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Motility > Block 11 > Flashcards

Block 11 Flashcards

1
Q

A vision condition in which a person cannot align both eyes simultaneously

A

Strabismus

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2
Q

4 types of neurological strabismus

A

Cranial Nerve Palsies
Neurological Diseases
Posterior Fossa Tumors or Malformations
Raised Intracranial Pressure

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3
Q

Symptoms of strabismum

A 
Double vision
Blurry vision
Reduced peripheral vision
HA
Dizziness
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4
Q

All 3 of the CN palsies can be caused by

A

Vasculopathic

Tumor

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5
Q

Aneurysms can cause which type of strab

A

3rd nerve palsy

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6
Q

Which type of strab is usually caused by trauma or congenital

A

4th nerve palsy

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7
Q

Which type of strab is caused by cranial pressure

A

6th nerve palsy

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8
Q

What muscles are affected in CN 3 palsy

A 
SR
MR
IR
IO
Sup palpebral levator muscle
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9
Q

Which way will the eye be in a CN 3 palsy

A

Down and out
Ptosis
Dilated pupil
No accommodative response

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10
Q

What nucleus can be affected in a 3rd nerve palsy

A

Edinger-Westphal nucleus

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11
Q

Which etiology of CN 3 palsy is pupil sparing

A

Ischemic/vascular

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12
Q

Most common arteries involved in CN3 palsy with an aneurysm cause

A

Posterior communicating a.

Also internal carotid a. Or basilar a.

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13
Q

Muscle affected in CN4 palsy

A

SO

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14
Q

Which way will the eye move in a CN4 palsy

A

Up and in

Usually with a head tilt

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15
Q

Which way will the head tilt in CN4 palsy

A

To opposite side of palsy

Rt tilt –> LSO palsy

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16
Q

Longest intracranial pathway is with which nerve

A

CN 4

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17
Q

CN4 palsy is often associated with what type of syndrome

A

Horner’s

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18
Q

Most common causes of acquired isolated CN4 palsy

A

1- idiopathic
2- head trauma
3- microvasculopathy (diabetes, HTN, atherosclerosis)

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19
Q

Which muscle is affected in CN6 palsy

A

LR

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20
Q

Which way does the eye turn in LR palsy

A

Turns in

Compensatory head turn

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21
Q

Which way does the head turn in LR palsy

A

Towards affected eye

OD in –> turn to right

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22
Q

CN6 has a long external course through the cranium, making it susceptible to

A 
Injury
Inc ICP
Mastoid infection
Skull fracture
Tumors
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23
Q

Most commonly affected oculomotor nerve in adults

A

CN 6

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24
Q

Most commonly affected oculomotor nerve in kids

A

CN 4

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25
Q

Second most commonly affected oculomotor nerve in children

A

CN 6

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26
Q

Which muscle is more affected by ischemia than other EOMS and why

A

LR bc it only has 1 ant ciliary a., the rest have 2

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27
Q

If the cavernous sinus is affected, what nerves are affected

A

3, 4, 5-1, 5-2, 6

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28
Q

Main cause of a cavernous sinus palsy

A

Neoplasm

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29
Q

Orbital apex syndrome involves which nerves

A

3, 4, 5-1, 6

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30
Q

Which multiple nerve palsy is horners syndrome seen in

A

Cavernous sinus

Orbital apex syndrome

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31
Q

Main cause of orbital axis syndrome

A

Neoplasms

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32
Q

Exo greater at near

A

Medial rectus palsy

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33
Q

Hyper and exo

A

Inferior rectus palsy

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34
Q

Bilateral

V exo pattern

A

Superior rectus palsy

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35
Q

An A eso

A

Inferior oblique palsy

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36
Q

SR and IO of the same eye are affected

A

Double elevator palsy

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37
Q

In double elevator palsy, is there elevation in abduction and adduction

A

No

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38
Q

What is usually present in double elevator palsy

A

Bell’s phenomenon

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39
Q

2 etiologys of double elevator palsy

A

Congenital

Supra/nuclear defect

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40
Q

Possible differential diagnosis of double elevator palsy

A 
Blowout fracture
Thyroid eye disease
Brown's syndrome
Congenital fibrosis of IR
General fibrosis syndrome
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41
Q

IR and SO of same eye are affected

A

Double depressor palsy

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42
Q

What does the head do in double depressor palsy

A

Chin down to compensate for hypertrophic eye

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43
Q

Lesion above the level of ocular motor nerve nuclei

A

Supranuclear neurogenic palsy

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44
Q

Where would a lesion be that causes an internuclear neurogenic palsy

A

Lesion of medial longitudinal fasiculus

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45
Q

In younger patients, what is often a cause of internuclear neurogenic palsy

A

MS

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46
Q

In elderly patients, what is often a cause of internuclear neurogenic palsy

A

Vascular origin

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47
Q

Presentations of nuclear neurogenic palsy

A 
Unilateral CN 3 with bilateral ptosis
Unilateral CN3 with contralateral SR underaction
Isolated EOM palsy of IR, IO or MR
Brown's syndrome
Bilateral CN 3 with spared levator
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48
Q

Infranuclear neurogenic palsies can affect which CNs

A

3, 4, and 6

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49
Q

Cause of CN3 palsy: central sparing the pupil

A

Vascular

-infranuclear neurogenic palsy

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50
Q

Cause of CN3 palsy: peripheral with pupil involvement

A

Aneurysm

- infranuclear neurogenic palsy

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51
Q

If you suspect Na aneurysm, what test should immediately be ordered

A

Angiography or MRA

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52
Q

If suspect an neoplasm, what test should you immediately order

A

MRI or CT

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53
Q

First step in managing strabsimic symptoms is

A

Prescribing glasses

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54
Q

Short term treatment of diplopia with glasses is

A

Fresnel press-on prisms

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55
Q

Which eye do you put the fresnel prisms over

A

Nondominant eye

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56
Q

A short term treatment for diplopia that is often uncomfortable for patients

A

Occlusion

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57
Q

Common treatment for acute paralytic strabismus due to unilateral 6 nerve palsy

A

Botox

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58
Q

What does Botox do

A

Prevents ACh release, resulting in paralysis

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59
Q

What treatment often has temporary side effects that are uncomfortable to patients

A

Botox

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60
Q

What are possible Botox side effects

A

Soreness at side of injection, weakness in the injected muscle, muscle soreness in whole body, difficulty swallowing, red rash

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61
Q

Long term treatment for strab

A

Surgery

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62
Q

What are the possible risks with surgery correction

A

Mild discomfort after Sx, continued strab, endophthalmitis, ocular ischemia

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63
Q

What is a mechanically restricted muscle

A

EOM is tethered or a systemic disease reduces the elasticity

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64
Q

Are mechanically restrictive deviations congenital or acquired

A

Both

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65
Q

3 examples of a congenital mechanically restrictive deviation

A

Duane Syn, Brown’s Syn, Fibrosis Syn

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66
Q

2 examples of acquired mechanically restrictive deviations

A

Thyroid myopathy and trauma causing deviations

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67
Q

Forced duction test results in mechanically restricted muscle

A

Positive

68
Q

Will you see a deviation in primary gaze in a mechanically restricted muscle

A

Will either be very small or ortho

69
Q

Will alternate CT and prisms give accurate results when measuring the magnitude of a mechanically restricted muscle

A

No

70
Q

What addition tests should you do to determine the magnitude of a mechanical deviation of 1 eye

A

Maddox rod/prism bar

71
Q

If both eyes are restricted, which tests may be best for determining the amount of deviation in mechanically restricted muscles

A

Hirschberg or krimsky

72
Q

Charazcterized by limitations in abduction, adduction, or both

A

Duane Syn

73
Q

Type 1 Duane syn

A

Limited ABDuction

74
Q

Type 2 Duane syn

A

Limited ADDuction

75
Q

Type 3 Duane syn

A

Limited ABDuction and ADDuction

76
Q

Most common type of Duane syn

A

Type 1

77
Q

Least common type of Duane syn

A

Type 2

78
Q

Is Duane syn usually unilateral or bilateral

A

Unilateral

79
Q

What does the globe do in Duane syn

A

Enophthalmos (globe retracts)

80
Q

What type of patterns may be seen when looking up and down in Duane syn

A

A/V patterns

81
Q

Is Duane syn usually hereditary or sporadic

A

Sporadic

82
Q

Is amblyopia usually seen in Duane syn

A

No

83
Q

Head turns toward affected side in which type of Duane syn

A

Type 1

84
Q

How is Duane syn different from LR palsy

A

Palsy: no retraction of globe, eso angle is larger, (-) forced duction, few vertical anomalous movements

85
Q

Clinical pearl with Duane Syn

A

If a pt has limited abduction isn’t he absence of a significant strab in primary position, consider it Duane syn until proven otherwise

86
Q

2 ways to treat Duane syn

A

Surgery - rarely improved abd/adduction, but improved field of bino vision, head turn is improved
Prisms - alleviate head postures

87
Q

Superior oblique tendon sheath syn

A

Brown’s syn

88
Q

Brown’s syn: usually unilateral or bilateral

A

Unilateral

89
Q

Brown’s syn: more in OD or OS

A

OD

90
Q

Brown’s syn: more in females or males

A

Females

91
Q

What is Brown’s syn commonly due to

A

Thickening of the SO tendon

92
Q

When the eye cannot elevate and adduct

A

Brown’s syn

93
Q

Is Brown’s syn congenital or acquired

A

Usually congenital, but can be aquired due to injury or inflammation at the region of the trochlea

94
Q

May have a V pattern in up gaze, but no A pattern in down gaze

A

Brown’s syn

95
Q

May hear audible click when the eye elevates

A

Brown’s syn

96
Q

Head posture with Brown’s syn

A

Chin elevation and pointing toward OPPOSITE shoulder

97
Q

How is the palpebral fissure affected when trying to adduct with Brown’s syn

A

Widens

98
Q

Is amblyopia common in Brown’s syn

A

No

99
Q

How to tell the difference between Brown’s syn and IO paresis

A

IO paresis: hypotropia in primary, head tilt to affected side, A-pattern, can fulfill Parks3

100
Q

Does Brown’s syn usually required treatment

A

No

101
Q

When treating Brown’s syn, what is the primary treatment

A

Surgery

102
Q

When treating Brown’s syn, what is the secondary treatment

A

Prism (yoked or BU)

103
Q

Etiology of Duanes syn

A

Mechanical, anatomy (muscle insertions), or innervation

104
Q

Head turns away from affected side in which type of Duane’s syn

A

Type 2

105
Q

Lid changes in Duane’s syn

A

Narrowing

106
Q

Lid changes in browns syn

A

Widening

107
Q

Autoimmune, neuromuscular disorder characterized by the fatigability of voluntary striated muscles

A

Myasthenia gravis

108
Q

Myasthenia gravis: more common in which gender

A

Females

109
Q

Is MG congenital or acquired

A

Neonatal or congenital

110
Q

Many experience initial symptoms during what in MG

A

Emotional upset

111
Q

Etiology of MG

A

Abs block and destroy ACh receptors —> less nerve signals —> weakness

112
Q

Which gland may trigger Ab production and be larger in MG patients

A

Thymus

113
Q

2 forms of MG

A

Generalized and ocular

114
Q

Hallmark of MG

A

Muscle weakness that worsens after activity and improves after rest

115
Q

Which muscles are usually seen first with weakness in MG

A

Lid and EOM abnormalities

116
Q

Generalized MG signs and symptoms

A

Weakness of arm and leg muscles

Difficulties with speech, chewing, swallowing and breathing

117
Q

Ocular signs and symptoms of MG

A

Ptosis
Diplopia
Nystagmus

118
Q

Is ptosis usually unilateral or bilateral in MG

A

Unilateral

119
Q

Difficulty with what muscles are common in MG

A 
Orbicularis oculi
Masseter muscle
Sternocleidomastoid
Tongue
Diaphragm
120
Q

When does myasthenia crisis occur

A

Muscles are too weak to control breathing

121
Q

Are most thymomas in MG benign or malignant

A

Benign

122
Q

Is thymus hyperplasia common in MG

A

Very common

123
Q

3 things to look for when diagnosing MG

A 
Ptosis with prolonged up gaze
Cogan’s twitch (when looking down, twitch when look up)
Ice test (2mm elevation after 2 minutes)
124
Q

Presence of an inconsistent deviation along with ptosis and restricted ocular motility

A

Suspect myasthenia gravis

125
Q

Ocular treatment for MG

A

Occlusion

126
Q

Are prisms useful in ocular treatment of MG

A

No

127
Q

An autoimmune disorder that results in overproduction of thyroid hormone

A

Graves’ disease

128
Q

Common signs and symptoms of GD

A 
Goiter
Weight loss
Heat sensitivity
Bulging eyes
Rapid, irregular heartbeat
Thick, red skin
129
Q

Most common cause of spontaneous diplopia in middle age

A

GD

130
Q

Will EOMs be larger or smaller in GD

A

Larger (reduced elasticity and motility)

131
Q

Is GD usually unilateral or bilateral

A

Bilateral

132
Q

Big risk factor for GD

A

Smoking

133
Q

Common ocular signs of GD

A 
Periorbital congestion
Proptosis (lid retraction)
Lid lag
Exophthalmos
Optic neuropathy
Impaired ocular motility
134
Q

Patient symptoms with GD

A

Dry sensation, photophobia, excessive tearing, double vision, pressure behind eye, vision loss

135
Q

GD: forced duction test results

A

Positive

136
Q

Muscle most involved in GD (most to least)

A

IR MR SR LR

137
Q

GD may be mistaken as paresis of which muscle

A

SR

138
Q

Affected eye in GD often demonstrates

A

Restriction of elevation and abd

HypoT in primary position

139
Q

Other tests to help diagnose GD

A 
Tonometry
Hertel exophthalmometer
Slit lamp
ON eval
CT
thyroid function tests
140
Q

Ocular treatment of GD

A 
Fresnel prisms
Surgery if stable for 6 months
Artificial tears
Cold compress for edema
Stop smoking
141
Q

How to record limitations in ductions (2 ways)

A
  • As a percentage of normal
  • on a scale of -4 to +4
    —minus is underaction, plus is overaction, 0 is normal
142
Q

Different management options for fibrosis syndrom

A

Amblyopia Tx
Sx (for cosmetics and comfort)
Ptosis (dry eye)
Abnormal head posture

143
Q

How to manage fibrosis syndrome if caught early

A

Amblyopia Tx

144
Q

Is amblyopia seen in fibrosis syn

A

Yes

- strab in primary gaze

145
Q

Forced duction results with fibrosis syn

A

Positive

146
Q

Do pts with fibrosis syn have bino vision

A

No

147
Q

Genetics of fibrosis syn

A

Autosomal dominant

148
Q

Is fibrosis syn usually congenital or aquired

A

Congenital but can be both

149
Q

Which muscle is most likely to be fibrotic

A

IR

- cause hypo deviation

150
Q

Lids and head posture in fibrosis syn

A

Ptosis with chin elevation

151
Q

Is fibrosis syn usually uni or bilateral

A

Bilateral

152
Q

Severely restricted eye movement is seen what what syn

A

Fibrosis syn

153
Q

Tissue of the EOMs are abnormal and replaced with fibrotic tissue

A

Fibrosis syn (CFEOM)

154
Q

Maddox Rod: above the light

A

Left hyper

155
Q

Maddox Rod: below the light

A

Right hyper

156
Q

Maddox Rod: to the left of the light

A

Crossed

157
Q

Maddox Rod: to the right of the light

A

Uncrossed

158
Q

Worth 4 dot: only see 3 green

A

OD suppression

159
Q

Worth 4 dot: only see 2 red

A

OS suppression

160
Q

Worth 4 dot: 5 dots with red below green

A

Right hyper

161
Q

Worth 4 dot: 5 dots with red to the left

A

Crossed

162
Q

Worth 4 dot: 5 dots with red to the right

A

Uncrossed

163
Q

How to treat uncrossed diplopia

A

BO

164
Q

How to treat crossed diplopia

A

BI

165
Q

Crossed

A

Exo

- image hits temporal retina

166
Q

Uncrossed

A

Eso

- image hits nasal retina

Motility (3 decks)

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