A&V:13 Disturbances of Vision | 235-258

Question 1

About what percentage of sensory input does CNII provide based on number of fibers ?

Answer 1

44%

Question 2

Define amarousis

Answer 2

partial or complete loss of sight

Question 3

define ambylopia

Answer 3

monocular deficit with normal ocular structures

Question 4

Define Nyctalopia and 5 associated conditions

Answer 4

poor twilight vision - Vit A def, Ret. Pigmentosa, extreme myopia, cataracts,color blindness

Question 5

4 positive visual symptoms

Answer 5

phosphenes, migranous, scintillations, illusions, hallucinations,

Question 6

define presbyopa

Answer 6

decrease in ability to accommodate

Question 7

Visual acuity corrects with pinhole indicating a refractive issue …why ?

Answer 7

light is focused on the fovea without excess distortion

Question 8

What can you not see with the direct ophthalmoscope ?

Answer 8

anything on the retina/ora serrata/pars plana ,anterior to the equator of the globe

Question 9

Three important things to note on the cornea

Answer 9

band keratopathy, pigment changes in descemet’s membrane, arcus senilis (high cholesterol if younger)

Question 10

visual deficits in the lower nasal field could indicate

Answer 10

glaucoma

Question 11

Two things to note when looking at the lens

Answer 11

Cataract ?

subluxation - up in marfans down in homocystinuria

Question 12

Two tings to note about the vitreous humor

Answer 12

hemorrhage
vitreal traction with age = increased RD (burst of flashing lights and increased loaters, Moore temporal lightning streaks (phosphenes) may indicate incipient dtear/detach

Question 13

Anterior Uveitis two associations

Answer 13

HLA-B27 and Vogt-koyanagi-Harada disease (recurrent meningitis)

Question 14

Posterior uveitis tow associations

Answer 14

Sarcoidosis, Behcet disease , lymphoma

Question 15

Describe pathway from ganglion cells to hypothalamus

Answer 15

light–> ganglion cell layer –> optic nerve –> chiasm –> optic TRACT –> Lateral Geniculate ganglion – superior colliculi –> midbrain pretectum –> suprachiasmatic nucleus of hypothalamus

Question 16

Most sensitive nerve bundle to metabolic/toxic effects

Answer 16

papillomacular bundle runs temporal then central (cecocentral scotoma on exam)

Question 17

type of visual deficit seen with compressive damage at nerve/chiasm junction

Answer 17

junctional scotoma (c/l superior quadrantopsia), wilbrands knee possibly a nasal bundle that turns contralaterally breifly

Question 18

anterior wall of the third ventricle is formed by the

Answer 18

optic chiasm

Question 19

3 inferior and 2 superior optic chiasm compressive etiologies

Answer 19

pituitary adenoma, aneurysm, meningiom of the tuberculum sellae
superiorly by a craniopharyngioma or dilated 3rd ventricle

Question 20

blood supply of lateral geniculate body and visual deficit seen

Answer 20

ant/post choroidal arteries

multiple sectoral field deficit

Question 21

two major branches of the ophtalmic artery to the eye

Answer 21

posterior ciliary artery (gives rise to arterial circle of zinn haller in lamina cribrosa)
central retinal artery

Question 22

Antomical deviation seen in albinism

Answer 22

majority of optic fibers (including temporal) decussate at chiasm

Question 23

Two findings in chronic HTN on the retina

Answer 23

straightened arterioles (nicking) 
silver wire

Question 24

HTN findings that are likely indicators of CNS HTN changes.

Answer 24

cotton wool spots (soft exudates, infarct of NFL causing cytoid bodies (terminal swelling of nerve heads) and, micro aneurysms

Question 25

Hard vs soft exudates

Answer 25

soft will obscure vessels , blurry.

Question 26

falme/splinter hemorrhages vs. dot and blot hemorrhages

Answer 26

superficial layer of horizontal nerve fibers vs. vertical alignment of outer plexiform layer (deeper)

Question 27

Roth spot , define

Answer 27

hemorrhage (splinter and dot) that has an white spot of lipid/histiocytes,fibrin and amorphous material)

Question 28

Drusen are associated with

Answer 28

ARMD

Question 29

buried drusen vs peripheral dursen

Answer 29

pseudopapilledema vs. not dead axons and not visibel on CT

Question 30

You see a big artery and big vein extending out of view what should be concerned for ?

Answer 30

hemangioblastoma

Question 31

Four ischemic lesions to the retina

Answer 31

TMB (embolus) CRAO CRVO AION

Question 32

metamorphopsia

Answer 32

distortion of vision and generally not acuity (serous retinopathy possibly caused by cstoids)

Question 33

Examples of chorioretinits and degnetrations of retina

Answer 33

toxo,histo etc. | RP (assoc with other mitos) , paraneos, medications (vigabatrin,toxifen,phenothiazine,niacin,plaquenil bulls eye)

Question 34

What is a macular photostress test

Answer 34

test for retinal disease by shining strong light in eye for 10s and timing necessary to return to pretest visual acuity (nl =

Question 35

does papilledema cause RAPD ?

Answer 35

No unless is it succeeded by optic atrophy

Question 36

signs of mild papilledema

Answer 36

blurring of sup/ing disc margin and vein enlargement/hyperemia of dics

Question 37

SVP are a reliable indicator that...

Answer 37

pressure is below 200 mm H20

Question 38

signs of more serious papilledema

Answer 38

optic disc mushrooming, cottonwool spots

Question 39

papilledema with cl optic atrophy

Answer 39

Foster-kennedy syndrome think olfactory meningioma or frontal lobe tumor I/L to atrophy

Question 40

two elements of pathogenesis of papilledema

Answer 40

blockage of axoplasmic flow and vascular congestion

Question 41

visual loss with papilledema

Answer 41

binocular,non or transient blurring, enlargement of blind spot and constriction of visual fields

Question 42

commonality between AION and Optic neuritis

Answer 42

RAPD

Question 43

pain difference in AION vs optic neuritis

Answer 43

temporal in AION vs. in the globe

Question 44

visual loss in optic neuritis

Answer 44

monocular usually, rapid, central scotoma

Question 45

does acute papilledema affect visual acuity ?

Answer 45

not greatly

Question 46

blurring of vision when hot

Answer 46

uhthoff phenomenon

Question 47

8 general categories of optic neuropathy

Answer 47

Demyelinative, Ischemia, parainfectious, toxin/drugs, deficiency, hereitary, compressive, radiation

Question 48

why are most cases of optic neuritis not seen on exam ?

Answer 48

most are retrobulbar

Question 49

temporal pallor of the optic disc may indicate a h/o

Answer 49

optic neuritis

Question 50

three things about AION

Answer 50

abrupt, central fixation visual loss (altitudinal in ischemic), painless

Question 51

RF for AION

Answer 51

small cup-disc ratio

Question 52

Three things that have been temporally linked with ION

Answer 52

sildenafil, massive blood loss , laminectomy

Question 53

Visual point to point projections exists at the ____ then the same again to the ____.

Answer 53

Lateral geniculate ganglion | calcarine cortex

Question 54

what color is best for tangent screen ?

Answer 54

red-green

Question 55

changes of red hue may indicate ___

Answer 55

a scotoma

Question 56

what lesions cause a scotome

Answer 56

those that are prechiasmal (optic nerve, macula, retina)

Question 57

how are scotomas described

Answer 57

position and shape

Question 58

define dolichoectatic

Answer 58

elongation and dilation of artery

Question 59

define palinopsia and locate the lesion

Answer 59

persistence of repetitiive after images , right parietooccipital

Question 60

blue yellow vs red green

Answer 60

retina damage - loss of blue yellow | optic nerve red green is more likely to be lost

Question 61

Localize prosopagnosia

Answer 61

bilateral occipitotemporal (specifically the infer medial fusiform and lingual gyri)

Question 62

two types of ambylopia (degradation of vision and disuse of fovea)

Answer 62

anisometropic (unequal refraction) | strabismus