38 & 39 Clinical: Opthalmology I and II

Question 1

Pupils: Basics

• What are the 2 kinds of muscles that control the pupil and what is the function of each?

Answer 1

Question 2

Pupils: Basics

• What part of the ANS governs pupil constriction?
• What are the 3 general things that will cause constriction to increase?

Answer 2

Question 3

Pupils: Basics

• What part of the ANS governs pupil dilation?
• What are the 3 general things that will cause dilation to increase?

Answer 3

Question 4

Pupils: Basics

• What happens to the pupil parasympathetic control of the right eye is disrupted?
• What happens to the pupil sympathetic control of the right eye is disrupted?

Answer 4

Question 5

Pupil: Basics

• What is it called when someone has unequal pupils?
  
  • How can you tell it is a problem with parasympathetic or sympathetics?
• If size difference is greatest in bright light:
  
  • Is this a sympathetic or parasympathetic problem?
  • Which eye is the dysfunctional one?
• If size difference is greatest in dim light:
  
  • Is this a sympathetic or parasympathetic problem?
  • Which eye is the dysfunctional one?

Answer 5

Question 6

Pupil: Basics

• Physiologic anisocoria
  
  • What percentage of the population has this?
  • What is the size difference between the pupils?

Answer 6

Question 7

Pupil: Parasympathetic

• If you shine a bright light in your left eye, both eyes will constrict.
  
  • What eye represents the afferent pathway, and what nerve is utilized?
  • Which pupil is the efferent pathway affecting, and what nerve is being utilized?

Answer 7

Question 8

Pupil: Parasympathetic

• Fill in the blacked out words about the AFFERENT pathway

Answer 8

Question 9

Pupil: Parasympathetic

Fill in the blacked out words about the EFFERENT pathway

Answer 9

Question 10

Pupil: Parasympathetic

• What neurotransmitter is released from the short ciliary nerves?
  
  • What muscle does this act NT act on?

Answer 10

Question 11

Pupil: Parasympathetic

• Blown Pupil aka 3rd nerve palsey
  
  • What are the 2 possible causes of this?
    
    • What structure would compress the parasympathetic fibers on the 3rd cranial nerve?
  • Pharmacologic Mydriasis
    
    • What kind of drugs can cause this?
    • What is notable about the size of the pupil in this?

Answer 11

Question 12

Pupil: Sympathetics

• Who many types of neurons make up the oculosympathetic pathway? Which ones are pre-ganglionic and which ones are post-ganglionic?

Answer 12

Question 13

Pupil: Sympathetic

• 1st order neuron
  
  • Where is the cell body of this type of neuron located?
  • Where does it axons synapse in the spinal cord?

Answer 13

Question 14

Pupil: Sympathetic

• 2nd order neuron
  
  • What pathway does this neuron take to get from the inferior cervical ganglion to the superior cervical ganglion?
    
    • Do not forget to mention any organ or artery involved

Answer 14

Question 15

Pupil: Sympathetic

• 3rd order neuron
  
  • These axons run with the common carotid artery. What artery do these axons run with after the bifurcation: the internal or external carotid artery?
  • These axons run through the carotid cavernous sinus along with what other cranial nerves?
  • What muscles does the 3rd order neuron innervate?

Answer 15

Question 16

Pupil: Sympathetic

• What are the physical manifestations of dysfunction in the sympathetic pathway?

Answer 16

Question 17

Pupil: Sympathetic

• Horner’s Syndrome
  
  • Besides miosis and ptosis, what else can happen to the eye in this syndrome?
  • List 3 common causes of this syndrome

Answer 17

Question 18

Pupil: RAPD

• What does RAPD stand for?
• What nerve is implicated?
• Are the pupils equal or unequal?
• What kind of response do the pupils have when light is shined into them?

Answer 18

Question 19

Optic Nerve: Basics

• What forms the optic nerve?
• What is axoplasmic flow/transport?
  
  • Where does this usually get damned up, and what is the consequence of this?

Answer 19

Question 20

Optic Nerve: Basics

• What are the 3 main causes of optic disc swelling?

Answer 20

Question 21

Optic Nerve: Disease

• What is the difference between disc edema and papilledema?
  
  • What can cause disc edema?
    
    • What kind of exam can you visualize this?
  • What can cause papilledema?

Answer 21

Question 22

Optic Nerve: Disease

• What is idiopathic intracranial hypertension (pseudomotor cerebri)?
  
  • Who usually gets this disease?
  • What 3 symptoms do these patients have?
  • Patients will lose their vision if this is untreated. What part of their vision will be lost first?

Answer 22

Question 23

Optic Nerve: Disease

• If you suspect a patient has increased intracranial pressure, what 2 things must you do before you assume it is idiopathic intracranial hypertension?
  
  • Why is the order of these 2 things EXTREMELY important?

Answer 23

Question 24

Optic Nerve: Disease

• What will giant cell arteritis or temporal arteritis do to the optic nerve?
  
  • What patient population does this effect?
  • What do patients present with (3)?
  • What part of the patient’s head may be tender?
  • What will you see when you examine the optic nerve via Funduscopic exam?

Answer 24

Question 25

Optic Nerve: Disease

• Giant Cell Arteritis
  
  • This can cause blindness. If you suspect a patient has this, what 2 labs must you get?
  • If the above labs are elevated, what is your next move?
  • What is the definitive way to dx this?

Answer 25

Question 26

Optic Nerve: Disease

• What kind of diseases are associated with optic neuritis?
  
  • What is the most common disease for the above answer?
    
    • What kind of patients usually get this disease?
    • What kind of ocular symptoms do patients have?
    • What test needs to be done in order to assess the possibility a patient may have this disease?
    • How is this disease treated?

Answer 26

Question 27

Visual Fields

• Nasal Retina
  
  • What does this do?
  • Does innervation from this cross over at the chiasm or does it stay on the same side?
  • What does a pituitary tumor do to your vision?

Answer 27

Question 28

Visual Fields

• What is important to remember when considering the visual manifestations of lesions in the brain, relative to the optic chiasm.
  
  • What will be the visual manifestations of damage in the parietal lobe?
  • What will be the visual manifestations of damage in the temporal lobe?
  • What will be the visual manifestations of damage on the right side of the brain?

Answer 28

Question 29

Visual Fields

• Define
  
  • Homonymous hemianopia
    
    • What lesion is associated with this?
  • Inferior quadrantanopia
    
    • What lesion is associated with this?
  • Superior quadrantanopia
    
    • What lesion is associated with this?
• What lesion is associated with a pituitary tumor?
• What will damage to the occipital lobe result in?

Answer 29

• Homonymous hemianopia
  
  • Hemianopic visual field loss on the same side of both eyes.
• Inferior quadrantanopia
  
  • a loss of vision in the same lower quadrant of the visual field in both eyes
• Superior quadrantanopia
  
  • a loss of vision in the same upper quadrant of the visual field in both eyes

Question 30

Higher Visual Functions

• What are the two locations that higher visual processing occurs?
  
  • What one is associated with the “WHAT” type of processing?
  • What one is associated with the “WHERE” type of processing?
  • What one is associated with facial processing?

Answer 30

Question 31

Higher Visual Functions

• Define the following conditions and state if it involves the dorsal or ventral streams of vision
  
  • Topographagnosia
  • Simultanagnosia
  • Prosopagnosia
  • Astereognosis
  • Akinetopsia
  • Achromatopsia

Answer 31