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INTEGRATION 1 > CASE 1: VISION > Flashcards

CASE 1: VISION Flashcards

1
Q

The transparent parts of the eyes that let light pass through to reach the retina.

A

Ocular Media

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2
Q

Directly anterior to the cornea

A

Tear Film

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3
Q

3 Layers of the Tear Film

A

LAM - Lipid, Aqueous, Mucus

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3
Q

Maintains a smooth surface for light refraction and lubricates the eyelids, conjunctiva, and cornea.

A

Tear Film

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4
Q

The most superficial layer of the tear film that facilitates surface tension to prevent evaporation and spillover

A

Lipid Layer

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5
Q

Elaborated by the major/minor lacrimal glands and contain WATER-SOLUBLE SUBSTANCES and facilitate hydration to nourish cornea.

A

Aqueous Layer

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6
Q

Monomolecular film from Lipid layer is derived from?

A

Meibomian Gland

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7
Q

Facilitates tear spreading through Mucin, and a layer composed of glycoproteins

A

Mucus Layer

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8
Q

Consists of cornea, iris, lens and is filled with aqueous humor

A

Anterior Chamber

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9
Q

Aqueous Humor is produced where?

A

Ciliary processes from Posterior Chamber

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10
Q

Where do Aqueous humors drain?

A

Scleral Venous Sinus

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11
Q

Avascular structures supported by the Aqueous Humor

A

Lens and Cornea

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12
Q

Forms anterior 1/6 of the fibrous layer of the eye and 2/3 of the refractive power of the eye

A

Cornea

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13
Q

Cornea and Sclera junction

A

Limbus

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14
Q

Cornea contains __ to elicit blinking reflex and tear secretion when touched

A

Pain receptors

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15
Q

5 Layers of the Cornea

A

Anterior Epithelium
Bowman’s Layer
Stroma
Descemet’s Membrane
Endothelium

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16
Q

Tough Membrane that maintains the shape of cornea

A

Bowman’s Membrane

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17
Q
  • Maintains clarity and mechanical strength
  • Makes up 90% of the cornea
  • It is composed of parallel collagenous fibers to maintain cornea’s transparency
  • Main refracting lens of cornea
A

Stroma

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18
Q
  • Resting Layer of Endothelial cells
  • Anchors endothelium to cornea
  • allows nutrients and macromolecules to the stroma
A
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19
Q

provides smooth optical surface for the refractive power of eyes

A

anterior epithelium

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20
Q

this layer is important for corneal rehydration, a process that removes fluid from corneals stroma to prevent swelling and maintain corneal clarity

A

endothelium

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21
Q

dysfunction to this layer may cause corneal edemas and loss of collagen uniformity

A

endothelium

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22
Q

between cornea and iris

A

anterior chamber

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23
Q

contributes to light refraction, maintains IOP, and supplies nutrients to avascular structures

A

aqueous humor

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24
Q

visible colored part of the eye

A

iris

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25
Q

smooth muscles that are used in close and bright vision

A

sphincter pupillae

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25
Q

two smooth muscles in the iris that control pupil size

A

dilator pupillae
sphincter pupillae

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26
Q

smooth muscles for dim and far vision

A

dilator pupillae

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27
Q

between iris and lens

A

posterior chamber

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28
Q

what kind of disc is the lens

A

biconvex disc

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29
Q

light is refracted and focused into the retina to create clear images of objects

A

lens

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30
Q

parts of the lens

A

lens capsule, lens epithelium, lens fibers

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30
Q

ability of the eyes to focus at objects near or far; chnaging optical power to maintain clear images

A

accommodation

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31
Q

outermost layer that encloses the lens

A

lens capsule

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32
Q

occupies anterior surface of the lens which creates lens fibers, allowing for lifelong growth

A

lens epithelium

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33
Q

bulk of the lens precisely folded to make lens transparent

A

lens fibers

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34
Q

the posterior segment of the eyes is composed of what 2 components

A

Retina and Vitreous Humor

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35
Q

2/3 of the eyes volume and weight, gelatinous, clear and avascular

A

Vitreous Humor

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36
Q

T or F. Vitreous Humor is renewed in the Ciliary Bodies

A

False; VH cannot be renewed since it is permanent

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37
Q

holds the retinas neural layer against the pigmented layer

A

vitreous humor

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37
Q

what encloses the retina

A

sclera

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38
Q
  • semitransparent multilayered sheet
  • lines inner aspect of the posterior 2/3 of the eye
A

retina

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39
Q

how many layers in the retina

A

10 layers

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39
Q

receives light focued from cornea and converts light into neural signals

A

retina

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40
Q

Enumerate the 10 layers of the retina from inner to outer

A
  1. internal limiting membrane
  2. nerve fiber layers - contains ganglion cell axon
  3. ganglion cell layers
  4. inner plexiform layer - connections of ganglion cells with amacrine and bipolar cells
  5. inner nuclear layer of bipolar, amacrine and horizontal cell bodies
  6. outer plexiform layers - contain connections of bipolar and horizontal cells with photoreceptors
  7. outer nuclear layer of photoreceptor cell nuclei
  8. external limiting membrane
  9. photoreceptor layer of rod and cone
  10. retinal pigment epithelium
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41
Q

basement membrane of the retinal pigment epithelium

A

inner layer of bruch’s membrane

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42
Q

vitreous is composed majority of

A

water (99%)

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43
Q

attaches lens to the ciliary bodes

A

ciliary zonules/ suspensory ligaments

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44
Q

The cornea and lens bend light onto a ___ in the retina.

A

focal point

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45
Q

near objects send (paralled/divergent) beams

A

divergent (rapidly)

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46
Q

proper convergence: clear vision; improper convergence: ___

A

blurred vision

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47
Q

SNS and PNS innervates what structure which directly affects lens.

A

ciliary muscles

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48
Q

PS preganglionic membrane come from?

A

edinger-westephal nucleus in the midbrain

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49
Q

parasympathetic ns in the eyes is mediated by ____ through _____

A

acetylcholine; muscarinic 3 receptors

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50
Q

CN 3 projects to where?

A

ciliary ganglion

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51
Q

sympathetic preganglionic efferent comes from iml cell column in the ____ segments of spinal cord, ascends and synapses with ____

A

T1-T2; superior cervical ganglion

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52
Q

which type of ciliary muscle fiber is responsible for the tightness of the zonules

A

circular fibers

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52
Q

sympathetic function is mediated by ____ through ____

A

epinephrine; beta 2 receptors

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53
Q

ciliary muscle fiber type responsible for changing the pore size of the trabecular network of aqueous humor drainage in the anterior eye

A

longitudinal
- remember ICOL

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54
Q

middle ciliary muscle fiber

A

radial

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55
Q

what happens to cm, cz, and lens during close vision

A

cm would contract, cz would be less tense, and lens would bulge
- vice versa for near vision

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56
Q

in far vision, what common type of light rays are created

A

parallel light rays

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57
Q

focal length in a. diverging light rays b. parallel light rays

A

a>b

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58
Q

contracting and the bulging of lens leads to a more convex shape, increasing refractive power leading to ____ focal length

A

decreasing

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59
Q

two factors affecting vision

A

eyeball length
curvature of the eyes

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60
Q

term that implies balance between refractive power of cornea and lens, and the axial length of eyeball; absence of refractive error

A

emmetropia

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61
Q

sharper eyesight: a. 20/15 vision b. 20/25 vision

A

a>b

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62
Q

refraction is measured in

A

diopters

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63
Q

refractive power: lens humor cornea

A

cornea>lens>humor

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64
Q

fine-tunes focus for differnet distances

A

lens

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65
Q

4 factors contributing to normal vision

A

refractive power
corneal shape and dimension
axial eyeball length
lens elasticity

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66
Q

refers to the presence of refractive error

A

ametropia

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67
Q

positive diopter; 0 diopter; negative diopter

A

hyperopia; emmetropia; myopia

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68
Q

4 types of ametropia

A

hyperopia
myopia
prebyopia
astigmatism

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69
Q

happens when the eye produces an image with multiple focal points or lines due to the unequal curvature of the cornea or lens or sometimes of the retina

A

astigmatism

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70
Q

in presbyopia, what aspect of normal vision is commonly affected

A

lens eslaticty which leads to decreased near vision; due to aging and loss of accommodation

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71
Q

in hyperopia, where is the formed focal point located
hint: beyond the eye

A

behind the retina

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72
Q

axial hyperopia entails

A

shorter axial length

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73
Q

term for the absence of lens which entails losing about 20% of the eyes refractive power

A

aphakia (misplaced lens)

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74
Q

3 causes of refractive hyperopia

A

lens - flattened
refractive index - decreased
aphakia

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75
Q

accomodation in hyperopia

A

cm - contracts
cz - less tense
lens - bulge (thicker and more curved) to decrease focal length and concentrate it on the retina

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76
Q

T or F. in mild hyperopia, accommodation can still correct the image

A

True

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77
Q

excessively high hyperopia in children can cause what two conditions

A

corssed eye (esotropia) and monocular amblyopia (lazy eye - imbalance of the strength of the two eyes)

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78
Q

In myopia, image is found where

A

front of the retina (unaccommodated eye)

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79
Q

squinting is a primary sign of

A

myopia
- smaller aperture
- pinhole test

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80
Q

most common myopia

A

axial

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81
Q

axial myopia means

A

axial length is elongated

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82
Q

1 mm increase in axial length means ___ additional diopters

A

3

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83
Q

Without increased axial length, myopia also entails 2 refractive conditions

A

lenticular myopia: inc ref index of lens
–> eyes converge too early—> ends up focusing in front of the retina
positional myopia: lens of the eye shift forward

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84
Q

1 mm change in radius of corneal curvature in myopia

A

6 additional diopters

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85
Q

VR: a. far point distance b. refractive power

A

B. inc a leads to dec b —> vice versa is myopia (there is too much refractive power)

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86
Q

too curved cornea means ____ ref index

A

greater

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87
Q

What distinguishes prebyopia to hyperopia

A

presbyopia occurs in old people due to aging and decreased lens elasticty

88
Q

thickness: a. pigmented layer b. neural layers

A

a<b

89
Q

layer that houses the light-sensitive photoreceptors

A

neural layer

90
Q

absorbs light and prevents it from being scattered in the eyes

A

pigmented layer

91
Q

yellow spot

A

macula lutea

92
Q

fovea centralis contains only what photoreceptor

A

cones

93
Q

central vision

A

fovea centralis

94
Q

periphery of retina contains mainly what receptor

A

rods

95
Q

this area has absence of rods or cones

A

optic disc

96
Q

quantity: a. rods b. cones

A

a>b (100 million>3 million)

97
Q

size: a. rods b. cones

A

a<b
rods - 2-5 micrometers (narrower and longer)
cones - 5-8 micrometers (wider)

98
Q

pigment of cones

A

iodopsin

99
Q

shape of rods

A

cylindrical

100
Q

mediated by rods which allow for primary contrast, motion, and night or low-light vision that involves seeing only varying shades of gray

A

scotopic vision

101
Q

mediated by cones for good spatial resolution and color vision

A

photopic vision

102
Q

response and recovery time: a. rods b. cones

A

a<b

103
Q

this receptor has a convergent retinal pathway whoch leads to a lower spatial resolution

A

rods

104
Q

describe the retinal pathway of cones and bipolar cells which preserves clarity and visual info for higher resolution

A

one-to-one

105
Q

which vision has a higher threshold (photopic/scotopic)

A

photopic

106
Q

which vision is highly sensitive to weak light (photopic/scotopic)

A

scotopic

107
Q

loss of cone function

A

functional blindess

108
Q

loss of rod function

A

night blindness

109
Q

number of neurons coursed: a. rods b. cones

A

a>b
rods- rods, bipolar, amacrine, ganglion (4)
cones- cones, bipolar, ganglion (3)

110
Q

2 parts of rhodopsin

A

opsin: scotopsin
chromophore: 11-cis-retinal

111
Q

2 parts of iodopsin

A

opsin: photopsin
chromophore: 11-cis-retinal

112
Q

Degree of spatial summation: a. rods b. cones

A

a>b
rods - convergent retinal pathway - greater summation - more sensitive to weak light
cones - one-to-one retinal pathway- weaker summation - less sensitive to weak light

113
Q

which receptor plays a role in minimal peripheral distortion

A

cones - concentrated in fovea centralis which contributes less distortion in central visual field

114
Q

L-cone/ Porphyropsin

A

red

115
Q

M-cone/ Iodopsin

A

green

116
Q

S-cone/ Cyanopsin

A

blue

117
Q

process of converting light energy into electrical energy made possible by photoreceptor cells

A

phototransduction

118
Q

photochemical reaction starts with the decomposition of

A

rhodopsin = scotopsin + carotenoid (11-cis retinal)

119
Q

sources of 11-cis-retinal

A

Vitamin A / Beta-carotene

120
Q

beta carotene is cleaved by ___ to form 2 molcules of ___

A

beta-carotene dioxygenase; 2 all-trans retinal

121
Q

all trans retinal to all trans retinol via what enzyme

A

retinal reductase

122
Q

all-trans retinol to ____ via retinoid isomerase

A

11-cis retinol

123
Q

11-cis retinol to 11-cis retinal via

A

11-cis retinol dehydrogenase

124
Q

11-cis retinal combines with scotopic opsin to form ____

A

rhodopsin

125
Q

alternative pathway for 11-cis retinal

A

all-trans retinal to 11-cis retinal via retinal isomerase

126
Q

What type of receptor is Rhodopsin in Rod cells

A

GPCR

127
Q

T or F. Rhodopsin and Transducin are active during darkness

A

False; they are INACTIVE

128
Q

What keeps sodium ion channels open in rod cells

A

cGMP

129
Q

______ activation triggers enzyme to break down cGMP and close sodium channels, which happens when light is present

A

Transducin

130
Q

In dark state, the cGMP-mediated sodium channels are ____

A

open
- photoreceptors remain depolarized

131
Q

VR. a. sodium permeability b. less negative RMP

A

A
- rods are in functional state

132
Q

what neurotransmitter is constantly produced in the dark when rods are depolarized

A

glutamate

133
Q

activated rhodopsin

A

metarhodopsin II

134
Q

rhodopsin breakdown forms scotopsin, enumerate the biochemical pathway afterwards

A

scotopsin –> bathorhodopsin –> lumirhodopsin –> metarhodopsin I –> metarhodopsin II

135
Q

metarhodopsin II forms into what?

A

initial scotopsin + all trans retinal

136
Q

asctivation if metarhodopsin II activates what?

A

transducin

137
Q

alpha subunit of transducin activates what

A

cGMP phosphodiesterase –> decrease cGMP –> decrease intracellular sodium –> 5’ GMP

138
Q

net effect of closure of cGMP-mediated Na channels, reinforced by Na-K Pump

A

Less Intracellular Na —> Hyperpolarization

139
Q

in light state, what happens to the photoreceptors

A

hyperpolarized

140
Q

greater electronegativity leads to greater

A

hyperpolarization

141
Q

Phototransduction employs __, activating more rhodopsins with increase light energy

A

graded potentials

142
Q

VR. a. Metarhodopsin II b. Depolarization

A

B

143
Q

VR. a Hyperpolarization b. Glutamate

A

B

144
Q

Outer Plexifrom Layers have what two cells

A

Bipolar (vertical path) , Horizontal cells (horizontal path)

Path:
Horizontal cells –> Bipolar cells

145
Q

Inner Plexiform Layers have what two cells

A

Amacrine, Ganglion cells

146
Q

Amacrine cells transmit signals from

A

Bipolar cells

147
Q

Amacrine cells have two transmission pathways:

A
  1. directly towards ganglion cells
  2. horizontally within i. plexiform layer
    a. to other amacrine cells
    b. to dendrites of ganglion cells
148
Q

penultimate signal receivers

A

ganglion cells

149
Q

transmit signals from retina and sends signals to optic nerve to brain for further processing

A

ganglion cells

150
Q

deactivation cascade involes what enzyme that inactivates activated rhodopsin (metarhodopsin II)

A

rhodopsin kinase

151
Q

calcium-binding protein bound to rhodopsin kinase

A

recoverin

152
Q

recoverin is active when calcium levels are ___ due to phototransduction

A

low

153
Q

summary of deactivation cascade involving rhodopson kinase

A

reoverin with ca is bounded to rhodopsin kinase –> low ca due to phototransduction –> ca is released along with rhodopsin kinase –> rk phosphorylates metarhodopsin II –> less activation of transducin –> depolarization of rod cells continue

154
Q

A protein that binds to the phosphorylated metarhodopsin II to completelt deactivate it

A

arrestin

155
Q

what type of organic compound do you see cis-trans isomerization

A

alkenes

156
Q

if all-trans-retinal undergoes isomerization, it forms ___.

A

11-cis-retinal
-from trans to cis

157
Q

Axons from the ganglionic layer of the retina project to form the fibers of the ___

A

Optic nerve

158
Q

Fibers of optic nerves are myelinated by

A

Oligodendrocytes

159
Q

where two opposite optic nerves converge

A

optic chiasm

160
Q

fibers that carry peripheral field signals and the one that decussates

A

nasal fibers

161
Q

fibers that carry nasal field signals, originates from temporal retina, and continue ipsilaterally

A

peripheral fibers

162
Q

Left Optic Tract carries what fibers

A

Left peripheral fibers and Right nasal fibers

163
Q

What vision fields are carried by right optic tract

A

left nasal field and left peripheral field

164
Q

T or F. relative to optic tract side, it always carries visual fields of the opposite side

A

True

165
Q

Nasal fibers visual field is

A

Peripheral visual field

166
Q

crucial for depth perception and judging distances accurately; partial crossover ensures integration of visual information from both eyes to the brain

A

Binocular Vision

167
Q

Optic tract synapses where in thalamus

A

Lateral Geniculate Nucleus

168
Q

relay center between optic nerve and visual cortex “gate to the visual cortex”; constructs contralateral visual hemifield representation

A

LGN

169
Q

what pathway of LGN perceives movement, depth, brightness from rods

A

magnocellular

170
Q

what pathway perceives color from cones

A

parvocellular

171
Q

axonal projections from lateral geniculate nucleus

A

optic radiations

172
Q

primary visual area broadmann and sulcus

A

broadmann area 17, calcarine sulcus

173
Q

receives from ba 17 and relates visual information to past visual experiences

A

broadmann area 18,19

174
Q

ventral stream of visual association area
dorsal strea

A

object form and recognition; motion and spatial relationships

175
Q

right visual field is projected to which brain hemisphere/ cortical side

A

left cortical side

176
Q

upper visual field is what retinal quadrant and side of calcarine sulcus

A

lower quadrant and inferior calcarine sulcus

177
Q

lower visual field is what retinal quadrant and side of calcarine sulcus

A

upper quadrant and superior calcarine sulcus

178
Q

Visual field: Right Inferior
Visual cortex:

A

Left Superior
(pina-opposite tanan)

179
Q

T or F. Visual Fields and Visual Cortex are ALWAYS opposite.

A

True

180
Q

Measures the ability of the eye to distinguish shapes and details of objects at a given distance; eyes seeing fine details with clarity and sharpness

A

Visual Acuity

181
Q

test for visual acuity for illiterate or mute patients; involves tumbling Es wherein each patient is asked where the E is facing as it gets smaller and smaller

A

Random E Test

182
Q

test that uses image outlines and vanishing prototypes designed for pediatric patients in the hard-to-test age group (12-30 months), individuals with intellectual impairment, and those with decreased consciousness; tests technique of preferential looking through eye movements

A

Cardiff Acuity Test

183
Q

preferntial-looking test used for patients who are unable to execute subjective visual test since they cannot speak or have impediments; a card is shown from a certain distance with lines on one side

A

Teller’s Test

184
Q

Most commonly used test for visual acuity; determines baseline vision and measured against 20/20 vision

A

Snellen Test

185
Q

Snellen Test assess what CN?

A

CN II Optic Nerve

186
Q

Makes use of rows of progressively smaller letters and corresponding numerical values taht denote degree of VA

A

Snellen Test

187
Q

portabe snellen chart

A

pocket vision chart

188
Q

INTERPRET: 8 out of 8 letters in 20/20 line + 2 out of 8 letters in next line

A

20/20 + 2 = vision is slightly better than 20/20

189
Q

INTERPRET: 20/80 vision

A

Severe vision impairment

190
Q

done after a patient’s vision was confirmed not to be 20/20 after visual acuity test; one can determine if a patient has a refractive error, allowing you to suggest correcting their visual problems with lenses

A

pinhole test

191
Q

in pinhole test, what is the implication if the vision worsened?

A

amblyopia (lazy eye)

192
Q

in pinhole test, what is the implication if the vision improves?

A

refractive errors (myopia, hyperopia, astigmatism, presbyopia)

193
Q

What type of light rays do not need to be focused?

A

Central Light Rays

194
Q

in pinhole occluder, explain why refractory error is associated with better vision

A

the pinhole occluder eliminates the peripheral light rays which lessens the task of refractory media in bending the light which means reduced refractory errors

195
Q

temporary solutions similar to pinhole occluder

A

squinting, pulling the corner of eyes together

196
Q

most defects are in what visual field

A

peripheral visual field

197
Q

assess the visual field of the patient

A

visual field confrontation

198
Q

assess an individual’s mear visual acuity to read small print comfortably at a normal reading distance

A

Jaeger’s test

199
Q

in jaeger’s test, the test cards must be how many inches away?

A

14 inches

200
Q

artificial lenses impanted through surgery, done for cataracts or aphakic people

A

intraocular lenses

201
Q

Concave lens:
____ lenses
____ at the edges, ____ at the center
d/c lenses
focal point on the ____ side
+/- focal length
dec/inc refractive power
dec/inc focal length
used to treat

A

minus lenses
thicker at the edges, thinner at the center
diverging lenses
focal point on the same side
negative focal length
decrease refractive power
increase focal length
myopia

202
Q

Convex lens:
____ lenses
____ at the edges, ____ at the center
d/c lenses
focal point on the ____ side
+/- focal length
dec/inc refractive power
dec/inc focal length
used to treat

A

Plus lenses
thinner at the edges, thicker at the center
converging lenses
focal point on the opposite side
positive focal length
increases refractive power
decreases focal length
hyperopia

203
Q

a person with hyperopia should be given what lenses

A

convex

204
Q

the constriction of the pupil in response to a broght light shone into the eyes

A

pupillary light reflex

205
Q

in pupillary light reflex pathway, optic tract send fibers to the

A

superior colliculus

206
Q

in pupillary light reflex pathway, superior colliculus sends fibers to the ____ via the

A

pretectal nucleus via the lateral geniculate nucleus

207
Q

in pupillary light reflex pathway, pretectal nucleus sends fibers to

A

edinger-westephal nucleus

208
Q

afferent limb of the pupillary light reflex pathway

A

optic nerve

209
Q

coordinating center of the afferent pathway of pupillary light reflex

A

pretectal nucleus

210
Q

efferent limb of the pupillary light reflex

A

oculomotor nerve

211
Q

visceral nucleus portion of the CN III and gives rise to the parasympathetic preganglionic fibers

A

edinger-westephal nuclei

212
Q

effector of the pupillary light reflex

A

sphincter pupillae

213
Q

fibers from _____ send bilateral fibers

A

pretectal nucleus

214
Q

fibers from e-w nucleus synapse with

A

ciliary ganglion

215
Q

postsynaptic neurons of the efferent limb of pupillary light reflex

A

ciliary nerves

216
Q

from pretectal to e-w nucleus via the

A

posterior commissure

217
Q

diagnostic tests that deal with eye movement, alignment, coordination, and overall extraocular muscle health

A

eye motility test

218
Q

what extraocular eye muscle plays a role in superior lateral movement

A

inferior oblique muscle

219
Q

what movement is controlled by a muscle innervated by the CN IV

A

Inferior Lateral –> controlled by Superior Oblique Muscle

220
Q

extraocular muscle for inferior medial movement

A

inferior rectus muscle

221
Q

this means when one can is able to maintain their gaze on a single location

A

foveal fixation

222
Q

is a disorder in which both eyes do not line up in the same direction. Therefore, they do not look at the same object at the same time.

A

Strabismus

223
Q

In strabismus, since only one eye can view in the correct orientation, the patient may experience

A

diplopia

224
Q

It is a condition where your eyes make rapid, repetitive, uncontrolled movements; fine rhythmic oscillation of the eyes

A

Nystagmus

225
Q
A

INTEGRATION 1 (2 decks)

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