of many drugs.
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Term
| know the ocular physical exam findings in patients with underlying systemic illnesses: Wilson's disease, hyperthyroidism, myasthenia gravis, osteogenesis imperfecta |
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Definition
"Wilson’s: golden brown rim around the rim of the cornea due to copper deposition.
Hyperthyroidism: in hyperthyroid diseases like Graves, there is exophthalmos which is protrusion of the eyes due to soft tissue swelling. There is also the “stare sign” where the upper lid is overly retracted and this causes drying of the cornea. Even when the patient looks down, the lid stays retracted for a period of time.
Myasthenia Gravis: ptosis with sustained upward gaze is the key finding. Also, variable change in extraocular muscle movement.
Osteogenesis imperfect: BLUE-GREY SCLERA
" |
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Term
| know the anatomy and findings in a patient with a normal otoscopic exam |
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Definition
"Key Anatomy for Exam:
a) Outer ear = pinna, auricle concha, external auditory meatus
b) Middle ear = tympanic membrane with malleus seen behind it
Normal exam= clear canal that’s free of any discharge, impacted cerumen, masses, inflammation, of foreign bodies. The tympanic membrane should be translucent, a pearly grey color and not retracted or bulging. A cone of light should be seen spreading from the center, outward to the edge of the tympanic membrane. The malleus should be seen behind the upper part of the eardrum. |
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Term
| know the physical exam findings in patients with otitis externa, otitis media, perforated eardrum |
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Definition
"Otitis Externa: Pain is the predominant symptom and is worsened when the outer ear (pinna, auricle, tragus) is touched or pulled gently [tug test]. May also have tenderness behind the ear. The canal is often swollen, narrowed, moist, pale, and tender, and itchy.
Otitis Media: Patients complain of pain and fullness in the ear. On inspection, tympanic membrane is red and bulging with a dull or absent light reflex and diminished movement on pneumatic otoscopy. Purulent material may also be seen behind the tympanic membrane.
Perforated Eardrum: on inspection, see a reddened ring of granulation tissue surrounding the perforation. Eardrum is scarred and no landmarks are discernable.
" |
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Term
| know the physical exam findings in patients with conductive and sensorineural hearing loss |
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Definition
"Conductive Hearing Loss:
a) Weber test = sound is louder in affected ear
b) Rinne test = bone is louder than air
Sensorineural Hearing Loss:
a) Weber test = sound is louder in normal ear
b) Rinne test = air is slightly louder than bone, but both equally reduced
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Term
| know the physical exam techniques and interpretation of findings when using the Weber and Rinne tests |
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Definition
"Weber Test: place vibrating tuning fork in middle of the forehead and ask patient to report which ear the sound is louder in. This detects for both unilateral conductive hearing loss and unilateral senorineural hearing loss.
Findings:
b) normal = equal sound in both ears
a) unilateral conductive hearing loss = sound is loudest in affected ear
b) unilateral sensorineural hearing loss = sound is louder in unaffected ear
Rinne Test: place vibrating tuning fork on mastoid process then next to the ear and ask patient to report which ear the sound is louder in. This detects for conductive hearing loss on the side testing.
a) normal = sound in air is louder than sound in bone (next to ear > mastoid)
b) conductive hearing loss = bone is louder than air (= negative result) |
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Term
| know the characteristics of normal and malignmant lymph nodes on physical exm |
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Definition
"
Normal = small, mobile, discrete, non-tender
Malignant = hard/fixed, swollen, irregularly shaped, non-tender
**tender lymph nodes suggest inflammation, notmalignancy |
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