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BMB Test 2 > B7-033 CBCL Pupillary Abnormalities > Flashcards

B7-033 CBCL Pupillary Abnormalities Flashcards

1
Q

parasympathetic pupillary light reflex: when you shine a light in one eye, […] constricts

A

both eyes

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2
Q

problems with the parasympathetic pupillary light reflex typically indicate an issue in the […]

A

midbrain

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3
Q

why does the parasympathetic pupillary light reflex illicit an equal response from both eyes?

A

it is a “double crossed” system

parasympathetic fibers cross at the posterior commissure of the midbrain at the Edinger-westphal nucleus and the pretectal nucleus

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4
Q

pupil constrictors are […] neurons with […] receptors

A

cholinergic
muscarinic

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5
Q

how would cholinergic agonists affect pupils?

A

constrict

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6
Q

how would cholinergic antagonists affect pupils?

A

dilate

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7
Q

unilateral dysfunction of the pupillary constrictors is called

A

internal ophthalmoplegia

(caused by anything that affects CN III)

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8
Q

causes of internal ophthalmoplegia

A

herniation
midbrain lesion (stroke, would see long tract involvement)
aneurysm in the posterior communicating (would see involvement of other eye muscles)
ciliary ganglion degeneration
thermal injury to short ciliary nerves
pharmacologic blockade (anticholinergic in eye)

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9
Q

aggressive photocoagulation for diabetic retinopathy can cause

A

thermal injury to short ciliary nerves

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10
Q

uncal herniation can compress CN […]

A

III

(cause of internal ophthalmoplegia- will have decreased consciousness)

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11
Q

extreme sensitivity to dilute pilocarpine can indicate a lesion at […]

A

short ciliary nerves (or postganglionic)

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12
Q

pupil doesn’t constrict in response to 1% pilocarpine

A

pharmacologic blockade

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13
Q

what emotions cause sympathetic pupillary dilation?

A

fear
anger
pain
arousal

(also contracts smooth tarsal muscles of eyelids to open eye more)

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14
Q

first order neuron of the sympathetic chain involved in Horner’s syndrome

A

hypothalamus to spinal cord

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15
Q

second order neuron of the sympathetic chain involved in Horner’s syndrome synapses at

A

superior cervical ganglion

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16
Q

third order neuron of the sympathetic chain involved in Horner’s syndrome projects to [4]

A

sweat glands of forehead
smooth muscle of eyelid
pupillary dilator
sweat glands of face

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17
Q

most of the sudomotor fibers of the face follow the […]

A

external carotid artery

(if a patient presents with Horner’s syndrome but is sweating normally, the lesion must be distal to the bifurcation of the carotid-must be along internal carotid, opthalmic artery, or eye)

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18
Q

pupillary dilators are […] neurons with […] receptors

A

noradrenergic
alpha 1

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19
Q

some causes of Horner’s syndrome

A

brainstem strokes (lateral medulla)
multiple sclerosis
syringomyelia
pancoast tumor
thyroid carcinoma
carotid artery aneurysm

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20
Q

anhidrosis is usually absent if the […] neuron of the sympathetic pathway was affected

A

3rd order

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21
Q

blocks the reuptake of norepinephrine

A

cocaine

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22
Q

use of […] drops can confirm the presence of Horner’s syndrome

A

cocaine

anisocoria worsens

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23
Q

anisocoria worsens with hydroxy amphetamine in both eyes

A

post-ganglionic lesion (sympathetic, 3rd order)

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24
Q

anisocoria lessens with hydroxy amphetamine in both eyes

A

preganglionic

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25
anisocoria worse in bright light indicates an issue with
CN III (parasympathetic issue)
26
anisocoria worse in dark room indicates an issue with
sympathetics (Horner's syndrome)
27
dilation lag in going from light room to dark
sympathetic issue (horner's)
28
shining light in the unaffected eye results in greater constriction than when light is shined in the affected eye
afferent pupillary defect
29
same relative anisocoria is present in all lighting conditions no dilation lag
benign essential anisocoria
30
if anisocoria is worse in the light its a [...] issue
parasympathetic
31
if anisocoria is worse in the dark its a [...] issue
sympathetic
32
if anisocoria is the same in the light and dark its a [...] issue
physiologic
33
muscle that serves as the pupillary dilator
radial muscle
34
muscle that serves as the pupillary constrictor
circular muscles in iris
35
circular muscle that rounds the lens
ciliary muscle
36
secretes the aqueous humor
secretory epithelium (raises IOP)
37
aqueous humor drains into the
canal of Schlemm (lowers IOP)
38
the ciliary muscle and sphincter are under [...] control
muscarinic
39
the pupillary dilator is under [...] control
a-1 adrenergic
40
the ciliary epithelium is under [...] control
beta adrenergic
41
[parasympathetic/sympathetic] miosis
parasympathetic
42
[parasympathetic/sympathetic] accomodation
parasympathetic
43
[parasympathetic/sympathetic] outflow of aqueous humor
parasympathetic
44
[parasympathetic/sympathetic] lacrimation
parasympathetic
45
parasympathetic effects can be mimicked by [...] agonist
muscarinic
46
in the accomodated state, the ciliary muscle [...] and the zonular fibers [...]
contract relax (rounds the lens)
47
in the unaccomodated state, the ciliary muscle [...] and the zonular fibers [...]
relax contract (flattens the lens)
48
[...] promotes aqueous humor drainage
accomodation
49
[parasympathetic/sympathetic] mydriasis
sympathetic
50
sympathetic effects can be mimicked by [...]
cocaine
51
stimulation of the ciliary epithelium via [...] receptor activity promotes aqueous humor
beta
52
in what type of glaucoma does drainage occur normally?
open angle (IOP can be increased or normal)
53
in what type of glaucoma does the iris and cornea impinge, occluding drainage?
closed angle (IOP is increased)
54
pharmacologic treatment for closed angle glaucoma
muscarinic agonists that open the trabecular network carbachol (direct) physostigmine (indirect)
55
surgery to treat closed angle glaucoma
iridectomy
56
pharmacologic treatment for open angle glaucoma
beta antagonists timolol (topical application, long half life)
57
internal ophthamoplegia causes weakness of the [...] muscles
pupillary constrictors
58
constriction of the pupil due to a dilute cholinomimetic drug (pilocarpine) indicates a [...] lesion
postganglionic
59
most of the structures involved in parasympathetic innervation of the eye are contained in the [...]
midbrain
60
an afferent pupillary defect indicates a lesion in the
optic nerve
61
symptoms of Horner's syndrome
miosis ptosis anhidrosis
62
sympathetic innervation to the face controls [3]
pupillary dilation eyelid elevation anhidrosis
63
[...] ciliary nerves constrict the eye
short
64
the majority of sudomotor fibers traveling to the sweat glands of the face follow the [...] carotid
external
65
[...] nucleus sends fibers to the Edinger-Westphal nucleus
pretectal
66
fibers from the right pretectal nucleus will go to [...] Edinger-Westphal nucleus
both (left and right EWN receive information from both sides)
67
if one pupil is larger than the other or reacts differently, it is called
anisocoria
68
[...] ciliary nerves dilate the eyes
long
69
in ambient light, will a patient with an occulomotor nerve lesion have anisocoria?
yes affected pupil will appear dilated
70
will a patient with an occulomotor nerve lesion have a direct or consensual response to light shone directly in the eye?
no response to either
71
in ambient light, will a patient with a Horner's syndrome have anisocoria?
yes affected eye will be constricted
72
will a patient with a Horner's syndrome have a direct or consensual response to light shone directly in the eye?
yes, both (affected eye may constrict more than unaffected eye) (will be a dilation lag going from light to dark)
73
in ambient light, will an afferent pupillary defect have anisocoria?
no
74
will a patient with an afferent pupillary defect have a direct or consensual response to light shone directly in the eye?
they will have a consensual response they will NOT have a direct response (swinging flashlight test is useful)
75
the same relative anisocoria is present is all lighting conditions no dilation lag
benign essential anisocoria
76
common cause of afferent pupillary defect
optic neuritis (multiple sclerosis)
77
ocular procedures are sometimes complicated by damage to the [2]
iris sphincter short ciliary nerves
78
short ciliary nerve injury will have what response to low dose pilocarpine?
preserved constriction (Adie's tonic pupil- denervation hypersensitivity causes upregulation of postsynaptic ACh receptors)
79
pupillary sphincter muscle injury will have what response to pilocarpine?
no response
80
in physiologic anisocoria, both pupils have [...] to light
retained reaction (constriction)
81
what medication can be given to discern between physiological anisocoria and Horner's syndrome?
cocaine
82
how would a patient with physiological anisocoria react to cocaine? contrast with Horner's syndrome
physiological anisocoria: bilateral pupillary dilation Horners: minimal dilation effect (less NE released)
83
prevents the reuptake of NE
cocaine
84
uncal herniation can compress the [...] nerve
oculomotor (interruption of parasympathetic fibers)
85
parasympthetic fibers of the occulomotor nerve are located where?
periphery (damaged first)
86
large, non-reactive pupil that responds quickly to a weak parasympathetic agent
Adie's Tonic pupil
87
in a patient with Horner's syndrome, dilation with hydroxy amphetamine hydrobromide indicates a lesion where?
1st or 2nd order (preganglionic) (pupil would not dilate with a post ganglionic lesion)
88
what effect does iprotropium have on the pupil?
inhibits parasympathetic output --> mydriasis (commonly found in nebulizing treatments)
89
post-operative non-reactive pupil that does not recover with instillation of pilocarpine indicates injury to
pupillary sphincter muscle (preganglionic)
90
post-operative non-reactive pupil that **does** recover with instillation of pilocarpine indicates injury to
short ciliary nerve
91
bilateral small pupils that do not react to light but do constrict with near vision
Argyll-Robertson pupils (Light-Near dissociation, heavily associated with neurosyphilis)
92
Light-Near dissociation caused by neurosyphilis
Argyll Robertson pupil
93
afferent pupillary defect, with pupil constricting if the opposite eye has light shone into it is called
Marcus Gunn pupil
94
a pharmacologically dilated pupil [would/would not] easily constrict to a dilute parasympathetic agent
would not
95
unilateral pupillary defect that has a robust response to a low dose parasympathetic agent
Adie's tonic pupil (indicates post ganglionic parasympathetic damage)
96
cause of the afferent defect in Marcus Gunn pupil
unilateral optic neuropathy (commonly optic neuritis or tumors of the optic nerve sheath)
97
a normal pupil will [...] when cocaine is instilled
dilate
98
a pupil affected by a lesion in the third order neuron of the sympathetic chain will [...] when cocaine is instilled
no response
99
a pupil with physiologic anisocoria will [...] when cocaine is instilled
dilate
100
hallmark of physiologic anisocoria
pupil size difference remains the same in the light or the dark
101
anisocoria is clearly worse in the light
parasympathetic problem
102
anisocoria is clearly worse in the dark
sympathetic problem
103
most likely structure to be affected by a syrinx causing Horner's syndrome
intermediolateral cell column
104
the afferent visual fibers serving the pupillary light reflex cross in the [...] of the midbrain
posterior commissure (allows for consensual response)
105
a pineal gland tumor can cause what symptoms?
bilateral unreactive pupils with decreased vertical gaze
106
bilateral, unreactive pupils with decreased vertical gaze indicates [...] syndrome
dorsal midbrain (aka Parinaud syndrome, caused by compression of PCA, often by pineal gland tumor)
107
dilation of both pupils following hydroxyampehtamine drops indicates a lesion where?
1st or 2nd order neuron (there is NE to release) **preganglionic**
108
absence of dilation of both pupils following hydroxyampehtamine drops indicates a lesion where?
3rd order neuron (no NE to release) **postganglionic**
109
aggressive laser therapy for diabetic retinopathy may cause thermal damage to [...]
short ciliary nerves **postganglionic**
110
how does denervation hypersensitivity of the short ciliary nerves react to pilocarpine?
after axons degenerate, the smooth muscles become super sensitive to ACh and its agonists, so would cause constriction at a very dilute dose
111
one or both pupils do not constrict normally
internal ophthalmoplegia
112
muscle that adducts the eye
medial rectus
113
innervates the superior oblique
trochlear
114
innervates the lateral rectus
abducens
115
why is neuro just word salad?!?! 😩
116
[internal/external] In Horner's syndrome, sudomotor fibers follow the [...] carotid artery
external sweating can be preserved with Horner syndrome if lesion is past bifurcation of the common carotid "sweat outside"
117
[internal/external] In Horner's syndrome, pupil dilator fibers follow the [...] carotid artery
internal

BMB Test 2 (17 decks)

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