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PPO 2 Midterm (Pg. 9-18) > Conditions > Flashcards

Conditions Flashcards

1
Q

What does RAPD stand for?

A

Relative Afferent Pupillary Defect. Aka o Marcus-Gunn pupil.

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2
Q

What causes a RAPD?

A

Due to massive retinopathy or optic neuropathy (lesion on optic nerve of the non-dialating eye located before the optic chiasm). NOT due to cataract, corneal scar, or functional amblyopia.

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3
Q

What is Light-Near Dissociation?

A

Pupils constrict when accommodating, but not from light.

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4
Q

What is Anisocoria?

A

Pupil size is more than 0.5mm difference between two eyes

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5
Q

What is an Amaurotic pupil?

A

A “blind” pupil (no light reflex)

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6
Q

What is a Hutchinson’s pupil?

A

Unilateral, fixed, dilated pupil; usually seen in coma

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7
Q

What is a miotic pupil?

A

A pupil that stays constricted. Usually more noticeable in the dark.

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8
Q

What can cause a miotic pupil?

A 
o	Drops
o	Iritis
o	Horner’s syndrome
o	Argyll Robertson’s pupil
o	Long standing Adie’s pupil
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9
Q

What is a mydriatic pupil?

A

A pupil that stays dilated. More noticeable in bright light.

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10
Q

What can cause a mydriatic pupil?

A 
o      Trauma
o	Adie’s tonic pupil
o	3rd nerve palsy
o	Drops
o	Hutchinson’s pupil
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11
Q

The defect of which branch of the ANS causes Horner’s Syndrome?

A

Sympathetic Nervous System.

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12
Q

What are the observable symptoms of Horner’s Syndrome?

A
  • Ptosis
  • Miosis
  • Anhydrosis
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13
Q

How is ptosis caused by Horner’s syndrome measured?

A

Measure by measuring entire palpebral fissure and then from Herschberg corneal reflex up to upper lid on right eye and write as a fraction; then repeat for left

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14
Q

What is physiological anisocoria?

A

Difference in pupil size that is no larger than 0.5mm.

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15
Q

What percent of the population has physiological anisocoria?

A

20%

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16
Q

Does the level of physiological anisocoria change with level of illumination?

A

No

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17
Q

Damage to which types of neurons can lead to Horner’s Syndrome?

A

First order, second order and 3rd order neurons.

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18
Q

What is the path of travel of a 1st order neuron?

A

Origin: posterior hypothalamus
Passage: down spinal cord
Destination: synapse in the Cilliospinal center of Budge (C8-T1,2).

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19
Q

What is the most common cause of first order neuron damage?

A

A lesion that this caused by a cerebro-vascular accident (CVA). ie. Multiple sclerosis, Neck trauma.

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20
Q

What is the path of travel of a 2nd order neuron?

A

Origin: Cilliospinal center of Budge (C8-T1,2)
Passage: exits SC, travels over apex of lung
Destination: Synapse in the superior servical ganglion

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21
Q

What is the most common cause of 2nd order neuron damage?

A

A lesion caused by:

  • Pancoast’s tumor
  • Tuberculosis (TB)
  • Metastatic breast cancer
  • Trauma
  • Thyroid neoplasm/ surgery
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22
Q

What is the path of travel of a 3rd order neuron?

A

2 paths:
1) Post ganglionic neuron leaves SCG and follows the Internal Carotid A. -> Nasociliary N. -> Long Cilliary N. which innervates pupil dialator

2) Post ganglionic neuron leaves SCG and follows the Internal Carotid A. -> Ophtalmic A. then innervates Muller’s muscle.

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23
Q

What is the most common cause of 3rd order neuron damage?

A

-Path 1 (to pupil dialator):
• Internal carotid dissection and aneurysm
• Nasopharyngeal carcinoma

-Path 2 (to Muller’s muscle):
• Migraines

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24
Q

What can cause congenital Horner’s Syndrome?

A
  • Brachial plexus injury during birth

- Other factors Associated with heterochromia (different color irises)

25
What can cause Accuired Horner's Syndrome in children under 5?
Neuroblastoma in sympathetic chain of chest and neck. Must refer to pediatrician to rule this out.
26
What causes Adie's pupil?
A disorder of the Para-Sympathetic NS. De-nervated ciliary ganglion -> Sectoral palsy of the iris sphincter
27
What are symptoms of Adie's pupil?
- Unilaterally dilated pupil - Poor reaction to light - Slow tonic re-dilation
28
Is Adie's pupil usually found in one eye or both?
80% unilateral and will become bilateral at a rate of 4% per year
29
What is Light-Near Dissociation?
o Response to accommodation is stronger than to light | o Accommodation fibers outnumber pupil fibers 30:1
30
What can cause Light-Near Dissociation?
o Midbrain lesion close to pretectal nucleus | o Can be found in severe retinopathy and optic neuropathy
31
In what conditions is the phenomenon of Light-Near Dissociation observed?
-Adie’s tonic pupil -Argyll-Robertson pupil - Caused by Diabetes Others: -Dorsal midbrain syndrome -Aberrant regeneration of -CN III: miosis with ADDuction Amyloidosis
32
What are the symptoms of Argyll-Robertson Pupils?
o Both pupils are constricted and irregular o Near-light dissociation o Dilate poorly in dark, and respond poorly to dilating agents
33
Argyll-Robertson Pupils can be seen in individuals suffering from what conditions?
``` Syphilis Diabetes Chronic alcoholism Multiple sclerosis Sarcoidosis ```
34
Why is the maintaining of an appropriate IOP important?
- IOP affects the shape of the eye which is essential for optical properties of the eye - An IOP that is too high can cause Optic Nerve damage and loss of vision
35
What factors affect IOP?
- Rate of filtration - Change of rate of production - Body position - Blood pressure - External pressure on the globe - Central venous pressure
36
How will a decrease in filtration affect IOP?
IOP will increase
37
How will excess production of aqueous humor affect IOP?
IOP will increase
38
Which body position coincides with the larges increase in IOP?
Supine (laying on back) from early morning till just before noon; Sitting coincides with highest IOP in the afternoon
39
In what structures can a change in aqueous humor filtration occur?
o Anterior chamber angle o Trabecular meshwork o Canal of Schlemm o Episcleral vessels
40
What is the balance between IOP and blood pressure called?
Perfusion Pressure
41
How is Perfusion Pressure calculated?
Diastolic BP - IOP = Perfusion Pressure
42
When does BP and Perfusion pressure become vitally important when it comes to vision?
When the optic nerve becomes damaged (glaucoma)
43
What phenomenon helps keep Perfusion pressure constant?
Autoregulation
44
What can cause external pressure on the globe? How does this affect IOP?
- Forceful closure/ blepharospasm - Digital pressure - Tumor - Varix
45
How is Central Venous Pressure (CVP) related to IOP?
Linearly, CVP is 1/2 IOP
46
What can cause an increase or decrease in Central Venous Pressure?
- Excess IV fluids raise CVP, can cause myocardial infraction - Blood loss decreases CVP
47
What associated conditions typically occur together in the "Glaucoma triad"?
- Increased IOP - Optic Nerve damage - Visual field loss
48
What are the symptoms of gradual IOP increase?
It is asymptomatic
49
What are the symptoms of acute IOP increase?
- Nausea - Pain - Haloes
50
What condition can result from a dramatically decreased IOP?
Phtisis Bulbi (deflated and non-functional eye)
51
What is a scotoma?
An absolute or relative area of poor visual function surrounded by a normal visual field
52
What are the types of scatomas?
- Arcuate | - Annular
53
What is a central visual field defect?
A defect in the portion of the field involved in fixation
54
What is a centrocecal visual field defect?
Defect in the field from fixation to the blind spot
55
What is a paracentral visual field defect?
Defect in the field adjacent to the area of fixation
56
What is a pericentral visual field defect?
Defect in the field surrounding fixation
57
What is a Homonymous visual field defect and where is the lesion located?
same side visual field loss, lesion posterior to chiasm
58
What is a Heteronymousvisual field defect and where is the lesion located?
opposite sides of visual field loss, lesion at the chiasm; bi-temporal visual field loss
59
What is a Congruous visual field defect?
relatively similar in location and size. The more “posterior” the lesion is on the visual tract, the more congruous the visual field defects will be between the two eyes

PPO 2 Midterm (Pg. 9-18) (3 decks)

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