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Ophthalmology Week 1 2017/18 > 3: Anatomy - orbital autonomics > Flashcards

3: Anatomy - orbital autonomics Flashcards

1
Q

Which two bones of the bony orbit is the suspensory ligament attached to?

A

Lacrimal (medially)

Zygoma (laterally)

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2
Q

If the zygoma is fractured, what happens to the suspensory ligament and the eye?

What symptom does this cause?

A

Suspensory ligament ruptures and eye drops

Diplopia (double vision)

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3
Q

Which cranial nerve is response for the sensation of the face?

A

CN V

(Trigeminal nerve)

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4
Q

Which nerves are responsible for sensation of

a) mandible and TMJ
b) maxilla
c) angle of mandible
d) cornea, conjunctiva and bridge of nose

A

a) CN V3

b) CN V2

c) C2 and C3

d) CN V1

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5
Q

What are the names of

a) CN V1
b) CN V2
c) CN V3?

A

a) Ophthalmic divison of trigeminal nerve

b) Maxillary division of “” ““

c) Mandibular division of “” ““

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6
Q

Which cranial nerves are responsible for the

a) sensory
b) motor

parts of the blink reflex?

A

a) CN V1

b) CN VII

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7
Q

Which cranial nerve supplies the orbicularis oculi?

A

CN VII (Facial nerve)

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8
Q

Which part of the orbicularis oculi is responsible for blinking?

A

Palpebral part

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9
Q

Which nerves pass through the

a) supraorbital notch / foramen
b) infraorbital notch

and which cranial nerves do they belong to?

A

a) Supraorbital nerve from CN V1

b) Infraorbital nerve from CN V2

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10
Q

Which fluid nourishes the cornea and washes away debris?

A

Lacrimal fluid

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11
Q

Which structures control

a) pupil diameter
b) lens shape?

A

a) Iris

b) Ciliary body

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12
Q

Where do sympathetic nerves originate?

A

Autonomic centres in the brain

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13
Q

At which levels do sympathetic nerves exit the spinal cord?

A

T1 - L2

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14
Q

Sympathetic nerves exit the spinal cord from __ - __.

A

T1 - L2

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15
Q

After exiting the spinal cord, where do sympathetic nerves go?

A

Sympathetic chain

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16
Q

How do sympathetic nerves reach somatic areas e.g the skin from the sympathetic chain?

A

Alongside spinal nerves

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17
Q

How do sympathetic nerves reach visceral areas i.e the organs?

A

In splanchnic nerves:

cardiopulmonary splanchnic nerves

abdominopelvic splanchnic nerves

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18
Q

How do sympathetic nerves reach

a) organs
b) the skin?

A

a) Splanchnic nerves

b) Spinal nerves

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19
Q

At which spinal level do sympathetic nerves exit the spinal cord to supply the head and neck?

A

T1

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20
Q

The sympathetic nervous system travels in the ___ outflow before reaching the sympathetic chains.

A

thoracolumbar outflow

T1 to L2

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21
Q

Where do sympathetic nerves synapse in the head and neck?

A

Superior, middle and inferior cervical ganglia

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22
Q

Sympathetic nerves for the head and neck exit the spinal cord at __ and travel in the sympathetic chains before synapsing where?

A

T1

Superior, middle and inferior cervical ganglia

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23
Q

After they synapse at the cervical ganglia, which structures do sympathetic nerves travel alongside?

A

Arteries

In peri-arterial plexuses

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24
Q

Which artery transports post-synaptic sympathetic nerves to the orbit?

A

Ophthalmic artery

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25
Q

Which cranial nerves do parasympathetic nerves come from?

A

CN III (Oculomotor)

CN VII (Facial)

CN IX (Glossopharyngeal)

CN X (Vagus)

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26
Q

CN III, VII, IX and X all transmit (sympathetic / parasympathetic) fibres.

A

parasympathetic

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27
Q

Apart from cranial nerves, which area transmits parasympathetic fibres?

A

Sacrum

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28
Q

The parasympathetic nervous system has a ___ outflow - why?

A

craniosacral

Parasympathetic nerves originate from CN III, VII, IX and X plus the sacral spinal nerves

Where as the sympathetic nervous system has a thoracolumbar outflow because its nerves come from T1 - L2 spinal nerves only

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29
Q

The (sympathetic / parasympathetic) nervous system supplies the body wall.

A

sympathetic

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30
Q

Which internal organs are supplied by parasympathetic fibres of

a) CN III
b) CN VII
c) CN IX
d) CN X
e) Sacral spinal nerves?

A

a) Eye
b) Submandibular, sublingual and lacrimal glands
c) Parotid glands
d) Neck, chest and abdominal organs up to midgut
e) Hindgut, pelvic and perineal organs

31
Q

Through which hole in the bony orbit does CN III exit?

A

Superior orbital fissure

32
Q

Which extraocular muscles are supplied by CN III?

A

Medial rectus

Superior rectus

Inferior rectus

Inferior oblique

Levator palpebrae superioris

33
Q

CN III’s (sympathetic / parasympathetic) fibres control muscles of the ___ and synapse at which ganglion?

A

parasympathetic fibres

eye

ciliary ganglion

34
Q

CN III splits into superior and inferior ___ to supply muscles of the eye.

A

divisions

35
Q

Which extraocular muscles are supplied by the

a) superior division
b) inferior division

of CN III?

A

a) Superior rectus, Levator palpebrae superioris

b) Medial rectus, Inferior rectus, Inferior oblique

36
Q

Which nerves supply sympathetic and parasympathetic fibres to control the diameter of the iris and the shape of the lens?

A

Long ciliary nerve (superior)

Short ciliary nerve (inferior)

37
Q

The eyes have a lot of involuntary __ in response to different stimuli.

A

reflexes

38
Q

Sympathetic fibres…

(open / close) the eyes

get (more / less) light into the eyes

focus on (near / far) objects

produce lacrimal fluid in response to (debris / emotions)

A

OPEN the eyes

get MORE light in

focus on FAR objects

produce lacrimal fluid in response to EMOTIONS

39
Q

Parasympathetic fibres…

get (more / less) light into the eyes

focus on (near / far) objects

A

LESS light into the eyes

focus on NEAR objects

40
Q

Which muscle opens the upper eyelid?

Which cranial nerve supplies it?

Which type of autonomic fibres cause it to open in a reflex?

A

Levator palpebrae superioris

CN III

Sympathetic

41
Q

What structure is the levator palpebrae superioris attached to?

A

Superior tarsus

42
Q

Which autonomic fibres dilate the pupils?

A

Sympathetic fibres

43
Q

A non-physiologically dilated pupil is called a ___ pupil.

A

mydriatic

44
Q

Which muscle dilates the pupil?

A

Dilator pupillae

45
Q

Which autonomic fibres constrict the pupils?

A

Parasympathetic fibres

46
Q

Which muscle constricts the pupils?

A

Sphincter pupillae

47
Q

In which light conditions does the pupil

a) constrict
b) dilate?

A

a) Bright light

b) Low light

48
Q

A non-physiologically constricted pupil is called a ___ pupil.

A

miotic pupil

49
Q

Mydriatic pupils are abnormally ___.

Miotic pupils are abnormally ___.

A

dilated

constricted

50
Q

Which syndrome, caused by reduced sympathetic impulses to the head and neck, causes miotic pupils?

A

Horner’s syndrome

51
Q

Which drugs cause miosis?

A

Opiates

52
Q

A fixed-dilated pupil is a sign of problems with which cranial nerve?

A

CN III

53
Q

What is the pupillary light reflex?

A

Pupils BILATERALLY constrict into response to bright light

54
Q

Is the pupillary light reflex unilateral or bilateral?

A

Bilateral

55
Q

Which nerves control the

a) sensory
b) motor

parts of the pupillary light reflex?

A

a) CN II

b) CN III

56
Q

The pupillary light reflex is a _ neurone chain.

A

4 neurone chain

57
Q

Which ganglia do impulses from the optic nerve travel through?

A

Retinal ganglia

58
Q

Which part of the midbrain do impulses synapse at in the pupillary light reflex?

A

Pretectal ganglia

59
Q

Which specific part of the pretectal nucleus do nerve impulses synapse at in the pupillary light reflex?

A

Edinger-Westphal nucleus

60
Q

Which cranial nerve has parasympathetic fibres in the Edinger-Westphal nucleus?

A

CN III

Oculomotor nerve

61
Q

After synapsing at the EW nucleus, parasympathetic nerves then synapse in ___ ganglia before travelling along which nerve to the sphincter pupillae muscles?

A

ciliary

short ciliary nerves

62
Q

Which structures are responsible for the shape of the lens?

A

Suspensory ligament

Ciliary muscles

63
Q

What do ciliary muscles do to focus the lens on near objects?

Which autonomic nerves control this?

A

Contract

Parasympathetics

64
Q

What do ciliary muscles do to focus the lens on far objects?

Which autonomic nerves control this?

A

Relax

Sympathetic

65
Q

When the ciliary muscles contract, the lens (flattens / becomes spherical) to focus on (near / far) objects.

A

contraction

becomes spherical

near objects

66
Q

When the ciliary muscles relax, the lens (flattens / becomes spherical) to focus on (near / far) objects.

A

relaxation

flattens

far objects

67
Q

Which cranial nerve controls the ciliary muscles?

A

CN III

Oculomotor nerve

68
Q

What is the accomodation reflex?

A

Focusing of eyes on object coming towards you in the midline

69
Q

In the accommodation reflex, CN III controls three different actions. What are they?

A

1. Bilateral pupillary constriction by sphincter papillae muscles

2. Adduction of eyes towards midline by medial rectus muscles

3. Focusing of lens on near object by ciliary muscles

70
Q

Which fluid nourishes the cornea?

A

Lacrimal fluid

71
Q

Lacrimal fluid is also known as what?

A

Tears

72
Q

Which cranial nerves control the

a) sensory
b) motor

components of the reflex production of lacrimal fluid?

A

a) CN V1 - ophthalmic division of trigeminal nerve

b) CN VII - facial nerve (which supplies lacrimal glands)

73
Q

With regard to the eyes and face, what are the functions of CN VII?

A

Glands: lacrimal, submandibular, sublingual

Muscles: orbicularis oculi (and other muscles of facial expression)

74
Q

What are the symptoms of Horner’s syndrome?

A

Miosis (constricted pupil unilaterally)

Ptosis (droopy eyelid ipsilaterally)

Reduced sweating (anhydrosis)

Increased warmth and redness

Ophthalmology Week 1 2017/18 (10 decks)

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