Block 3 More plz Flashcards
sympathetic NS
mydriasis a1 contracts pupillary dilator muscle a1 contracts superior tarsal muscle b2 relax ciliary muscle = increase long distance vision b increase aq humor formation
parasympathetic NS
miosis ptosis muscarinic receptors: M3 contract pupillary sphincter M3 contract ciliary muscle = increase near vision M3 increase drainage of aq humor
mydriatic agents
ATROPINE: muscarinic receptor antagonist > cycloplegia (paralysis of ciliary muscle)
PHENYLEPHRINE a1 agonist, reverts ptosis in Horner’s syndrome
EPINEPHRINE a1 agonist, increases aq humor outflow, inhibits aq humor formation*
COCAINE blocks axoplasmic pump, inc NE
AMPHETAMINE release of NE
miotic agents
PILOCARPINE muscarinic agonist
ACETYLCHOLINE muscarinic agonist
NICOTINE activates para sympathetic nerves
PHYSOSTIGMINE anticholinesterase AChE
TERAZOSIN a1 antagonist
RESERPINE depletes NE
Tx for glaucoma
ECOTHIPHATE and PHYSOSTIGMINE anticholinesterases
PILOCARPINE muscarinic agonist
= increase outflow of aqueous humor
APROCLONIDINE a2 agonist
ACETAZOLAMIDE CA inhibitor
TIMOLOL b antagonist/blocker
= suppress aq humor formation
alpha agonists
phenylephrine a1
epinephrine a1
aproclonidine a2
muscarinic agonists
pilocarpine
acetylcholine
anticholinesterases
physostigmine
ecothiophate
botulism toxin
suppresses ACh release from neurons
optic nerve pathway
retinal ganglia > optic nerve > optic chiasm > optic tract > lateral geniculate nucleus > optic radiation > visual cortex (occipital lobe)
Meyer’s Loop/sublenticular
upper visual field fibers –> temporal lobe –> visual cortex
retrolenticular
lower visual field fibers –> parietal lobe –> visual cortex
Area 17
and 18 and 19
visual cortex in occipital lobe
then 18 and 19 association cortex
CN I special neurons
BIPOLAR
bipolar neurons through
cribriform plate to olfactory bulb
receptors and 1* neuron process
- activate receptor protein
- activates G protein (G-olf)
- inc cAMP
- cAMP opens ligand gated Na+ channel > DEPOLARIZATION
2* olfactory neuron called
mitral neuron, in olfactory bulb, which goes to synapse a bunch of places
primary olfaction cortex
piriform “pear shaped” cortex
orbital frontal cortex
where taste and smell meet to produce “flavor”
gustation involves which CN
CN V (touch and temp), VII (taste), IX (taste touch temp), X
gustation receptor cells are not
primary neurons
they are RECEPTOR CELLS
(100 receptor cells per taste bud, each cell does one of five tastes, receptor cells turn over q10days)
gustation process/pathway
- receptor is activate
- G protein (sweet, omami, bitter) / Na channel or proton closes K channel (sour, salty)
- 2nd mess (sweet, umami, bitter)
- open channel for DEPOLARIZATION
- open VG Ca++ or release intracellular Ca++
- AP
gustation receptor cell types
sweet, sour, bitter, omami, salty
taste buds (tip to back of tongue)
fungiform, foliate, circumivallate
CN XI origin
C 1-5 of spinal cord
CN XI stroke on right
Sx
weak SCM same side (can’t turn to opposite side)
CN IX glossopharyngeal supplies
tonsillar area and TM
retropharyngeal space
worry about infeciton
adenoidectomy
pharyngeal tonsils
cough afferent reflex
CN VII
cricothyroid muscle innervation
external branch of superior laryngeal nerve of vagus
piriform recess innervation
internal branch of superior laryngeal nerve of vagus
CN X vagus
cough swallow speech
PALATOGLOSSUS
4 gaze systems
- saccadic movements (rapid, jerky movements, scan to find salience)
- smooth pursuit (moving image centered on fovea)
- VOR (steady fovea during head movement)
- vergence (image on fovea when object is nearer or farther away)
MLF medial longitudinal fasciculus
nerves that supply pairs of eye muscles yoke together through this column of axons
UMN vs LMN anatomy
UMN: cortex to nucleus
LMN: nucleus to wherever (innervating or synapse)
anisocoria
pupils of different size
uveitis
iris
ciliary body
choroid
chorioretinitis
choroid
retinal layers
endophthalmitis
aqueous and vitreous humor
RECENT INTRAOCULAR SURGERY esp cataracts
normal flora: pseudomonas, staph, candida
Tx: fluoroquinolone or vance injected into eye
eye infections: route of infection
trauma paranasal sinuses IC anatomical abnormalities (dysfxn tear states) blood born sexually transmitted
tear include
sIgA and lysozome
lubrication
sIgA (secretory IgA = dimer) protects IgA from being degraded
why not use corticosteroids during eye infections?
corticosteroids facilitate corneal penetration
Chlamydia trachomatis serotypes
INCLUSION conjunctivits serotypes D-K
TRACHOMA serotypes A-C *leading cause of blindness worldwide (due to multiple inf and non lasting immunity, scar cornea each time)
Chlamydia trachomatis Dx
direct fluorescent ab
Chlamydia trachomatic inf
*co-infection with N. gonorrhea
BASOPHILIC INCLUSION BODIES
elementary bodies (rigid membrane) enter epithelia cell > change into reticulate bodies > replicates binary fission > leaves as EB
Tx chlamydia
AZITHROMYCIN
adenovirus
ds DNA non enveloped lytic in epithelial cells latent in lymphoid highly contagious
*infects epithelia cells of RESPIRATORY TRACT, CONJUNCTIVA, ENTERIC ORGANS because antigen and ability to act on certain receptors > Sx
path: migration into (HOST CELL) microtubules > induce cell cycle > block apoptosis > block host mRNA transport and translation > disrupt cytokeratin network
(HOST ORG) antagonize interferon, TNF
how Dx adenovirus
ADENOPLUS test
detects hexon proteins (part of viral capsid)
chronic conjunctivitis associated with
blepharitis
staphylococcus
hordeolum
STYE Tx: erythromycin ointment warm compress massage open keep clean
allergic rhinoconjunctivitis
IgE response
Tx: antihistamines, avoid steroids
viral conjuctivitis
neonatal
adult
HSV adenovirus Tx: cold compress topical vasoconstrictors
acute bacterial conjunctivitis
kids
adults
staph aureus+
strep pneumo+
h flu-
staph aureus+
Tx:
EMPIRIC (gram - and gram +)
TRIMETHOPRIM
POLYMYXIN OPHTHALMIC DROPS = POLYTRIM*
hyperacute bacterial conjunctivits
Neisseria gonorrheae
preauricular adenopathy
copious yellow/green PURULENT DISCHARGE
Tx:
CEFTRIAXONE
newborns receive prophylactic
erythromycin ointment
to prevent ophthalmia neonatorum
keratoconjunctivitis HSV
topical trifulridine and system acylovir
trifluridine
pyrimidine analog
*effective aginst acyclovir resistant virus bc can be phosphorylated BY HOST KINASES
TOXIC, TOPICAL ONLY
pseudomonas aeroginosa
gram -, rod, flagella
PYOCYANIN inhibits mto enz, disrupts ciliary beating
biofilms
adherence factors
secreted cytotoxins (destroy corneal epithelium)
host imm resp damages cornea > scarring, loss visual acuity
Tx:
POLYMYXCIN B
acanthamoeba
single cell, EUK
cysts and trophozoites in tissue
Tx: AZOLES
CMV retinitis
BRUSHFIRE
Toxoplasma
Dx: IgM serology
Tx: pyrimethamine and sulfadiazine
keratitis Sx
vision defects
photophobia
pain (cornea has lots nerve endings)
foreign body sensation
keratitis Tx
acyclovir and trifluridine VIRAL
moxifloxacin eyedrops
iritis (anterior uveitis)
notn infectious
chorioretinitis
IC or HIV: toxoplasma or CMV
conjunctivitis bilateral
allergic (usually)
conjunctivitis discharge type
viral, serous
Chlamydia, mucoid/mucopurulent
bacterial, mucopurulent
preauricular adenopathy
viral
chlamydia
neisseria gon
labyrinthitis
inner ear infection
associate recurrent OM (otitis media) with
conductive HL
meningitis
mastoiditis