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54 Cards in this Set

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T or F: Proper order is: NaFl before anesthetic
T (foreign body lecture)
When don't you do IOP (foreign body lecture)?
penetrating wounds
What objects can you NOT do an MRI with?
metallic
If the patient feels less pain WITH the contact lenses on, where could the foreign body be?
in the conjunctiva (palpebral)
What's the easiest method of removing a conjunctival foreign body?
irrigation (forcefully irrigate by aiming the sterile saline spray at the edge of the FB)
T or F: for a conjunctival foreign body you usually prescribe a prophylactic antibiotic
F...she said in-office is all thats needed for these (ex: tobramycin, vigamox)
What are you worried about with a history of working with metal on metal or high speed machinery?
perforating injury (intraocular FB)
What light on the slit lamp does she recommend for evaluating corneal foreign body?
OPTIC SECTION...16X, medium-high illum
When do we refer for a FB removal in the cornea (when it penetrates what layer?)
Bowman's layer (we can't remove past this point)
What instrumentation is easier for children when removing a FB?
loop
When using a QTIP to remove a corneal FB, use ____ strokes.

When is this method mainly used?
tangential

to remove dislodged FB (by irrigation)
What is the instrument of choice for FB removal in the cornea? The bevel (hook) always faces where?
spud (and needle)

toward the doctor (not pointed toward the cornea)
Metallic Fb can be oxidized _-_ hrs after being embedded. What can be used to remove this?
12-24; alger brush
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
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
After FB removal, when should you F/U?
1 day
What is siderosis and when does it occur?
metal toxicity; increasing inflamm after FB removal may indicate remaining IOFB
For symptom assessment with dry eye, always ask if __________.
blurred vision improves with blink
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)
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/...)
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)
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
F! no anesthetic
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
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)
Diabetes is responsible for ___% of new cases of blindness (per year?)
12
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
Re check refractive status ___ (time) after the blood sugar is well controlled
one month
Increased ___ and frequent ___ are signs of diabetes.

T or F: diabetes can cause diplopia due to a nerve palsy.
thirst; urination

T
Vision fluctuations:

within minutes, think what?
days?
months?
accom spasm
diabetes
cataracts
Cataracts occur in ___% of patients 65 years and older. They occur in ___% of patients 80 and above
50; 84
What's the most common type of cataract? What's it look like? What refractive error does it shift to?
nuclear sclerosis; yellowing; myopic

least likely to reduce BCVA and effects color perception in 2+ and above
Which cataract do you monitor more closely than the other types?
posterior subcapsular (about every 6 months)
Glare and light sensitivity are two complaints that can happen with which type of cataract?
congential cataracts (but the pt has dealt with this their whole life)
When is it appropriate to give the patient a final Rx after cataract sx?
1-2 weeks
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
T or F: wavefront refraction may be influenced by accommodation
T
Higher order aberration values are dependent on __________.

What eliminates most HOA?
pupil size

a pupil size of 4mm or less
> ___ microns in HOA is clinically observable to patients

.25D is approximately __ microns.
.4

3
Which would you NOT do on a blind eye:

A. Tonometry
B. Acuities
C. Pupils
D. Stereo
D!
What is the Bruckner test used for, what instrument does it use and what info can it tell you?
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
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
What did Crandall say regarding checking the box: in your opinion, would wearing of corrective lenses be advisable for driving purposes? If not, why?
unaided under 20/40 but improves with glasses: check yes
What are the two visual field tests that you could use for the florida drivers license requirement?
goldmann kinetic or humphrey esterman program (binocular estermann)
For a driver over 80 years old, when does the "long form" have to be used?
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
Always alert your preceptor if the patient has what two conditions?
diabetes and/or HTN
T or F: unaided distance VAs are required for all patients
false...only new comprehensive ones
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
Automated visual fields are done after ____ and before ___, ___ or ___.
acuities; IOP check, gonio, dilation
What do you do on every case of uncorrectable decrease in vision andand/or the pt describes a defect in visual field?
amsler grid (PRE dilation)
What would you do immediately following tonometry if the patient is a glaucoma suspect?
pachymetry (it needs anesthetic anyway!)
Under Medicare, how is a new patient defined?
a patient who has not received any professional services from your office within the past 3 years
What 3 things are covered under Medicare?
non routine eye care

yearly exams for diabetic patients on medicare

doctor advised return to office visits
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
T
What three elements control the level of service for medicare?
History, Exam components, medical decision making