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Fundoscopy (Ophthalmoscopy) OSCE Examination Quiz
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During direct ophthalmoscopy, you increase the positive (plus) lenses to examine anterior structures. Dark opacities come into focus behind the iris against the red reflex, and the retinal view is blurred. What is the best explanation?
- A A lens subluxation, with the edge of the lens crossing the visual axis You picked ✕
- B A retinal haemorrhage, with blood obscuring the back of the eye You picked ✕
- C A corneal opacity, which clouds the media and can spoil the retinal view You picked ✕
- D A vitreous haemorrhage, with blood obscuring the back of the eye You picked ✕
- E A cataract, which clouds the media and can spoil the retinal view You picked ✓
Correct!
Incorrect
The answer is E: A cataract, which clouds the media and can spoil the retinal view
Explanation
Why E is correct
See Anterior Segment. Option E is correct. On the ophthalmoscope's dioptre dial (the wheel of lenses), turning up the positive, or plus, lenses brings the more superficial structures at the front of the eye into focus. These are the cornea and the lens. Lens opacities show up as dark shadows or specks silhouetted against the red reflex, and they represent cataract, which means clouding of the lens. Finding them at this stage matters because cloudy lens tissue is in the way of the light, which explains why your later view of the retina is blurred. It stops you mistaking an obstruction at the front for disease of the retina. In practice you check the red reflex first, then move closer and add plus lenses to look at the anterior segment, and only then focus back on the retina. A memory aid: plus lenses focus on the front of the eye, so shadows seen there belong to the front of the eye, not to the retina.
- Dial setting: plus lenses bring the front of the eye into focus.
- Structures: the cornea and the lens.
- Lens opacities: dark shadows against the red reflex, which means cataract.
Why the other options are incorrect
- A. A lens subluxation, with the edge of the lens crossing the visual axis: Lens subluxation gives a displaced lens edge, not multiple dark opacities in the media against the red reflex. Your answer
- B. A retinal haemorrhage, with blood obscuring the back of the eye: Retinal haemorrhages are in the retina, so they would be seen when the retina is in focus, not when the ophthalmoscope is focused on the anterior segment with plus lenses. Your answer
- C. A corneal opacity, which clouds the media and can spoil the retinal view: A corneal opacity lies in front of the iris; the opacities here are behind the iris, pointing to lens opacity (cataract). Your answer
- D. A vitreous haemorrhage, with blood obscuring the back of the eye: A vitreous haemorrhage can spoil the retinal view, but the blood lies behind the lens; the stem places the dark opacities behind the iris in the lens, which fits a cataract. Your answer
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What you will practise
More questions from this set. Start the quiz to answer them and see each explanation.
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1
You are checking the red reflex in a young child with an ophthalmoscope. Instead of a matching reddish-orange glow filling each pupil, one pupil shows a white reflex. What is the best interpretation and next step?
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2
You have finished direct fundoscopy after using dilating drops, and the retina looks suspicious for early macular disease. How should you finish off the examination?
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