An infectious node on eye lid is called? Can be on the eye lid margin or on the lid its' self.
Hordeola / stye, warm compresses, 90% Staph a.
drooping eye lid is called
ptosis/blepharoptosis
increasing weakening of accommodation is called
Inability to focus Presbyopia
Site of central vision in the Retina is called?
Macula
What are the cranial nerves that control eye movement
III = Oculomotor, IV = Trochlear, VI = Abducens
Adams apple cartilage is called
Thyroid cartilage
Name the major lymph nodes of head/neck
Occipital, Post auricular, Pre auricular, Tonsilar (retropharyngeal), Submandibular, Submental, Posterior cervical, deep & superficial cervical, supraclavicular, & Infraclavicular
Infant skull characteristics/landmarks
Coronal, sagittal, & Lambdoid sutures. Anterior and posterior fontanels. Posterior fontanel closes by 2 months, Anterior fontanel closes by 24 months.
Shortening of sternocleidomastoid is called
Head stays turned (Torticollis)
Weakness of only the mouth could be a dysfunction of.....
Trigeminal nerve V
rhythmic nodding of the head, tracheal tugging synchronous with pulse could indicate?
Possible aortic aneurysm
Pregnancy has what affect on thyroid
Enlargement of thyroid and possible increase in function
edemitous swelling of the scalp (Newborn)
Caput succedaneum, crosses suture lines, typicall from vaginal birth trauma, Soft, margins poorly defined. If hard more likely a cephalhematoma
collection of blood under scalp (Newborn)
Cephalhematoma, typically subperiosteal and so does not cross suture lines, hard and well definied boarders. If soft and less well definied think caput succedaneum
mass high in the neck (anterior) Three possibilities non cancerous possibilities
could be a thyroglossal duct cyst if midline and directly above thyroid cartilage but under the thyoid bone or a brachial cleft cyst if just to the left or right of thyroid. Also could be a enlarged anterior cervical lymph node.
Name 6 categories/types of HA
Classic migraine, common migraine, cluster migraine, hypertensive migraine, muscular tension HA, & Temporal arteritis
Name the migraine: Age of onset=childhood, Location=Unilateral, lasts hrs to days, morning or night, pulsating/throbbing, prodromal=aura/scotoma, freq=twice a wk, can cause N/V
Classic Migraine
Name the migraine: Age of onset=childhood, Location=Generalized, lasts hrs to days, morning or night, pulsating/throbbing, prodromal=vague/personality changes, freq=twice a wk, can cause N/V
Common Migraine
Name the migraine: Age of onset=adult Location=Unilateral, lasts 30min-2hrs, occurs @ night, intense burning/searing/knifelike, prodromal=sleep disturbances/personality changes, freq=several times nightly for several nights then none, can cause lacrimatio
Cluster Migraine
Name the migraine: Age of onset=adult Location=bilateral/occipital, lasts hrs, occurs in morning, Throbbing, prodromal=None, freq=Daily, typically remits as day goes on
Hypertensive Migraine
Name the migraine: Age of onset=adult Location=Unilateral or bilateral, lasts hrs-days, occurs anytime, constricting, prodromal=none, associated c stress/anger, freq=Daily
Muscular Tension Migraine
Name the migraine: Age of onset=older adult Location=Unilateral or bilateral, lasts hrs-days, occurs anytime, Throbbing, prodromal=none, freq=Daily
Temporal (Giant Cell) Arteritis, can cause visual changes/loss, has a high association with polymyalgia rheumatica, unexplained fever, elevated sed rate. Pt must be started on prednisone immediately to prevent vision loss. Also give ASA 81mg.
Technical term for when the eyes don't line up when focusing on an object.
Strabismus is the finding, Amblyopia is "lazy eye" which is the condition in which strabismus is one of the defining characteristics.
a defect of vision in a defined area of the visual field in one or both eyes
Scotomata
What can nocturnal eye pain be indicative of
sign of subacute angle closure & a symptom of Glaucoma
Cranial Nerve II is?
Optic Nerve
What does the 20/200 mean? for vision
The pt can read @ 20ft what a normal vision person can read @ 200 ft.
yellow tinted lesions on the periorbital tissue. May be flat to slightly raised, oval irregularly shaped
Xanthelasma, May be indicative of abnormal lipid metabolism. Cause by lipid deposits. Most common on the nasal portion of the upper or lower lid
Turning in of the eyelid (Top or Bottom)
Entropion, Can cause abrasion of cornia from eyelashes rubbing.
Turning out of the eyelid (Top or Bottom)
Ectropion, Also note the corneal circus senilis in this eye.
crusting of eyelashes
Blepharitis (Typically from bacterial infection)
Erythemia &/or exudate of the schlera & surrounding structures
Allergic/infectious conjunctivitis
Hemorrhage of schlera
Subconjunctival Hemorrhage
schlera that abnormally grows into/over the cornea
Pterygium
White arc around the cornea
Arcus Senilis, Normal over 60yo. If seen <40yo can be sign of lipid disorder, also note the ectropion
Pupillary constriction < 2mm &
Pupillary dilation > 6mm are generally called?
Miosis (Constriction) &
Mydriasis (Dilation)
Rhythmic movements of eyeballs back and forth is called
nystagmus
Inward & outward fixed turning of the eye (two terms)
Esotropia (inward) & Exotropia (Outward)
In the retinal fundus are arteries or veins larger?
Veins are larger by a degree of 3:2 then arteries
What is the site of central vision on the fundus?
Macula Lutea / Covia Centralis
Located 2 DD temporal
Pathology seen as white area around optic disc.
Myelinated nerve fibers, typically has ill defined boarders around optic disc.
Pathology seen as loss of definition of the optic disc margin
Papilledema. Caused by increased ICP.
Pathology seen as small discrete spots on retina that are slightly more yellow
Drusen Bodies. Consequence of aging. precurser of senile macular degeneration. Antioxidant supplements (Vit C, E, Beta carotine, Zinc, & copper) significantly preserved vision from macular degeneration.
Pathology seen as dark red or black spots on retina
Red splotches are Hemorrhages. This image also shows drusen bodies and supposedly edema.
Linear white spots around iris of an infant
Brushfield spots. Highly indicative of downs syndrome or mental retardation
By what age should a child's vision reach 20/20?
by 6 years old.
3yo 20/50
4yo 20/40
5yo 20/30
6yo 20/20
A 5yo has 20/50 in the R eye and 20/30 in the L eye.
What is this indicative of?
This is a 2 line difference in vision between eyes indicative of Amblyopia. "lazy eye," is the loss of one eye's ability to see details and is common in children. Provide an eye patch to encourage use of affected eye.
Increase in volume of eye ball causing protrusion forward is called. Can indicate?
Exophthalmos or Proptosis: Most common in Graves disease. A tumor can cause unilateral Exophthalmos
Horizontal grayish band across the cornea
Band Keratopathy. Calcium deposits across cornea. Associated c chronic corneal disease. This person also has chronic conjunctivitis.
Ipsilateral miosis & mild Ptosis indicates ______.
Horner's syndrome. Indicative of a tumor affecting the cervical sympathetic trunk. Instillation of cocaine will exaggerate the anisocoria and an increasing difference of >1mm in pupil size is positive confirmation. MRI is then indicated.
you notice extensive development of fine blood vessels on the retina. What is this?
Proliferative Diabetic Retinopathy: Hemorrhages may be seen and are a major source of blindness in diabetics. There are also Cotton-wool spots(soft exudates) in this photo
You find an abundance of cotton wool (soft exudate) spots, hard exudates, and dot hemorrhages on a patient's retina. What could this patient have?
Background Diabetic Retinopathy: Cotton wool spots, hard exudates, and hemorrhages can be seen here.
Gradual loss of peripheral vision can be an indication of______?
Developing chronic Glaucoma
A patient complains of intense eye pain, blurred vision, halos around lights, and you notice that they have mydriasis and conjunctivitis. What does this patient have?
Acute Glaucoma:
You find that a 1.5 yr old has a normal red reflex in the L eye but a white relfex in the R eye. What is this indicative of?
Retinoblastoma: Embryonal malignant tumor of the retina occurring in 1st 2 years of life.
A 4 month old does not appear to be visually aware of the surroundings. Fundoscopic examination reveals multiple retinal hemorrhages. What is this indicative of?
And infant with multiple retinal hemorrhages must be worked up for physical abuse, specifically shaken baby syndrome.
Intraocular blood is called...?
Hyphema
Pt presents c c/o dry eyes, dry mouth, and you notice enlargement of the parotid glands. What might the diagnosis be?
Sjogren syndrome.
Dry eye syndrome (keratoconjunctivitis sicca)
Dry mouth (xerostomia)
Schirmers test: paper strips placed in eyes to measure tear production. <5mm is + for Sjogren
Most pts have autoantibodies: +ANAs (95%)
A 2 week old newborn that was born at home has bilateral purulent conjunctivitis. This is likely ........?
Chlamydial conjunctivitis typically presents 5-30 days after birth.
If BL purulent conjunctivitis is 3-5 days PP then think gonococcal infection.
Azythromycin cream used PP to prevent.
Three pathologies that photophobia indicates
Acute Glaucoma
Iritis
Uveitis
(conjunctivitis will never have photophobia)
Parents bring a 4 month old in c/o persistent tearing and crusting of eyes. This is likely....?
Dacryostenosis (Nasolacrimal duct obstruction, NDL). (also investigate infantile glaucoma) Dacryostenosis is present in 6% of children up to 1 yr. Treatment = Crigler massage (Massage from canthus down edge of nose). If erythema & redness of an enlarged d
Teenage pt presents c B/L ocular itching & tearing disproportionate to findings. No blepharitis or crusting noted. This is likely....?
Allergic Conjunctivitis causes excessive bilateral itchiness, eye rubbing, and watery eyes and sometimes a watery discharge. Crusting/matting, especially if unilateral indicates viral/bacterial conjunctivitis.
At what age can you start to use a visual acuity chart with a child?
3 1/2 yo.
3yo 20/50
4yo 20/40
5yo 20/30
6yo 20/20
Types of conjunctivitis. Peripheral vs circumcorneal injection. What are they and what can they indicate?
Circumcorneal injection is on the Right, indicative of keratopathy, uveitis, scleritis, or abrasions on cornea.
Peripheral injection is on the Left, indicative of infectious etiology.
Swelling or edema of the conjunctiva is called ...?
Chemosis
I think this person also has some arcus senilis
What is the Palpedral conjunctiva
The conjunctiva that comprises the underside of the eye lids.
What is the other technical term for iritis?
Anterior Uveitis:
Generally acute in onset
Deep eye pain
Photophobia (consensual)
Circumcorneal injection
Associated Infection (often URI)
Hypopyon or hyphema
Frequently unilateral
What is a Chalazion? How is it different then a Hordeolum?
Granulomatous inflammation of a meibomian gland nodule that is firm & not tender and has no inflammatory signs. A Hordeolum is infection of the sebacious glands of Zeis or Moll along the lash line and is tender and inflamed.
A patient presents with unilateral peripherally injected conjunctivitis, minimal crusting/blepharitis, and palpable preauricular lymphadenopathy. Is this likely viral or bacterial?
Preauricular lymphadenopathy is indicative of viral conjunctivitis and rarely present with bacterial etiologies.
Medical term for Nearsightedness. How do you test?
Myopia. Things are clear when close and blurry when farther away. Use Rosenbaum chart @ 14" to assess.
Legally blind is vision worse then?
20/200