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Ophthalmology -FA > CK > Flashcards

CK Flashcards

1
Q

Refractive errors - types / explain

A
  1. Hyperopia –> Eye too short
  2. Myopia –> eye too long
  3. Astigmatism –> abnormal curvature of cornea
  4. Presbyopia –> Age - related impaired accommodation (focusing on near objects), 1ry due to decreased lens elasticity
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2
Q

uveitis is divided to (according the place) (AKA)

A
  1. anterior uveitis (iritis)
  2. intermediate uveitis: pars planitis
  3. posterior uveitis (choroiditis and/or retinitis)
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3
Q

Uveitis may have - symptoms/findings

A
  1. hypopyon (accumulation of pus in anterior chamber)

2. conjuctival redness

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4
Q

Uveitis is associated with

A

systemic inflammatory disorders:

  1. Sarcoidosis 2. Rheumatoid arthritis 3. juvenile arthritis
  2. Bechet disease 5 . HLA-B27
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5
Q

optic disc is

A

the point of exit for ganglion cell axons leaving the eye.

optic nerve head

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6
Q

The optic disc is shaped like a (and why)

A

doughnut with a pink neuroretinal rim and a central white depression called the physiologic cup.

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7
Q

Glaucoma - characteristic cupping

A

thinning of outer rim of the optic nerve head versus normal

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8
Q

open angle glaucoma is associated with

A
  1. increased age
  2. African american race
  3. family history
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9
Q

open angle glaucoma is divided to

A
  1. primary

2. secondary

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10
Q

causes of primary open glaucoma

A

unclear

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11
Q

causes of secondary open glaucoma

A

blocked trabecular meshwork from

a. WBC (eg uveitis)
b. RBCs (eg vitreous hemorrhage)
c. retinal elements (eg retinal detachment)

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12
Q

primary closed/closed narrow angle - mechanism

A

enlargement or forward movement of lens against central iris (pupil margin) –> obstruction of normal aqueous flow through pupil –> fluid builds up behind iris, pushing peripheral iris against cornea and impeding flow through trabecular meshwork

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13
Q

secondary closed/narrow angle - mechanism

A

hypoxia from retina disease (diabetes mellitus, vein occlusion) –> vasoproliferation in iris that contracts the angle

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14
Q

chronic closed/narrow angle - symptoms and findings

A
  1. often asymptomatic
  2. damage to optic nerve
  3. damage to peripheral vision
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15
Q

acute closed/narrow angle - mechanism

A

elevated intraocular pressure pushes iris forward –> angle closes abruptly

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16
Q

acute closed/narrow angle - do not give (and why)

A

epinephrine because of its mydriatic effect

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17
Q

acute closed/narrow angle - symptoms and signs

A
  1. very painful
  2. red eye
  3. sudden vision loss
  4. halos around halos
  5. rock hard eye
  6. frontal headache
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18
Q

Conjunctivitis - types and presentation (and MC)

A
  1. Allergic –> itchy eyes
  2. Bacterial –> pus
  3. Viral (MC)–> sparse mucous discharge, swollen preauricular node
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19
Q

Viral vs bacterial conjunctivitis - transmissible

A

Virus easy

Bacterial poorly

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20
Q

Viral vs bacterial conjunctivitis - adenopathy

A

Only virus (preauricular)

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21
Q

characteristics of Viral conjunctivitis

A

bilateral, Watery discharge, easily transmissible, normal vision. itchy, preauricular adenopathy, no specific therapy

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22
Q

characteristics of Bacterial conjunctivitis

A

unilateral, purulent + thick discharge, poorly transmissible, normal vision, not itchy, no adenopathy, topical antibiotics

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23
Q

red eye (opthalmologic emergencies) - types and presentation

A
  1. conjunctivitis: itchy eyes with discharge
  2. uveitis autoimmune disease
  3. glaucoma: pain
  4. abrasion: trauma
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24
Q

red eye (opthalmologic emergencies) - types and eye findings

A
  1. conjunctivitis: normal pupil
  2. uveitis: photophobia
  3. glaucoma: fixed dilated pupil
  4. abrasion: like sand in the eye
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25
Q

red eye (opthalmologic emergencies) - types and most accurate test

A
  1. conjunctivitis: clinical diagnosis
  2. uveitis: slit lamp examination
  3. glaucoma: tonometry
  4. abrasion: fluorescein stain
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26
Q

red eye (opthalmologic emergencies) - types and best initial therapy

A
  1. conjunctivitis: topical antibiotics
  2. uveitis: topical steroids
  3. glaucoma: acetazolamide, mannitol, pilocarpine, laser trabeculoplasty
  4. abrasion: no specific therapy, patch not clearly beneficial
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27
Q

glaucoma treatment if medical treatment fails

A

laser trabeuloplasty

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28
Q

it can precipitate closed angle glaucoma

A

walking into a dark rook can precipitate pain because of pupillary dialation (SOS)

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29
Q

acute angle-closure glaucoma - the diagnosis is confirmed by

A

tonometry

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30
Q

keratitis - definition / presentation

A

infection of cornea

the eye may be very red, swollen and painful, but do not use steroids (make it worse)

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31
Q

hepres keratitis - diagnosis

A

Fluorecein staining of the eye helps confirm the dendritic pattern seen on examination

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32
Q

hepres keratitis - treatment

A

oral acyclovir, famciclovir or valacyclovir

topical anthepretic treatment is trifluridine and

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33
Q

Cataracts - diagnosis

A

early Cataracts: ophthalmoscope or slit lamp exam

advanced: visible on examination

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34
Q
  1. Hypertropia is corrected by

2. myopia is corrected by

A
  1. convex lens

2. biconcave lens

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35
Q
  1. astigmatism is corrected by

2. presbyopia is corrected by

A
  1. cylindric lens

2. convex lens

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36
Q

tunics of the eye?

A
  1. retina (inner)
  2. uvea or vascular (middle)
  3. fibrous tunic (outer)
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37
Q

fibrous tunic is divided to

A

sclera and cornea

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38
Q

uvea tonic is divided to

A

iris - ciliary body - choroid

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39
Q

retina is divided to

A

pigmented layer and neural layer

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40
Q

vascular arcades of retina

A

retinal artery

retinal vein

41
Q

vessels that perforate into eye with optic nerve

A

central retinal vein

central retinal artery

42
Q

The central retinal artery branches off the

A

ophthalmic artery (from internal carotid artery)

43
Q

ciliary muscle contraction - receptors

A

M3

44
Q

ciliary epithelium - function (and control by)

A

nonpigmented epithelium of ciliary –> body produces aqueous humor (decreases by β-blocker, α2-agonists and carbonic anhydrase inhibitors)

45
Q
  1. dilator muscle of iris - receptor

2. splinter muscle of iris- receptor

A
  1. a1

2. M3 (accommodation)

46
Q

splinter muscle of iris- receptor

A

M3 (accommodation)

47
Q

vision accommodation (adaptaing to short range focus) mechanism

A

ciliary muscle contraction –> releases the tension (relaxation) on the lens caused by the zonular fibers –> lens becomes more spherical –> adapts to short range focus.

48
Q

aqueous humor outflow

A
  • Trabecular flow (90%) –> drainage through trabecular meshwork –> Canal of Schlemm –> episcleral vasculature
  • Uveoscleral outflow (10%) –> drainage into uvea and sclera
49
Q

α1 - agonists effect on aqueous humor

A

decrease aqueous humor synthesis via vasoconstriction

50
Q

prostagladin effect on aqueous humor

A

increase uveoscleral outflow

51
Q

Ophthalmoscopy (funduscopy) - how to identify left and right eye

A

the macula is in the center of the image, and the optic disk is located towards the nose

52
Q

glaucoma drugs - classes

A
  1. α-agonists 2. β-blockers 3. diuretics

4. cholinomimetics 5. Prostagladin

53
Q

glaucoma drugs - α agonists - drugs (and receptors)

A

epinephrine (α1)

Brimonidine (α2)

54
Q

glaucoma drugs - α1-agonists - do not use in (and why)

A

in closed - angle glaucoma

Mydriasis

55
Q

glaucoma drugs - α-agonists - side effects

A
  1. Mydriasis (α1 epinephrine) 2. Blurry vision 3. ocular hyperemia
  2. foreign body sensation 5. ocular pruritus
  3. ocular allergic reaction
56
Q

glaucoma drugs - α-agonists - action on glaucoma

A

α2 –> decrease aqueous humor synthesis via inhibition of nonpigmented epithelium on ciliary body
α1 –> vasoconstriction –> decrease aqueous humor synthesis

57
Q

glaucoma drugs - β-blockers - action on glaucoma

A

decrease aqueous humor synthesis via inhibition of nonpigmented epithelium on ciliary body

58
Q

glaucoma drugs - β-blockers - side effects and drugs

A

no papillary or vision changes

  1. timolol
  2. betaxolol
  3. carteolol
59
Q

glaucoma drugs - acetazolamide mechanism of action

A

carbonic anhydrase inhibitor –> decreases aqueous humor synthesis via inhibition of nonpigmented epithelium on ciliary body

60
Q

glaucoma drugs - prostagladin (PGF2a) - drugs and mechanism of action

A
  1. Bimatoprost
  2. latanoprost
    increases outflow of aqueous humor through the Uveoscleral outflow
61
Q

glaucoma drugs - PGF2a - side effect

A
  1. Darkness of color of iris (browning)

2. eyelash growth

62
Q

glaucoma drugs - cholinomimetics are divided to (and which drugs)

A

direct –> a. pilocarpine b. carbachol

indirect –> a. physostigmine c. echothiophate

63
Q

glaucoma drugs - cholinomimetics side effects

A
  1. Miosis

2. cyclospasm (contraction of cilliary muscle)

64
Q

glaucoma - in emergencies - drug? (and why)

A

pilocarpine

very effective at opening meshwork into canal Schlemm

65
Q

glaucoma - drugs that decrease aqueous humor synthesis

A
  1. α - agonists
  2. β - blockers
  3. acetazolamide
66
Q

glaucoma - drugs that increase aqueous humor outflow

A
  1. cholomimetics

2. Prostagladins

67
Q

miosis mechanism - 1st neuron / 2nd neuron

A

1st. Edinger-Westphal nucleous to ciliary ganglion via CN III
2nd: short ciliary nerves to pupillary sphincter muscles (M3)

68
Q

Pupillary light reflex - mechanim

A

Light in EITHER retina sends signals via CN II (and chiasm and tract) to pretectal nuclei in midbrain that activates bilateral Edinger-Westphal nucleous –> Pupils contract bilaterally (consensual reflex)

69
Q

mydriasis vs miosis - number of neurons

A

miosis: 2
mydriasis: 3

70
Q

mydriasis - 1st neuron (beginning and end)

A

hypothalamus to ciliospinal center of Budge (C8-T2)

Synapse in the lateral horn

71
Q

mydriasis - 2nd neuron - direction

A

exit T1 - travels along cervical sympathetic chain near lung apex, sublavian vessels - superior cervical ganglion

72
Q

mydriasis - 3rd neuron - direction

A

superior cervical ganglion - plexus along internal carotid through cavernous sinus - enters orbit as LONG CILIARY NERVE - sypathetic fibers also innervate smooth muscle of eyelids (minor retractors) and sweat glands of forehead and face

73
Q

Marcus Gunn pupil - clinical finding

A

decreased bilateral pupillary constriction when light is shone in affected eye relative to unaffected eye

74
Q

Marcus Gunn pupil - mechanism

A

Afferent pupillary defect due to optic nerve damage or severe retinal injury

75
Q

Some causes of Horner syndrome

A
  1. spinal cord above T1: Brown-Sequard syndrome (cord hemisection), Late stage syringomegalia
  2. Pancoast tumor
  3. Lateral medullary (Wallenberg) syndrome
  4. Infernal carotid dissection
  5. Carvenous sinus syndrome
76
Q

Ocular motility - muscles and innervation

A
  1. Superior rectus (CN III)
  2. Lateral rectus (CN VI)
  3. Inferior oblique (CN III)
  4. Inferior rectus (CN III)
  5. Medial rectus (CN III)
  6. Superior oblique (CN IV)
77
Q

Superior rectus action

A

Elevate the abducted eye

78
Q

superior oblique action

A

Depress the adducted eye

79
Q

MC affected CN by tuberculosis

A

CN VI is the most commonly affected VI in immunocompetent people with tuberculosis

80
Q

Abducens nerve (CN VI) damage/palsy - physical finding

A

Medially directed eye that cannot abduct

  • adducted at rest
  • cannot be abducted
  • diplopia occurs on lateral gaze to the side of the affected eye
81
Q

Trochlear nerve (CN IV) damage/pulsy - eye at rest

A

Eye moves upward (hypertropia)

82
Q

Trochlear nerve (CN IV) damage/pulsy - increased elevation with

A
  1. adduction (contralateral gaze)

2. head tilting to the affected side

83
Q

Trochlear nerve (CN IV) damage/pulsy - solution

A

may present with compensatory head tilt in the opposite direction

84
Q

Oculomotor nerve (CN III) has both ……. components (and area)

A
  1. motor (central of the nerve)

2. parasympathetic (peripheral of the nerve)

85
Q

Motor output of CN III to ocular muscles is affected primarily by ….. due to …..

A

vascular disease (diabetes mellitus: glucose –> sorbitol) due to decreased diffusion of oxygen and nutrients to the interior fibers from compromises vasculature that resides on outside of nerve

86
Q

Motor output of CN III to ocular muscles - signs of damage

A
  1. ptosis

2. down and out gaze

87
Q

Parasympathetic output of CN III - examples of compression

A
  1. uncal herniation (an anterior extremity of the Parahippocampal gyrus)
  2. Posterior communicating artery aneurysm
88
Q

Parasympathetic output of CN III - signs of damage

A
  1. diminished or absent papillary light reflex
  2. Blown pupil (mydriasis)
  3. often with down and out gaze
89
Q

visual field defects - types

A
  1. (right/left) anopia (total blindness of left or right eye)
  2. Bitemporal hemianopia (vision is missing in the outer half of both the right and left visual field)
  3. (left/right) homonymous hemianopia (visual field loss on the left or right side of the vertical midline)
  4. (left/right) upper quadrantic anopia
  5. (left/right) lower quadrantic anopia
  6. (left/right) hemianopia with macular sparing
  7. Central scotoma
90
Q

Central scotoma is caused by

A

macular degeneration

91
Q

(right or left) anopia - mechanism

A

complete lesion of the right or left optic nerve

92
Q

(left or right) homonymous hemianopia is caused by

A
  1. a lesion in (left or right) of the left optic tract

2. a complete lesion in (left or right) of the left optic radiation

93
Q

left upper quadrantic anopia is caused by

A
  1. partial involvement of the optic radiation (Meyer loop) by a lesion in the right temporal lobe
  2. Middle cerebral artery stroke
94
Q

Mayer loop contains fibers from the

A

inferior retina (superior part of the visual field)

95
Q

left lower quadrantic anopia is caused by

A
  1. partial involvement of the optic radiation (dorsal optic radiation) by a lesion in the left parietal lobe
  2. Middle cerebral artery stroke
96
Q

Calcarine sulcus function

A

primary visual cortex (V1) is concentrated

97
Q

medial longitudinal fasciculus (MLF) is a

A

pair of tracts that allows for crosstalk between CN VI and the contralateral CN III nuclei
- it coordinates both eyes to move in same horizontal direction

98
Q

medial longitudinal fasciculus (MLF) - it coordinates both eyes to move in same horizontal direction - mechanism

A

when looking left, the left nucleus of CN VI fires, which contracts the left lateral rectus and stimulates the contralateral (right) nucleous of CN III (via the MLF) to contract the right medial rectus

99
Q

directional term for internuclear ophthalmoplegia (e.g. right INO, left INO)

A

refers to which eye is paralysed

Ophthalmology -FA (9 decks)

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