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NE Clinical Exam 1 > 11. Eyes and 12. Embryo clinical > Flashcards

11. Eyes and 12. Embryo clinical Flashcards

1
Q

Describe cleft lips and cleft palates

A

Form from defects in fusion of either the palatine processes or the maxillary processes to form the palate and the upper lip respectively

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2
Q

Which type of cleft lip/palate is most common and on which side?

A

Unilateral Left sided cleft lip is the most common

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3
Q

Describe choanal atresia

A

bony abnormalities of the pterygoid that causes an upper airway obstruction that gets worse with feeding and better with crying Basically the bone blocks the airway and causes issues

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4
Q

What is glossoschissis?

A

Bifid tongue

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5
Q

What is Ankyloglossia?

A

Short frenulum, can present with problems breastfeeding and speaking

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6
Q

Define macroglossia

A

Enlarged tongue; common with Down Syndrome and Beckwith-Wiedemann

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7
Q

Describe an orbital blowout fracture

A

Caused by indirect trauma; occurs medially and inferiorly in the maxillary bone The fracture is severe enough that a part of the orbital contents may go through the fractured area and protrude into the maxillary sinus

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8
Q

What are the sx of an orbital blowout fracture?

A

Diplopia, globe ptosis (eye sinking) and protrusion of the eyeball When the patient is asked to look up, they are not able to, and the eyeball is fixed

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9
Q

What is pictured?

A

Inferior floor fracture of the right orbit that is consistent with a blowout fracture. You can see the orbital contents going down into the maxillary area

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10
Q

What would be consistent with these clinical findings? Bruising, eye sinking, and inability to raise the eye on the affected side?

A

Orbital blowout fracture

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11
Q

Describe how you would clinically test the function of the superior rectus.

A
  1. You want to test elevation only of a rectus muscle, which means in order to do so, you need to abduct the eye via the lateral rectus muscle. (Have the patient abduct their eye)
  2. Since the superior rectus tests elevation, you can have the patient elevate their eye from this position, as the inferior oblique muscle, the other elevator of the eye is perpendicular to the gaze axis and is trapped in its function
  3. If the patient is able to elevate their eye then you know that the superior rectus muscle is intact and there is no issue with it or the oculomotor nerve that innervates it
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12
Q

When you are testing the superior rectus muscle with the inferior oblique trapped, what portion of the oculomotor nerve are you testing?

A

The superior division of the oculomotor nerve is being tested; if they can elevate their eye, then you know that there is not any damage in the upper division of the nerve

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13
Q

How do you clinically test the functionality of the inferior oblique muscle?

A
  1. In order to make sure that the oblique muscles are the only ones that are in charge of elevation, the patient must adduct their eye (look medially)
  2. With the eye adducted, have the patient elevate their eye.
  3. If they are able to do so, then you know that the oculomotor nerve is intact to that area of the eye
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14
Q

How would you test the functionality of the inferior rectus muscle?

A
  1. In order to tell if a rectus muscle is working, you need to have the eye abducted (looking laterally); have the patient look laterally
  2. In order to test for depression (which is a movement of the inferior rectus), have the patient look down since the superior oblique is now trapped as it is perpendicular to the visual gaze
  3. If they can, then you know that there is no damage to the muscle, which also means that the inferior divsion of the oculomotor nerve is intact
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15
Q

How would you test the functionality of the superior oblique muscle?

A
  1. In order to make sure that the oblique muscles are the only ones being tested, the patient must adduct their eye via the medial rectus (look inwards); so have them do that
  2. The only muscle that is now able to depress the eyeball would be the superior oblique muscle; so you have the patient look down
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16
Q

When testing the superior oblique from the inferior rectus, describe what is also being tested in regards to the nerves.

A

This test is discriminating the functionality of the trochlear nerve (which innervates the superior oblique) from the oculomotor nerve (which innervates the inferior rectus and the medial rectus (adduction to trap the inferior rectus)

***so if your patient is able to adequately perform this test, then you know that the oculmotor nerve and the trochlear nerve are intact (at least the portions that innervate the eye muscles)

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17
Q

What are the actions of the inferior oblique muscle?

A

Elevation, Abduction, Lateral rotation

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18
Q

What are the actions of the superior oblique muscle?

A

Depression, abduction, and Lateral rotation

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19
Q

What are the actions of the superior rectus muscle?

A

Elevation, ADduction, Medial rotation

20
Q

What are the actions of the inferior rectus muscle?

A

Depresses, Adducts, and laterally rotates the eyeball laterally

21
Q

Describe trochlear palsy

A

There is an issue with the superior oblique musle, so the patient is not able to medially rotate the eye as strongly…

  1. Laterally rotated eye which results in a head tilt away from the affected side to try to get the eye in the appropriate position that the body wants
  2. With depression of the of the eyeball, there will be increased diplopia because the superior oblique is not there to fully depress the affected eye
22
Q

Describe abducens palsy

A

The patient cannot look laterally with the affected eye

23
Q

What nerve is damaged if a patient has an eye that is looking down and out?

A

There is not ocular innervation to the LPS, IO, SR, IR, and MR but the SO and the LR are intact.

The SO and the LR are abductors, so the eye will look out and the SO is a depressor, so the eye will be looking down

24
Q

What nerve would you suspect is affected with complete ptosis of the eye?

A

Oculomotor because the LPS is not working adequately

25
Q

What is the result of the oculomotor nerve being damaged on the parasympathetics?

A

They are not able to constrict the eye, so you have pupil dilation

26
Q

What are three things that could result with an oculomotor palsy?

A
  1. Down and out eye
  2. Complete ptosis of the eye
  3. Pupil dilation
27
Q

Describe what happens when there is damage to the superior cervical sympathetics. What is this called? What are the sx?

A

Horner syndrome

  • constriction of the pupil
  • ptosis
  • redness and increased temperature due to vasodilation
  • absemce of sweating
28
Q

What is this picture consistent with clinically?

A

Bulbar conjunctiva

29
Q

What is this picture consistent with clinically?

A

Palpebral conjunctiva

30
Q

What is this picture consistent with clinically?

A

Bacterial conjunctivitis

31
Q

What is this picture consistent with clinically?

A

Viral conjunctivitis

32
Q

What is this picture consistent with clinically?

A

Subconjunctival hemmorhage: rupture of the blood vessels between the sclera and the bulbar conjunctiva

33
Q

Differentiate between complete ptosis and partial ptosis

A

Complete ptosis is the result of a lesion in the GSE of the oculomotor nerve that supplies the levator palpebrae superioris

Partial ptosis results from the damage of the sympathetic tract, or Honrers syndrome, which affects the tarsal muscle

** the tarsal muscle inserts on the pper lip and is innervated by postganglionic sympathetic fibers

34
Q

What is papilledema?

A

A bulging optic disc that is indicative of increased intraocular pressure, which is an emergency

35
Q

What is this picture consistent with clinically?

A

Bulging optic disc; papilledema

36
Q

What do the following arteries anastomose with in the eye?

  1. Ethmoidal
  2. Supraorbital
  3. Supratrochlear
  4. Lacrimal
A
  1. Ethmoidal anastomoses with sphenopalatine
  2. Supraorbital anastomoses with superificial temporal
  3. Supratrochlear anastomoses with angular
  4. Lacrimal anastomoses with middle meningeal
37
Q

If there is a slow occlusion of one of the anastomosis portions of the arterial supply of the eye, what occurs?

A

There is compensation from the other anastomoses in the eye

38
Q

If there is a quick occlusion of one of the blood vessels of the eye, what happens?

A

The anastomoses cannot compensate and the eye and vision is at high risk

39
Q

What are all of the arteries of the eye coming off of?

A

The internal carotid

40
Q

Describe how an infection from the triangle of death is able to be so detrimental

A

The infection can travel into the facial vein or travel posteriorly via the ophthamic (inferior and superior) veins to the cavernous sinus

41
Q

What is this picture consistent with clinically? What is the cause?

A

Central retinal vein occlusion

Cause: hardening of the CRA and HTN in the CRA can compress the CRV

HEmorrhages

Dilated veins

42
Q

What is this picture consistent with clinically? What is the cause?

A

Central Retinal ARtery Occlusion

Cause:

Artherosclerosis, Embolism

Retinal appears which with a cherry red spot where the macula is (because the macula is supplied the choroid which would be unaffected in damage of the retinal artery)

VEins and arteries are attenuated

43
Q

What is Schlemm’s canal? What is found clinically when there is blockage of the Schlemms canal?

A

It is how the aqueous humor is able to drain from the eye and reach the limbal plexus to be removed

If there is blockage, then there is increased pressure of the eye and glaucoma

44
Q

What is this picture consistent with clinically?

A

Hyphema: rupture of the blood vessels that are supplying the anterior chamber of the eye causing a hemorrhage

45
Q

When testing for accomodation (bringing the finger towards the patient) what are the three things that are being testing siultaneously?

A
  1. Convergence
  2. Pupil constrcition
  3. Rounding of the lens

NE Clinical Exam 1 (20 decks)

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