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NS2 Test 2 > Chapter 29 part 2 > Flashcards

Chapter 29 part 2 Flashcards

1
Q

Anterior chamber bound by?

A
  • anteriorly–cornea
  • laterally-trabecular meshwork
  • posteriorly–iris
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2
Q

aqueous humor formed by?

A

pars plicate of ciliary body

  • enters posterior chamber, bathes lens
  • circulates through pupil to anterior chamber
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3
Q

cataracts–describes?

A

lenticular opacities–congenital or acquired

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4
Q

age-related cataract

A
  • pacification of lens nucleus (nuclear sclerosis)

- accumulation of urochrome pigment–lens nuclear brown–distorts the perception of blue color

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5
Q

posterior subcapsular cataract

A
  • migration of lens epithelial posterior to lens equator

- secondary to enlargement of abnormally positioned lens epithelium

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6
Q

morgagnian cataract

A

lens cortex liquefies

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7
Q

phacolysis

A
  • proteins may leak through lens capsule

- can clog trabecular meshwork-elevation in intraocular P and optic nerve damage

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8
Q

glaucoma–what is it?

A
  • distinctive changes in visual field and cup of optic nerve
  • most associated with elevated intraocular pressure
  • normal or low-tension glaucoma–with normal intraocular pressure
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9
Q

2 major categories of glaucoma

A
  • open angle

- angle closure

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10
Q

open angle glaucoma

A
  • aqueous humor has complete physical access to trabecular meshwork
  • the elevation in intraocular pressure results from an increased resistance to aqueous outflow in the open angle
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11
Q

primary open-angle glaucoma–genes

A
  • most common–few changes are apparent structurally
  • MYOC gene mutation–juvenile and adult
  • OPTN mutation–adults
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12
Q

secondary open-angle glaucoma–most common type?

A
  • pseudoexfoliation glaucoma
  • deposition of fibrillar material throughout anterior segment
  • SNPs in LOX1 gene (lyse oxidase like)
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13
Q

secondary open-angle glaucoma–particulate material?

A
  • particulate material can clog up trabecular meshwork
  • proteins (phacolysis)
  • senescent red cells after trauma (ghost cell glaucoma)
  • iris epithelial pigment granules (pigmentary glaucoma)
  • necrotic tumors (melanoma lytic glaucoma)
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14
Q

angle closure glaucoma

A
  • peripheral zone of iris adheres to trabecular meshwork

- physically impedes aqueous humor

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15
Q

primary angle-closure glaucoma

A
  • in eyes with shallow anterior chambers, often in patients with hyperopia
  • pupillary margin of iris on anterior surface of lens–pupillary block
  • continued production of aqueous humor by ciliary body–causes iris to bow forward (iris bombe)
  • lens epithelium–gets its nutrition from aqueous humor–can be damaged–leads to minute anterior subcapsular opacities (glaukomflecken)
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16
Q

secondary angle closure galucoma

A
  • pathologic membranes can form over surface of iris, causing iris to draw over trabecular meshwork
  • chronic retinal ischemia–upregulates VEGF–VEGF in aqueous humor induces thin, fibrovascular membranes over iris–contraction of these in membranes leads to occlusion of trabecular meshwork–neovascular glaucoma
  • can also be caused by tumors in ciliary body–compresses iris onto trabecular meshwork
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17
Q

in intraocular inflammation, what happens?

A

vessels in ciliary body and iris become leaky–exudate accumulate in anterior chamber

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18
Q

keratic precipitates

A

inflammatory cells adhere to corneal endothelium

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19
Q

presence of exudate in anterior chamber can facilitate the formation of adhesion bw?

A
  • iris and trabecular meshwork or cornea (anterior synechiae)–leads to increased intraocular P
  • iris and anterior surface of lens (posterior synechiae)–deprive lens epithelium of aqueous humor–fibrous metaplasia of lens epithelium–anterior sub capsular cataract
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20
Q

endopthalmitis

A
  • inflammation in vitreous humor
  • retina lines the vitreous cavity
  • inflammation in vitreous humor–poorly tolerated by retina–causes irreversible injury
  • exogenous–from environment–gains access through a wound
  • endogenous–to eye hematogenously
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21
Q

panopthalmitis

A

-inflammation within eye–retina, choroid, sclera, extends into orbit

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22
Q

uvea–consits of?

A
  • iris, choroid, ciliary body

- choroid–richly vascularized

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23
Q

uveitis

A
  • inflammation in 1 or more tissues that compose the urea

- chronic disease

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24
Q

granulomatous uveitis

A
  • complication of sarcoidosis
  • anterior segment–exudate–“mutton fat” keratin precipitates
  • post segment–choroid and retina
  • retina–perivascular inflammation–“candle wax drippings”
25
retinal toxoplasmosis
-accompanied by uveitis
26
sympathetic ophthalmia--what is it? caused by? diagnostic findings?
- non-infectious uveitis - bilateral granulomatous inflammation--panuveitis (all urea) - can complicate a penetrating injury to eye--retinal ags gain access to lymphatics in conjunctiva--delayed hypersensitivity reaction--affects injured and uninjured eye - diagmostic findings--enucleation of a blind eye--diffuse granulomatous inflammation of uvea
27
most common inraocular malignancy in adults
metastasis to uvea, typically the choroid
28
uveal melanomas--genes
- GNAQ and GNA11 (GPCRs--promote proliferation) | - loss of chromosome 3--deletion of BAP1 (tumor suppressor gene)
29
uveal nevi-genes
- GNAQ and GNA11 mutations | - but rarely transform into melanomas
30
uveal melanomas--2 types of cells
- spindle cells--fusiform in shape | - epithelioid cells-spherical
31
uveal melanomas--spread by?
- vasculogenic mimicry | - hematogenous route--first to liver
32
retina responds to injury by?
gliosis
33
retinal detachment
- separation of neurosensory retina from RPE (retinal pigment epithelium) - RPE--role in maintenance of outer segments of RPE
34
persistent hyperplastic primary vitreous
-incomplete regression of fetal vasculature running through vitreous humor (adult humor is avascular)
35
posterior vitreous detachment
-with aging--posterior face of vitreous humor may separate from the neurosensory retina
36
retinal detachment classified by
-presence or absence of break in retina
37
rhegmatogenous retinal detachment
-full thickness retinal defect
38
retinal tears develop by?
- vitreous collapses structurally--posterior hyaloid (post face of vitreous humor) exerts traction on points of strong adhesion to retinal internal limiting membrane - vitreous humor seeps through tear--goes to potential space bw neurosensory retina and RPE
39
hypertension--opthalmoscopy
- retinal arteriosclerosis--thickened arteriolar wall changes - vessels appear narrowed - color of blood column changes from bright red to copper to silver (depending on vascular wall thickness)
40
malignant hypertension--what happens?
- retina and choroid vessels damaged - produce focal choroid infarcts--Elsning spots - exudate from damaged retinal arterioles--accumulate in outer plexiform layer of retina--macular star! (exudate in macula) - occlusion of retinal arterioles--infarcts of n fiber layer of retina--cytoid bodies--cotton wool spots
41
diabetes mellitus--reliable histologic marker
-thickening of basement membrane of epithelium of pars plicate of ciliary body
42
retinal vasculopathy of diabetes mellitus--classifed into?
- non-profliferative diabetic retinopathy | - proliferative diabetic retinopathy
43
non proliferative diabetic retinopathy
- basement membrane of retinal BVs thickens - microaneurysms--important manifestation - retinal microcirculation becomes leaky--macular edema - exudates--accumulate in outer plexiform layer
44
proliferative diabetic retinopathy
-appearance of new vessels sprouting on surface of the optic n head (neovascularization of disc), or on surface of retina (neovascularization elsewhere)
45
proliferative diabetic retinopathy--new vessels go where?
-breach the internal limiting membrane of retina
46
posterior vitreous detachment
if vitreous humor separates from internal limiting membrane of retina--massive hemorrhage from the disrupted neovascular membrane
47
retinal neovascular--accompanied by?
- neovascular membrane on iris surface (due to VEgF) - contraction of iris nonvascular membrane--adhesions bw iris and trabecular meshwork (anterior synechiae)--occludes aqueous outflow neovascular glaucoma
48
retinopathy of prematurity (retrolental fibroplasia)
- at term--temporal aspect of retinal periphery is incompletely vascularized - in premature babies treated with oxygen--immature retinal vessels constrict--retinal tissue distal to the zone is ischemic - retinal ischemia--up regulation of VEGF--retinal angiogenesis--contraction of neovascular membrane--drag the temporal aspect of retina toward peripheral zone--displace macula laterally--retinal detachment
49
retinopathy that affects patients with sickle hemoglobinopathies--2 types
- non-proliferative - proliferative - both cause vascular occlusion
50
retinopathy that affects patients with sickle hemoglobinopathies--what happens? visible changes?
- infarct of retina | - retina swells, becomes optically opaque--fundus appears white instead of red or orange
51
hollenhorst plaques
-fragments of atherosclerotic plaques can lodge in retinal circulation
52
total occlusion of central retinal a--produces
- diffuse infarct of retina - retina appears opaque - normal orange-red of choroid, highlighted by surrounding opaque retina (cherry red spot)
53
cherry red spot occurs in?
- occlusion of central retinal a | - Tay-sachs and Riemann-Pick diseases
54
AMD (age-related macular degeneration)
- dry AMD--deposits in Bruch membrane, atrophy of RPE - wet AMD--choroidal neovascularization--penetrate through RPE--becomes directly beneath the neurosensory retina--vessels can leak--exudated blood cause macular scars
55
AMD gene
CFH (complementary regulatory gene)
56
Retinitis pigmentosa
- inherited mutations that affect rods and cones or RPE - visual impairment - rods and cones lost to apoptosis - retinal atrophy--constriction of retinal vessels and optic nerve head atrophy (waxy pallor of optic disc)
57
retinitis pigmentosa
- inherited mutations that affect rods and cones, or RPE - visual impairement - rods and cones lost to apoptosis - retinal atrophy--constriction of retinal vessels and optic n head atrophy (waxy pallor of optic disc)
58
retinitis pigments pathogenesis
- candida- can disseminate to retina hematogenously--causes retinal abscesses - CMV--in immunocompromised

NS2 Test 2 (16 decks)

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