Eyes
Type Condition Definition/Cause Findings Location
A small whitish depression in the optic disc, from which the retinal May be visible either centrally or toward the temporal side of the
Physiologic Cupping Optic Disc
vessels appear to emerge. disc. Grayish spots are often seen at the base.
Normal Variations
Seen often around the optic disc. Not part of the disc itself and
Rings & Crescents Optic Disc
should not be included in your estimates of disc diameter.
Appears as irregular white patches with feathered margins
Medullated Nerve
Much less common, but a dramatic finding. obscuring the disc edge and retinal vessels. No pathologic Optic Disc
Fibers
significance.
Vein crossing beneath the artery can be seen right up to the column
Normal A-V Crossing Artery and vein cross. Retinal Vessels
of blood on either side.
Venous stasis leads to engorgement and swelling 2° to increased Color pink, hyperemic. Often with loss of venous pulsations. Disc
Papilledema Optic Disc
ICP (meningitis, subarachnoid hemorrhage, trauma, mass lesion). vessels more visible, more numerous, curve over borders of the disc.
Physiologic cup is enlarge, occupying more than 1/2 of the disc's
Increased pressure within the eye leads to increased cupping
Glaucomatous Cupping diameter. Retinal vessels sink and under it and may be displaced Optic Disc
(backward depression of disc) and atrophy.
nasally.
Optic Atrophy Death of optic nerve fibers leads to loss of tiny disc vessels. Color white. Absence of tiny disc vessels. Optic Disc
Small, linear, flame-shaped, red streaks in the fundi, shaped by
Superficial Retinal
Common in severe HTN, papilledema, occlusion of retinal vein. superficial bundles of nerve fibers that radiate from the optic disc. Fundus
Hemorrhage
May be in clusters or linear streaking at the edges.
Develops when blood escapes into the potential space between the Larger than retinal hemorrhages. Obscures any underlying vessels
Preretinal Hemorrhage Fundus
retina and vitreous. Common with sudden increase in ICP. since it is anterior to retina.
Abnormal Variations
Deep Retinal Small, rounded, slightly irregular red spots ("dot" or "blot"
Occur in deeper layer of retina. Common in DM. Fundus
Hemorrhage hemorrhages).
Minute dilatations of very small retinal vessels too small to be seen Tiny, round, red spots seen commonly in and around the macular
Microaneurysms Fundus
ophthalmoscopically. Common in DM retinopathy and other causes. area.
More numerous, tortuous, and narrower blood vessels. Grow into
Formation of new blood vessels. Common in the late, proliferative
Neovascularization vitreous, which can cause retinal detachment or hemorrhage and Fundus
stage of DM retinopathy.
loss of vision.
Soft Exudates: Cotton White or grayish, ovoid lesions with irregular, soft borders. Usually
Result from infarcted nerve fibers. Common in HTN. Fundus
Wool Patches smaller than the disc.
Creamy or yellowish, often bright, lesions with well-defined hard
Hard Exudates Common in DM and HTN. borders. Small and round, but may coalesce into larger, irregular Fundus
spots. Clusters, circular, star-shaped patterns.
Yellowish or round spots. Edges may be soft or hard. May
Drusen Common in normal aging, age-related macular degeneration. Fundus
concentrate at the posterior pole.
, Acute and chronic HTN changes may manifest in the eyes from
acute changes from malignant HTN and chronic changes from long-
Hypertensive term, systemic HTN. Ocular changes can be the initial finding in an Areas of focal or generalized narrowing. The light reflex is also
Retinopathy asymptomatic pt with HTN. Arteriosclerotic changes are chronic narrowed. The arterial wall thickens and becomes less transparent.
changes resulting from systemic HTN. In the retina, atherosclerosis
and arteriolosclerosis dominate.
Full and tortuous. Develop an increased light reflex with a bright
Copper Wiring Type of arteriolar change. Retinal Vessels
coppery luster.
Portion of a narrowed artery develops such an opaque wall that no
Silver Wiring Type of arteriolar change. Retinal Vessels
blood is visible within it.
Hypertensive Retinopathy
Chronic HTN stiffens and thickens arteries. At A-V crossing points,
A-V Nicking Vein appears to stop abruptly on either side of the artery. Retinal Vessels
arteries indent and displace veins.
Tapering Vein appears to taper down on the side of the artery. Retinal Vessels
Vein is twisted on the distal side of the artery and forms a dark, wide
Banking Retinal Vessels
knuckle.
Slight narrowing, sclerosis, and tortuosity of the retinal arterioles.
Group 1
Mild, asymptomatic HTN.
Definite narrowing, focal constriction, sclerosis, and A-V nicking. BP
Group 2
is higher and sustained. Few, if any, symptoms r/t BP.
Retinopathy (cotton wool patches, arteriolosclerosis,
hemorrhages). BP is higher and more sustained. Clinical
Group 3
manifestations of headaches, vertigo, and nervousness. Mild
impairment of cardiac, cerebral, and renal fx.
Neuroretinal edema, including papilledema. Siegrist streaks,
Elschnig spots. BP persistently elevated. Clinical manifestations of
Group 4
headaches, asthenia, weight loss, dyspnea, and visual disturbances.
Impairment of cardiac, cerebral, and renal function.
Microaneurysms, dot and blot hemorrhages, flame-shaped
hemorrhages, retinal edema and hard exudates, cotton wool spots,
Diabetic Retinopathy Microaneurysms are the earliest clinical sign. Fundus
venous loops and venous bleeding, intraretinal microvascular
abnormalities, macular edema.
At this earliest stage, microaneurysms occur. Small areas of balloon-
Mild Nonproliferative like swelling in the retina's tiny blood vessels. At least 1
Fundus
Retinopathy microaneurysm and also dot, blot, or flame-shaped hemorrhages in
all 4 fundus quadrants.
, As the disease progresses, some blood vessels that nourish the
Diabetic Retinopathy
retina are blocked. Presence of hemorrhages, microaneurysms, and
Moderate
hard exudates. Intraretinal microaneurysms and dot and blot
Nonproliferative Fundus
hemorrhages of greater severity in 1-3 quadrants. Cotton wool
Retinopathy
spots, venous calibre changes, including venous beading, and
intraretinal microvascular abnormalities are present but mild.
At least 1 of the following should be present: Sever hemorrhages
Severe and microaneurysms in all 4 quadrants of fundus, venous beading
Nonproliferative which is more marked in at least 2 quadrants, and/or intraretinal Fundus
Retinopathy microvascular abnormalities with are more severe in at least 1
quadrant.
Neovascularization is the hallmark. Microvascular pathology with New vessels growing on the retina = NVE (neovascularization
Proliferative capillary closure in the retina leads to hypoxia of tissue. Hypoxia elsewhere). Those on optic disc are called NVD (NV of the disc).
Fundus
Retinopathy leads to release of vasoproliferative factors which stimulate new These new vessels can bleed and produce hemorrhage into the
blood vessel formation to provide better oxygenation of tissue. vitreous.
Age-related macular degeneration (AMD) is the leading cause of
irreversible vision loss in the industrialized world. AMD is a
Macular Degeneration Macular Area
Macular Degeneration
degenerative retinal disease, presumably caused by both genetic
and environmental factors.
Dry Atrophic More common, but less severe. Macular Area
Wet
Macular Area
Exudative/Neovascular
Hard and sharply defined. Soft and confluent with altered
Drusen Undigested cellular debris. Macular Area
pigmentation.
, Type Condition Description
Inflammation of the nasal mucosa, characterized by nasal
Rhinitis congestion, sneezing, postnasal drainage. Acute can be bacterial or
viral. Chronic can be bacterial, allergic, noninfectious.
URIs
Gradual onset over a few days. Rare or low grade fever. Slight body
aches. Fatigue and weakness sometimes. Nasal congestion, sore
Common Cold
throat, mild-moderate hacking cough. Complications include sinus
congestion, AOM, asthma.
Abrupt onset. High fever for 3-4 days. Headache common. Severe
URI
body aches. Fatigue and weakness that can last >3 weeks.
Flu Exhaustion almost always present at beginning. Sometimes sore
throat and nasal congestion. Cough can be severe. Complications
include bronchitis, pneumonia, worsening chronic conditions.
Symptomatic inflammation of the paranasal sinuses and nasal
Rhinosinusitis cavity. Acute <4 weeks. Chronic >12 weeks. Recurrent acute 4 or
more episodes in a year without persistent symptoms in between.
Allergic Rhinitis Most common cause of chronic rhinitis.
Sore Throat
Type Condition Definition/Cause Findings Location
A small whitish depression in the optic disc, from which the retinal May be visible either centrally or toward the temporal side of the
Physiologic Cupping Optic Disc
vessels appear to emerge. disc. Grayish spots are often seen at the base.
Normal Variations
Seen often around the optic disc. Not part of the disc itself and
Rings & Crescents Optic Disc
should not be included in your estimates of disc diameter.
Appears as irregular white patches with feathered margins
Medullated Nerve
Much less common, but a dramatic finding. obscuring the disc edge and retinal vessels. No pathologic Optic Disc
Fibers
significance.
Vein crossing beneath the artery can be seen right up to the column
Normal A-V Crossing Artery and vein cross. Retinal Vessels
of blood on either side.
Venous stasis leads to engorgement and swelling 2° to increased Color pink, hyperemic. Often with loss of venous pulsations. Disc
Papilledema Optic Disc
ICP (meningitis, subarachnoid hemorrhage, trauma, mass lesion). vessels more visible, more numerous, curve over borders of the disc.
Physiologic cup is enlarge, occupying more than 1/2 of the disc's
Increased pressure within the eye leads to increased cupping
Glaucomatous Cupping diameter. Retinal vessels sink and under it and may be displaced Optic Disc
(backward depression of disc) and atrophy.
nasally.
Optic Atrophy Death of optic nerve fibers leads to loss of tiny disc vessels. Color white. Absence of tiny disc vessels. Optic Disc
Small, linear, flame-shaped, red streaks in the fundi, shaped by
Superficial Retinal
Common in severe HTN, papilledema, occlusion of retinal vein. superficial bundles of nerve fibers that radiate from the optic disc. Fundus
Hemorrhage
May be in clusters or linear streaking at the edges.
Develops when blood escapes into the potential space between the Larger than retinal hemorrhages. Obscures any underlying vessels
Preretinal Hemorrhage Fundus
retina and vitreous. Common with sudden increase in ICP. since it is anterior to retina.
Abnormal Variations
Deep Retinal Small, rounded, slightly irregular red spots ("dot" or "blot"
Occur in deeper layer of retina. Common in DM. Fundus
Hemorrhage hemorrhages).
Minute dilatations of very small retinal vessels too small to be seen Tiny, round, red spots seen commonly in and around the macular
Microaneurysms Fundus
ophthalmoscopically. Common in DM retinopathy and other causes. area.
More numerous, tortuous, and narrower blood vessels. Grow into
Formation of new blood vessels. Common in the late, proliferative
Neovascularization vitreous, which can cause retinal detachment or hemorrhage and Fundus
stage of DM retinopathy.
loss of vision.
Soft Exudates: Cotton White or grayish, ovoid lesions with irregular, soft borders. Usually
Result from infarcted nerve fibers. Common in HTN. Fundus
Wool Patches smaller than the disc.
Creamy or yellowish, often bright, lesions with well-defined hard
Hard Exudates Common in DM and HTN. borders. Small and round, but may coalesce into larger, irregular Fundus
spots. Clusters, circular, star-shaped patterns.
Yellowish or round spots. Edges may be soft or hard. May
Drusen Common in normal aging, age-related macular degeneration. Fundus
concentrate at the posterior pole.
, Acute and chronic HTN changes may manifest in the eyes from
acute changes from malignant HTN and chronic changes from long-
Hypertensive term, systemic HTN. Ocular changes can be the initial finding in an Areas of focal or generalized narrowing. The light reflex is also
Retinopathy asymptomatic pt with HTN. Arteriosclerotic changes are chronic narrowed. The arterial wall thickens and becomes less transparent.
changes resulting from systemic HTN. In the retina, atherosclerosis
and arteriolosclerosis dominate.
Full and tortuous. Develop an increased light reflex with a bright
Copper Wiring Type of arteriolar change. Retinal Vessels
coppery luster.
Portion of a narrowed artery develops such an opaque wall that no
Silver Wiring Type of arteriolar change. Retinal Vessels
blood is visible within it.
Hypertensive Retinopathy
Chronic HTN stiffens and thickens arteries. At A-V crossing points,
A-V Nicking Vein appears to stop abruptly on either side of the artery. Retinal Vessels
arteries indent and displace veins.
Tapering Vein appears to taper down on the side of the artery. Retinal Vessels
Vein is twisted on the distal side of the artery and forms a dark, wide
Banking Retinal Vessels
knuckle.
Slight narrowing, sclerosis, and tortuosity of the retinal arterioles.
Group 1
Mild, asymptomatic HTN.
Definite narrowing, focal constriction, sclerosis, and A-V nicking. BP
Group 2
is higher and sustained. Few, if any, symptoms r/t BP.
Retinopathy (cotton wool patches, arteriolosclerosis,
hemorrhages). BP is higher and more sustained. Clinical
Group 3
manifestations of headaches, vertigo, and nervousness. Mild
impairment of cardiac, cerebral, and renal fx.
Neuroretinal edema, including papilledema. Siegrist streaks,
Elschnig spots. BP persistently elevated. Clinical manifestations of
Group 4
headaches, asthenia, weight loss, dyspnea, and visual disturbances.
Impairment of cardiac, cerebral, and renal function.
Microaneurysms, dot and blot hemorrhages, flame-shaped
hemorrhages, retinal edema and hard exudates, cotton wool spots,
Diabetic Retinopathy Microaneurysms are the earliest clinical sign. Fundus
venous loops and venous bleeding, intraretinal microvascular
abnormalities, macular edema.
At this earliest stage, microaneurysms occur. Small areas of balloon-
Mild Nonproliferative like swelling in the retina's tiny blood vessels. At least 1
Fundus
Retinopathy microaneurysm and also dot, blot, or flame-shaped hemorrhages in
all 4 fundus quadrants.
, As the disease progresses, some blood vessels that nourish the
Diabetic Retinopathy
retina are blocked. Presence of hemorrhages, microaneurysms, and
Moderate
hard exudates. Intraretinal microaneurysms and dot and blot
Nonproliferative Fundus
hemorrhages of greater severity in 1-3 quadrants. Cotton wool
Retinopathy
spots, venous calibre changes, including venous beading, and
intraretinal microvascular abnormalities are present but mild.
At least 1 of the following should be present: Sever hemorrhages
Severe and microaneurysms in all 4 quadrants of fundus, venous beading
Nonproliferative which is more marked in at least 2 quadrants, and/or intraretinal Fundus
Retinopathy microvascular abnormalities with are more severe in at least 1
quadrant.
Neovascularization is the hallmark. Microvascular pathology with New vessels growing on the retina = NVE (neovascularization
Proliferative capillary closure in the retina leads to hypoxia of tissue. Hypoxia elsewhere). Those on optic disc are called NVD (NV of the disc).
Fundus
Retinopathy leads to release of vasoproliferative factors which stimulate new These new vessels can bleed and produce hemorrhage into the
blood vessel formation to provide better oxygenation of tissue. vitreous.
Age-related macular degeneration (AMD) is the leading cause of
irreversible vision loss in the industrialized world. AMD is a
Macular Degeneration Macular Area
Macular Degeneration
degenerative retinal disease, presumably caused by both genetic
and environmental factors.
Dry Atrophic More common, but less severe. Macular Area
Wet
Macular Area
Exudative/Neovascular
Hard and sharply defined. Soft and confluent with altered
Drusen Undigested cellular debris. Macular Area
pigmentation.
, Type Condition Description
Inflammation of the nasal mucosa, characterized by nasal
Rhinitis congestion, sneezing, postnasal drainage. Acute can be bacterial or
viral. Chronic can be bacterial, allergic, noninfectious.
URIs
Gradual onset over a few days. Rare or low grade fever. Slight body
aches. Fatigue and weakness sometimes. Nasal congestion, sore
Common Cold
throat, mild-moderate hacking cough. Complications include sinus
congestion, AOM, asthma.
Abrupt onset. High fever for 3-4 days. Headache common. Severe
URI
body aches. Fatigue and weakness that can last >3 weeks.
Flu Exhaustion almost always present at beginning. Sometimes sore
throat and nasal congestion. Cough can be severe. Complications
include bronchitis, pneumonia, worsening chronic conditions.
Symptomatic inflammation of the paranasal sinuses and nasal
Rhinosinusitis cavity. Acute <4 weeks. Chronic >12 weeks. Recurrent acute 4 or
more episodes in a year without persistent symptoms in between.
Allergic Rhinitis Most common cause of chronic rhinitis.
Sore Throat
