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Anatomy Flashcards

1
Q

What does the frontal nerve divide into?

A
  1. Supraorbital nerve

2. Supratrochlear nerve

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2
Q

What does the frontal nerve innerviate?

A
  1. Medal canthus
  2. Upper eyelid
  3. Forehead
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3
Q

What controls parasympathetic innervation?

A

The SHORT posterior ciliary nerves after SYNAPSING in the ciliary ganglion

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4
Q

What does parasympathetic innervation do for the eye? How does it enter the eye?

A
  1. Accommodation
  2. Pupillary constriction
  3. LACRIMAL GLAND STIMULATION
    Enters the eye as the short posterior ciliary nevers after SYNAPSING with the ciliary ganglion
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5
Q

What does sympathetic innervation do for the eye? How does it enter the eye?

A
  1. Controls pupillary dilation
  2. Vasoconstriction
  3. Controls smooth muscle function of eyelids -Muellers Muscle
  4. Hidrosis
    The nerve fibers follow the arterial supply to the pupil, eyelids, and orbit in a/w the LONG ciliary nerves.
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6
Q

What route do the sympathetic fibers take?

A

Follow arterial supply and LONG CILIARY nerves

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7
Q

What is the strongest orbital wall?

A

LATERAL wall

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8
Q

Which bone in the orbit is not made up of bone?

A

Lesser wing of sphenoid (cartilage)

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9
Q

How many bones make up the medial wall?

A

FOUR - “SMELL”

  1. Ethmoid
  2. Maxillary
  3. Lacrimal
  4. Sphenoid - lesser wing
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10
Q

The Frontal sinus drains into which meatus?

A

Middle

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11
Q

Which sinus reaches full size after puberty?

A

Sphenoid

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12
Q

How many fat pads are in the upper eyelid and which is paler?

A

2, NASAL

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13
Q

What embryological tissue makes up the orbital septum?

A

Mesoderm

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14
Q

What divides the 2 lobes of the lacrimal gland?

A

Levator aponuerosis

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15
Q

What are the 3 types of innervation for the lacrimal gland?

A
  1. Secremotor - CN 7
  2. Sensory - CN 5
  3. Sympathetic - superior cervical ganglion
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16
Q

Upper eyelid approximates what structures?

A

Levator aponeurosis to the PRETARSAL Orbiuclaris and skin (not just to the superior border of the tarsus)

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17
Q

Muscle of Riolan is made up of which muscle?

A

Pretarsal orbicularis

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18
Q

Horner’s muscle is made up of which muscle?

A

MEDIAL deep head of pre tarsal orbicularis

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19
Q

What cranial nerve innervates the frontalis muscle?

A

CN7

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20
Q

What muscle pulls the EYEBROW medially and inferiorly producing the vertical glabellar wrinkle?

A

Corrugator - CN7

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21
Q

What muscle pulls the FOREHEAD medially and medial eyebrow inferiorly producing horizontal lines in the nose?

A

Procerus - CN7

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22
Q

What orbital bone does the legator palpebrae originate and where?

A

From the LESSER wing of the sphenoid bone Above the annulus of zinn.

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23
Q

Where does the Muellers muscle originate?

A

at the level of Whitnall’s ligament originating from the undersurface of the levator.

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24
Q

Where is the peripheral arterial arcade found?

A

Between aponeurosis and muellers muscle?

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25
Q

Which limb of the medial canthal tendon is more important for appearance and function?

A

Posterior limb

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26
Q

Does the medial or lateral canthan tendon insert higher?

A

Lateral - 3mm

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27
Q

Sebaceous carcinoma orginates from which glands of the eyelid?

A
  1. Zeiss

2. Meiobian

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28
Q

What are the glands of the caruncle?

A
  1. Zeiss

2. Goblet cell

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29
Q

Which MRI image offers the best anatomical detail and has shorter acquisition times and less artifact?

A

T1

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30
Q

Which MRI image can differentiate a melanotic lesion from hemorraghic process of the choroid?

A

T2

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31
Q

Which fungal organism is non-septated, large branching hyphae that causes painful orbital apex syndrome and retinal vascular occlusions?

A

Mucormycosis

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32
Q

Which fungal bug causes necrotizing angitis, endophthalimitis and is septated branching hyphae?

A

Aspergillus

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33
Q

IOI in kids is U/L or B/L and what is associated?

A
  • 33% B/L

- Papillitis and iritis

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34
Q

What are the optic nerve lengths?

A 
125-1017
1 - Intraocular
25 - orbital
10 - intracanalicular
17 - intracranial
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35
Q

What are the 7 things that are transmitted through the SOF?

A
  1. CN3
  2. CN4
  3. V1
  4. SOVein
  5. CN6
  6. Sympathetic fibers to the iris dilator
  7. NASOCILLARY NERVE
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36
Q

What bone is the optica canal located in?

A

Lesser wing of sphenoid

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37
Q

How long is the optic canal?

A

10mm

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38
Q

What does the optic canal transmit?

A
  1. CN2
  2. Ophthalmic Artery
  3. Sympathetic fibers to the blood vessels (from the internal carotid plexus)
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39
Q

Foramen ovale transmits?

A

V3

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40
Q

Foramen rotundum transmits?

A

V2

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41
Q

How many mm does the central retinal artery enter posterior to the globe?

A

13mm

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42
Q

How many mm does the central retinal vein enter poster to the globe?

A

10mm

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43
Q

What are the 3 divisions of CNV1?

A
  1. NASOCILLARY (inside cone)
  2. Frontal
  3. Lacrimal
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44
Q

Does the short ciliary nerve of the nasocillary nerve synapse with the ciliary ganglion?

A

NO

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45
Q

In IOI on CT what is the ring sign?

A

Contrast enhanced sclera

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46
Q

Which muscles are mostly affected in orbital myositis?

A

MR + LR (33%) each

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47
Q

Which disease process has less pain and proptosis?

A

Orbital myositis

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48
Q

Sclerosing orbital pseudotumor is a/w which systemic condition?

A

Retroperitoneal fibrosis

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49
Q

What is Von Graffe sign?

A

Lid lag on DOWNGAZE

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50
Q

Recession of inferior rectus can cause increase or decreased lower lid retraction?

A

Increased because inferior rectus is connected to lower eyelid retractors.

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51
Q

What type of trauma is most common with direct (or high flow) CC fistulas?

A

Basal skull fracture

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52
Q

In low flow (or dural) CC fistulas what is the vascular communication?

A

carotid artery meningeal branches and dural walls of the cavernous sinus

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53
Q

Where are hemangiopericytoma located, in who, reflectivity, systemic status?

A

Superior orbit, women, metastasize to lung, bone, and liver.

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54
Q

Which sinus is most common for a mucocele to form?

A

Frontoethmoid sinus

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55
Q

How does botox work on the molecular level?

A

Stops release of ACH by disrupting Ca metabolism

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56
Q

What herniates in blepharochalsis?

A

Lacrimal gland

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57
Q

What are the 3 causes of involutional ENTROPION?

A
  1. Canthal tendon laxity
  2. Over-riding preseptal orbicular is
  3. Capsule palepebral fascia dehisence
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58
Q

Paralytic ECtropion is due to what?

A

CN7 Palsy

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59
Q

Appocrine vs Eccrine hydrocytomas, which has pigmented fluid?

A

Apocrine

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60
Q

Muir-Torre syndrome has what 3 things?

A
  1. Keratocanthoma
  2. GI viseral tumors
  3. Multiple sebaceous neoplasms
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61
Q

What eyelid lesion appears as a blue lesion above the skin with blue basaloid cells and keratin cysts and squamous eddies?

A

Seborrehic keratosis

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62
Q

What is pilomatrixoma a/w?

A
  1. Myotonic Dystrophy

2. Gardner’s syndrome

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63
Q

Actinic keratosis can evolve into what?

A
  1. BASAL cell CA

2. Squamous cell

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64
Q

Which nevi are pigmented?

A
  1. Junctional

2. Compound

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65
Q

Name 3 umbilicated lesions?

A
  1. Keratocanthoma
  2. BCC
  3. Mulloscum
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66
Q

How does SqCC spread?

A
  1. Direct extension

2. Metastsize via lymphatics and hematogenously

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67
Q

Give the order - most to least - common eyelid malignancy?

A
  1. BCC 2. SEBACEOUS 3. SqCC 4. Melanoma
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68
Q

What is the pathological description of Sebaceous Adenomacarcinoma of the eyelid?

A
  1. Skip areas

2. Pagetoid spread (spread of tumor into conj)

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69
Q

Lentigo Malinga has pigmentation where?

A

Acquired periocular and conjunctival not episcleral.

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70
Q

What is a rare, vascular tumor of the upper eyelid that metasizes in 30% of patient’s with neurogenic origin?

A

Merkel cell tumor

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71
Q

What Dx has confluent, waxy, yellow papules that may hemorrhage with minor trauma?

A

Amyloidosis (stains with congo red)

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72
Q

Is proptosis seen in both high & dural flow fistulas?

A

YES

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73
Q

What is the most common primary lacrimal sac tumor?

A

Squamous Papilloma

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74
Q

What is the natural course of orbital lymphangioma in kids?

A

Sponeteous regression - so observe

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75
Q

In 4 lid blephroplasty which muscle is most commonly responsible for vertical diplopia?

A

Inferior Oblique - b/c connection to capsulpalpebra fascia)

76
Q

What is the treatment for pleomorphic adenoma?

A

Excision to prevent malignant transformation

77
Q

Capsolopalpebral fascia disinsertion causes what?

A

ENTROPION

78
Q

Lymphoma causes proptosis or enophthalmosis?

A

Proptosis

79
Q

What are the characteristics of a junctional nevi?

A

Darker and thin

80
Q

What are characteristics of a compound nevi?

A

Lighter and elevated

81
Q

What is a keratincanthoma filled with?

A

Keratin NOT LIPID - can transform to SqCC

82
Q

Culter-Beard does what?

A

Replaces the upper eyelid with the lower eyelid transposition

83
Q

Hugh’s flap does what?

A

Transposes a bridge flap of tarsus and conj from the upper lid to fill a gap in the lower lid

84
Q

Does the conj or the orbit contain lymphatic vessels or nodes?

A

conj

85
Q

Xanthelesma is found in what layer of the skin and what percentage has a systemic association?

A

Dermis; 25% ; can have proptosis and has a perivenular distribution

86
Q

Give example of a Eccrine gland?

A

Aqueous glands

87
Q

Give an example of a holocrine gland?

A

Oil glands, goblet

88
Q

Steatoblepharon is what?

A

Bulging of orbital fat occuring with age or attenuation of the orbital septum

89
Q

Which turbinate is used for the DCR?

A

Middle turbinate - which is 10 mm within the cribiform plate

90
Q

What is the primary malignancy of the lacrimal sac and the second most common?

A
  1. SqCC
  2. Lymphomas
    Others - transitional cell and mixed
91
Q

Which Jones test accesses the functioning of a surgical osteotomy site Post DCR?

A

Jones 3

92
Q

Which Jones test has a high false negative rate?

A

Jones 1

93
Q

In Jones 2 testing, what does it mean when clear fluid is recovered vs dye fluid recovered?

A

Clear fluid - obstruction before the lacrimal sac

Dye - Lower system obstruction

94
Q

What bug causes acute dacroyscystitis in adults?

A

Strep Pneumo

95
Q

Retraction of the lower lid retractors makes the inferior cul da sac what?

A

Deeper

96
Q

Cavernous hemagioma has what type of internal reflectivity and why?

A

HIGH - c/w nonhomogenous tissue

97
Q

How do you treat Rhabdomyosacroma?

A

First - chemo

Second - Radiation

98
Q

What is treatment for Adenoid cystic CA?

A

Exenteration

99
Q

What is commonly seen in an orbital varix?

A

Phlebolith

100
Q

In lymphoma with polyclonal dx, what does that equate to?

A

Reactive lymphoid hyperplasia

101
Q

What is the most common location of lymphoma?

A

Lacrimal fossa

102
Q

How does optic nerve mengioma present in kids?

A

Lower eyelid edema and chemises - usually a/w NF2

103
Q

What percentage of congenital nevi convert to melanoma?

A

5-10%

104
Q

What is the most common cause of vision loss in CC FISTULA?

A

elevated IOP and GL

105
Q

What type of ptosis do you get with Horner’s?

A

BLEPHAROptosis (in horners, lesion BELOW cartoid artery bifurcation)

106
Q

What type of imaging is best to r/o Organic FB?

A

MRI

107
Q

What kind of striations are seen in Rhabo?

A

CROSS striations

108
Q

Late lung mets are seen in what LG tumor?

A

Adenoid cystic CA

109
Q

What causes indentation of the glob and is a/w choroidal folds and hyperopic shift?

A

Cavernous hemangioma

110
Q

What is used from spastic ENTROpion for the lower lid?

A

Quickert suture - insite scar between retractor and orbicular is muscle preventing preseptal orbicularis overide

111
Q

Lymphoma typically presents with?

A

Proptosis

112
Q

Silent sinus syndrome is what?

A

Progressie shrinking of the maxillary sinus with secondary NEGATIVE pressure in the sinus - causes U/L enophthalmos

113
Q

What are 4 characteristics of blepharoptosis?

A
  1. Fat atrophy
  2. LG prolapse
  3. ECTROPION
  4. Canthal ligament laxity
114
Q

Perineural spread of malignancy is characteristic of what dx?

A

SQUAMOUS cell CA

115
Q

Pagetoid spread is common for waht dx?

A

Sebaceous cell ca (intraepidermal)

116
Q

Prednisone is a/w what 3 SE?

A
  1. Psychosis
  2. HTN
  3. Increased in NA
117
Q

Which imaging device is better at picking up tissue Calcification?

A

CT

118
Q

What are the #1 and #2 ocular manifestations in Graves dz?

A
  1. Eyelid retraction

2. Proptosis

119
Q

Orbicularis muscle is innervated by what CN?

A

7

120
Q

Levator muscle is innervated by what CN?

A

3

121
Q

Orbital septum fuses how many mm above and below the tarsal bordre

A

Upper eyelid - 4 mm

Lower eyelid - 1 mm

122
Q

Which CN is most commonly affected by sarcoid?

A

Facial - CN 7 ( Second is optic nerve)

123
Q

Which fungi takes weeks to months to progress?

A

Aspergiullus

124
Q

Which fungi takes hours to progress?

A

Mucor

125
Q

What can cause enophthlmos at rest and proptosis?

A

Orbital varix

126
Q

Which has orbital disease: Wegners or Polyartertis Nodosa?

A

Wegener’s

127
Q

“Standing Room Only” is the pneomic for what?

A

Trigeminal nerve openings:
V1 -
V2 - Rotundum
V3- Ovale

128
Q

What are 2 bad prognostic characteristics for Conj melanoma?

A
  1. Arising de novo

2. not involving the limbus

129
Q

Which eyelid disease resembles Verccua?

A

Trichilemmoma

130
Q

What appers as a flesh colored plaque with overlying teleangectasia and can be confused with BCC?

A

Trichepitheleoma

131
Q

What appears as a reddish purple subcutaneous mass?

A

Pilomatricoma

132
Q

What is the name of the procedure that has a direct resection and then repair of the lower eyelid margin just before the lateral canthal angle (Ectropion)?

A

BICK procedure

133
Q

What is the Tenzel procedure?

A

Tarsal fracture for cicatricial ectropion

134
Q

Where does the frontal and anterior and middle ethmoid air cells drain?

A

Middle meatus

135
Q

Where does the sphenoid sinus drain?

A

Sphenoethmoidal recess

136
Q

Where does the posterior ethmoid sinus drain?

A

Superior meatus

137
Q

Where does the maxillary sinus drain?

A

Middle meatus

138
Q

Eczematous lesion over the eyelids equals?

A

Mycosis fungoides (T cell lymphoma)

139
Q

Which MRI has the best anatomical detail of the orbit?

A

T1 - require shorter acquisiton times than T2 so less artifact

140
Q

Which MRI has the advantage of showing methemoglobin brighter than melanin and can help differeriate melanotic lesions from heme process in the choroid?

A

T2

141
Q

Vitreous is dark in?

A

T1

142
Q

What provides better spatial resolution and precise location of a lesion?

A

CT

143
Q

Which test allows for better tissue contrast?

A

MRI (helpful in the evaluation of demyelination and in vascular and hemorrhagic lesions.)

144
Q

What helps differentiate between fresh and old hemorrhage?

A

MRI

145
Q

How do you treat Wegner’s?

A

Cyclophosphamide and prednisone

146
Q

Vasculitis is what type of hypersentivity run?

A

III

147
Q

How do u treat Wegeners?

A

Bactrim (prednisone alone may cause high rate of mortality )

148
Q

What distinguishes a menigioma from fibrous dysplasia?

A

A dural tail helps distinguish a menigoma. (seen on MRI)

149
Q

Deep superior sulcus deformity occurs why?

A

Decreased orbital volume. Fix by putting bigger implant.

150
Q

What muscle depresses the eyebrows and closes the eyelids?

A

Orbicularis oculi

151
Q

What causes forehead skin wrinkles?

A

Contraction of the frontalis muscle.

152
Q

Which accessory LG is located in the superior fornix?

A

Krause glands (found in upper and lower eyelids!!)

153
Q

Which accessory LG is located at the top of the upper eyelid tarsus?

A

Wolfring glands (found in upper and lower eyelids!!)

154
Q

A superior division palsy of the THIRD CN results in what and implies what?

A

Ptosis and decreased up gaze.

Implies an intraorbital disruption of the third CN.

155
Q

The posterior surface of the levator aponeurosis inserts where?

A

Firmly onto the anterior surface of the lower half of the tarus 3 mm above the eyelid margin and only very loosely attached to the superior 2-3 mm of the tarsus.

156
Q

When should coumadin be stopped before surgery?

A

4 days

157
Q

When should ASA be stopped before surgery?

A

5 days

158
Q

When should NSAIDS be stopped before surgery?

A

72 hours before

159
Q

What are small flesh colored papules with occasional telangiectasias that occur on the eyelids or forehead? May look like BCC.

A

Trichoepitheliomas

160
Q

What is a single, sometimes umbilicated lesion found mainly in adults?

A

Trichofolliculoma

161
Q

What lesion resembles verrucae?

A

Trichilemmoma

162
Q

What lesion affects young adults and usually occur in an eyebrow and central upper eyelid as a reddish purple subcutaneous mass?

A

Pilomatricoma

163
Q

What is a freckle?

A

Hyperpigmentation of the basal layer of the epidermis. The number of epidermal melanocytes is NOT increased.

164
Q

What is lentigo simplex?

A

Pigmented spots larger than freckles where the number of epidermal melanocytes are INCREASED.

165
Q

Dermal melanocytes in the nevus of ota proliferate where?

A

In the region of the first and second dermatomes of CNV.

166
Q

What is the name of SqCC in situ with elevated lesions non healing and erythematous in nature?

A

Bowen disease - NO dermal invasion. 5% of patients progress to vertically invasive SqCC.

167
Q

What is the name of the premalignant melanocytic lesion that is flat, irregularly shaped, unevenly pigmented, slowly enlarging that typically occurs on the malar region in older white patients?

A

Lentigo maligna (hutchinson melanotic freckle)

168
Q

What has strong prognostic implications for malignant melanoma?

A

tumor thickness (>1.5mm - 50% survivial rate)

169
Q

Marcus Jaw Wink is a synkinesis betwn what two nerves?

A

CN3 (Levator) and motor division of CN V (CONTRALATERAL ptyergoid muscle)

170
Q

What has a quicker onset and greater diffusion into tissues, but duration of action is shorter: BoTox A or B?

A

B

171
Q

What 3 muscles are involved in Benign Essential blepharospasm?

A
  1. Orbicularis oculi
  2. Procerus
  3. Corrugator muscles
172
Q

Which occurs during your sleep: BEB or Hemifacial spasm?

A

Hemifacial spasm (a/w ipsilateral facial nerve weakness)

173
Q

What are the 3 main complications?

A
  1. Retrobulbar heme
  2. Diplopia
  3. Lagophthalmos - from excessive skin removal.
174
Q

The afferent (sensory pathway) of the reflex tear arc is controlled by what nerve?

A

CN V1

175
Q

What muscles cause vertical wrinkles between the eyebrows?

A

Corrugator

176
Q

What muscle causes horizontal wrinkles between the eyebrows?

A

Procerus

177
Q

When the lower eye lid retractors disinsert what happens to the inferior fornix?

A

It deepens

178
Q

What is the thinnest portion of the maxillary bone?

A

Posterior medial

179
Q

What is the first step in managment for a keratocanthoma?

A

Incisional bx for tissue dx. Once that is done then complete surgical removal is recommended.

180
Q

Acute infections to the glands of Zeiss are called?

A

External Hordeloum or styes

181
Q

Acute infections to the orfice of the meibomian glands are called?

A

Internal hordeloum

182
Q

What is the main protractor of the eye lid and what is it innervated by?

A

Orbicularis and CN 7!! (CLOSES the eyelid)

183
Q

Where is the most common location of the lacrimal fistula ?

A

Inferonasal to the medial can thus area

184
Q

What is Meige’s syndrome?

A

Blepharospasm with facial dystonia

185
Q

What % of patients with hyperthyroidism develop TAO?

A

30%

186
Q

List in order of greatest to least common incidence of eyelid tumors?

A

Bcc> squamous > melanoma > sebaceous

Plastics (3 decks)

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