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54 Cards in this Set
- Front
- Back
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T or F: Proper order is: NaFl before anesthetic
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T (foreign body lecture)
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When don't you do IOP (foreign body lecture)?
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penetrating wounds
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What objects can you NOT do an MRI with?
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metallic
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If the patient feels less pain WITH the contact lenses on, where could the foreign body be?
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in the conjunctiva (palpebral)
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What's the easiest method of removing a conjunctival foreign body?
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irrigation (forcefully irrigate by aiming the sterile saline spray at the edge of the FB)
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T or F: for a conjunctival foreign body you usually prescribe a prophylactic antibiotic
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F...she said in-office is all thats needed for these (ex: tobramycin, vigamox)
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What are you worried about with a history of working with metal on metal or high speed machinery?
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perforating injury (intraocular FB)
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What light on the slit lamp does she recommend for evaluating corneal foreign body?
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OPTIC SECTION...16X, medium-high illum
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When do we refer for a FB removal in the cornea (when it penetrates what layer?)
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Bowman's layer (we can't remove past this point)
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What instrumentation is easier for children when removing a FB?
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loop
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When using a QTIP to remove a corneal FB, use ____ strokes.
When is this method mainly used? |
tangential
to remove dislodged FB (by irrigation) |
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What is the instrument of choice for FB removal in the cornea? The bevel (hook) always faces where?
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spud (and needle)
toward the doctor (not pointed toward the cornea) |
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Metallic Fb can be oxidized _-_ hrs after being embedded. What can be used to remove this?
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12-24; alger brush
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TQ: What's the first thing to do after you have removed the corneal foreign body with (for example) a spud?
What cycloplegics did she mention to use after removal is there are cells/a significant abrasion? |
IRRIGATE!
scopolamine and homatropine |
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Using a BSCL after FB removal:
1. ____ B.C. preferred 2. when wouldn't you use a CL (specifically in the notes)? |
1. steeper (tighter fit)
2. organic material FB/abrasion |
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After FB removal, when should you F/U?
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1 day
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What is siderosis and when does it occur?
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metal toxicity; increasing inflamm after FB removal may indicate remaining IOFB
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For symptom assessment with dry eye, always ask if __________.
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blurred vision improves with blink
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Fluorescein pools where?
Rose bengal interacts with impaired what? |
epithelial "grooves"
mucin layer on epithelial surface (both under ocular surface disease tests for dry eye as well as lissamine green) |
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When is TBUT reduced?
What should you watch out for that could mimic evaporation? |
less than 10 seconds
negative staining due to an elevation (epthelial basement membrane dystrophy/RCE/...) |
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When evaluating for dry eye, what is the first thing you perform before you put any other drops in the eye?
What size light does she say to use? |
TBUT (instill fluorescein) (B4 TONO!)
parallelepiped (low mag) |
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T or F: when doing TBUT, instill one drop of proparacaine and then 1 drop of fluorescein...tell pt to blink a couple times and then keep them open
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F! no anesthetic
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What needs to be evaluated before you touch or manipulate the lids in any way when assessing dry eye?
What's normal? What's not? |
measuring the tear meniscus
.3-.35= normal <0.1mm= diagnostic of aqueous deficient dry eye |
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MGD is present in ___% of patients with tear deficient dry eye.
Not only should you look at the opening of the glands but you should _________. |
70%
press on the lids (can do with Qtip) |
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Diabetes is responsible for ___% of new cases of blindness (per year?)
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12
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TQ: With diabetes, you get more ____ with elevated blood sugar levels.
Over what time span does this occur? |
myopia (RARELY to more hyperopic)
days to hours |
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Re check refractive status ___ (time) after the blood sugar is well controlled
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one month
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Increased ___ and frequent ___ are signs of diabetes.
T or F: diabetes can cause diplopia due to a nerve palsy. |
thirst; urination
T |
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Vision fluctuations:
within minutes, think what? days? months? |
accom spasm
diabetes cataracts |
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Cataracts occur in ___% of patients 65 years and older. They occur in ___% of patients 80 and above
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50; 84
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What's the most common type of cataract? What's it look like? What refractive error does it shift to?
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nuclear sclerosis; yellowing; myopic
least likely to reduce BCVA and effects color perception in 2+ and above |
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Which cataract do you monitor more closely than the other types?
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posterior subcapsular (about every 6 months)
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Glare and light sensitivity are two complaints that can happen with which type of cataract?
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congential cataracts (but the pt has dealt with this their whole life)
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When is it appropriate to give the patient a final Rx after cataract sx?
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1-2 weeks
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Wavefront refraction measures higher order aberrations as well as 1st and 2nd.
What are the higher order aberrations? Which causes glare, halos, and starbursts? Which reduces mesopic and scotopic vision? |
3rd: coma
4th: spherical 4th both |
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T or F: wavefront refraction may be influenced by accommodation
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T
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Higher order aberration values are dependent on __________.
What eliminates most HOA? |
pupil size
a pupil size of 4mm or less |
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> ___ microns in HOA is clinically observable to patients
.25D is approximately __ microns. |
.4
3 |
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Which would you NOT do on a blind eye:
A. Tonometry B. Acuities C. Pupils D. Stereo |
D!
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What is the Bruckner test used for, what instrument does it use and what info can it tell you?
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Children and special populationswho have decreased acuity (a rough test to detect either anisometropia or small angle strabismus); direct Ophthalmoscope; the brighter eye is the non-fixating eye AND inferior crescent= myopia while superior crescent= hyperopia
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What is Florida's minimum visual standard for licensing (to get an actual license)?
acuity and field of vision.... |
20/70 in either eye, or both eyes together with or without corrective lenses.
BUT if pt has an eye 20/200 or worse, the other eye must be 20/40 or better field of vision: 130 degrees minimum acceptable field of vision |
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What did Crandall say regarding checking the box: in your opinion, would wearing of corrective lenses be advisable for driving purposes? If not, why?
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unaided under 20/40 but improves with glasses: check yes
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What are the two visual field tests that you could use for the florida drivers license requirement?
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goldmann kinetic or humphrey esterman program (binocular estermann)
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For a driver over 80 years old, when does the "long form" have to be used?
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if the patient's visual acuity is 20/50 or worse in either eye or there's any indication of eye dz/injury that would affect the pt's driving ability
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Always alert your preceptor if the patient has what two conditions?
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diabetes and/or HTN
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T or F: unaided distance VAs are required for all patients
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false...only new comprehensive ones
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Do keratometry before/after retinoscopy.
What do you do first ALWAYS? Is it necessary to do trial frame for distance and near rx's? |
before
acuities YES |
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Automated visual fields are done after ____ and before ___, ___ or ___.
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acuities; IOP check, gonio, dilation
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What do you do on every case of uncorrectable decrease in vision andand/or the pt describes a defect in visual field?
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amsler grid (PRE dilation)
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What would you do immediately following tonometry if the patient is a glaucoma suspect?
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pachymetry (it needs anesthetic anyway!)
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Under Medicare, how is a new patient defined?
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a patient who has not received any professional services from your office within the past 3 years
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What 3 things are covered under Medicare?
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non routine eye care
yearly exams for diabetic patients on medicare doctor advised return to office visits |
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T or F: for an established patient, "Dr. requested return visit" is an appropriate chief complaint if the patient was seen a year ago and you told them to come back
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T
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What three elements control the level of service for medicare?
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History, Exam components, medical decision making
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