MCPHS Clinical Optometry Exam 2: Questions And
Accurate Answers
Charles Babbage (1847) Right Ans - developed the first opthalmoscope
Herman von Helmholtx (1851) Right Ans - developed the first "modern"
opthalmoscope
Direct O: Internal illumination system Right Ans - light source (light bulb),
condensing lenses, reflecting prism, apertures (dif sizes/shapes/filters)
Direct O: Observation system Right Ans - peephole, spherical lenses (+/-)
to modify focal length
Indirect opthalmoscopy Right Ans - BIO, fundus (78/90) --> real, inverted
images. Often binocular. Smaller magnification, larger field of view
Direct opthalmoscopy Right Ans - upright, virtual image magnified by
optical system of patient's eye. Monocular. Larger magnification, smaller field
of view
Direct O: Field of view Right Ans - Approx 6.5 degrees; similar to size of the
average optic nerve head; smaller in myopes, larger in hyperopes
Direct o: Magnification Right Ans - approximately 15x; larger in myopes,
smaller in hyperopes
Direct O: steps Right Ans - 1) inspect ocular media from distance (clear,
look for opacities)
2) examine anterior segment (front)
3) examine posterior segment (back)
Clear components of the eye Right Ans - cornea, aqueous humor, crystalline
lens, vitreous humor
Red Reflex Right Ans - reflection off of the retina; stand ~2ft from pt with
no power in O-scope; move side-to-side and up/down; opacities are shadows
, direct o: Ocular media Right Ans - examine aqueous humor and vitreous
w/ direct o -- difficult
direct o: anterior segment Right Ans - move closer and increase (+) power
to within 4-6 inches; evaluate cornea, iris, surrounding tissues.
direct o: posterior segment Right Ans - approach fixating on red reflex;
reduce amount of plus; positioned ~15degrees temporally from pts line of
sight; increases field of view as closer
posterior segment evaluations Right Ans - optic nerve head, peripapillary
area (adjacent to nerve), fundus/vasculature, macula (darker, temporal)
optic nerve head Right Ans - located ~15* nasal from macula and line of
sight --> color, nerve fiber layer, margins, cup/disc ratio, spontaneous venous
pulsation
optic nerve: color Right Ans - normal ONH slight pink - more so towards
rim/border; may have orangish/yellow; very white = pallor
pseudopallor Right Ans - post cataract surgery -- yellow lens removed,
making ONH appear far whiter in appearance
optic nerve: neuroretinal rim Right Ans - most important aspect of optic
nerve -- represents nerve fibers of retina heading towards brain. Look for
abnormal/thinning of neuroretinal rim tissue
ISNT rule Right Ans - normal distribution of neuroretinal rim tissue --
Inferior > Superior > Nasal > Temporal
optic nerve: margins Right Ans - edge of ONH is opening of scleral canal
(hole for all nerve fibers to pass thru) -- sets limit to size of optic disc;
border should be clearly defined and flat in comparison
elevated ONH margins Right Ans - could be a sign of optic nerve
swelling/edema
Peripapillary area Right Ans - surrounding retina just outside disc -- can
have various changes
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