Ears + Eyes Flashcards
The external ear borders are the _ to the _
The external ear borders are the auricle/pinna to the tympanic membrane (includes the tympanic membrane)
* Includes the external auditory canal
The middle ear contains: [structures]
The middle ear contains:
* Ossicles
* Eustachian tube
* Stapedial and tensor tympani muscles
From lateral to medial, the ossicles are _ , _ , _ (oval window)
From lateral to medial, the ossicles are malleus , incus , stapes (oval window)
The stapedial muscle is innervated by [CN]
The stapedial muscle is innervated by facial nerve (VII)
The tensor tympani muscle is innervated by _ nerve
The tensor tympani muscle is innervated by pterygoid nerve (branch of V3)
The eustachian tube is a connection between the ear and nasopharynx that allows for _
The eustachian tube is a connection between the ear and nasopharynx that allows for pressure equalization
The only part of the ear that is not mucosa lined is the _
The only part of the ear that is not mucosa lined is the external ear (skin-lined)
The _ labyrinth is filled with perilymph
The bony labyrinth is filled with perilymph
The _ labyrinth is filled with endolymph
The membranous labyrinth is filled with endolymph
(3) components of the bony labyrinth:
(3) components of the bony labyrinth:
1. Vestibule
2. Semicircular canals
3. Cochlea
Inside the vestibule, are two portions of membranous labyrinth that help detect head position, _ and _
Inside the vestibule, are two portions of membranous labyrinth that help detect head position, utricle and saccule
Inside the semicircular canals are the _ and inside the cochlea is the _
Inside the semicircular canals are the semicircular ducts and inside the cochlea is the cochlear duct
Vibration of the stapes –> _ –> movement of hair cells in the organ of corti –> _
Vibration of the stapes –> movement of perilymph in cochlea –> movement of hair cells in the organ of corti –> opening/closing of membrane channels and generation of nerve impulse
The base of the basilar membrane detects _ frequency sounds
The base of the basilar membrane detects high frequency sounds
The apex of the basilar membrane detects _ frequency sounds
The apex of the basilar membrane detects low frequency sounds
The _ branch of CN VIII receives signal from the inner and outer hair cells
The cochlear branch of CN VIII receives signal from the inner and outer hair cells
* It will then send information about pitch, volume, localization of sound
_ conduction is a way by which sound can vibrate through the skull and go directly to the coclea
Bone conduction is a way by which sound can vibrate through the skull and go directly to the coclea
* Skips the external and middle ear
In conductive hearing loss, the weber test will localize to the _
In conductive hearing loss, the weber test will localize to the affected ear
In sensorineural hearing loss, the weber test will localize to the _
In sensorineural hearing loss, the weber test will localize to the unaffected ear
In sensorineural hearing loss, the Rinne test will be better _
In sensorineural hearing loss, the Rinne test will be better in front of ear (air > bone)
In conductive hearing loss, the Rinne test will be better _
In conductive hearing loss, the Rinne test will be better behind the ear (bone > air)
Interpret this audiogram
Presbycusis: hearing loss at high frequencies
_ hearing loss means there is a problem in the external or middle ear; the problem is getting sound to the inner ear
Conductive hearing loss means there is a problem in the external or middle ear; the problem is getting sound to the inner ear
* Ex: cholesteatoma, otitis media, ossicular dysfunction, tympanic membrane perforation
Acquired cholesteatoma originates from _ dysfunction
Acquired cholesteatoma originates from eustachian tube dysfunction –> retraction of tympanic membrane –> build up of skin –> can degrade bone
When bone > air there is _ hearing loss
When bone > air there is conductive hearing loss
* On audiogram brackets = bone
Interpret the audiogram
Sensorineural hearing loss
* There is a problem of VIII
Examples of sensorineural hearing loss:
Examples of sensorineural hearing loss:
* Presbycusis
* Exposure to loud noise
* Congenital causes
* Tumor
* Ototoxic medications
Interpret the audiogram
Mixed hearing loss (combination)
The three main tissue layers of the eye are:
The three main tissue layers of the eye are:
1. Sclera/cornea from surface ectoderm
2. Uveal tract from mesoderm and neural crest
3. Retina/ neural from neuroectoderm
There are two segments of the eye; the _ which is the optical segment and the _ which is the sensory segment
There are two segments of the eye; the anterior segment which is the optical segment and the posterior segment which is the sensory segment
The anterior chamber is filled with _ and the posterior chamber is filled with _
The anterior chamber is filled with aqueous fluid and the posterior chamber is filled with vitreous fluid
The two chambers of the eye are in relation to the iris, the _ and _
The two chambers of the eye are in relation to the iris, the anterior and posterior
The _ are the output cells of the retina which send signal to the occipital cortex via the _
The retinal ganglion cells are the output cells of the retina which send signal to the occipital cortex via the lateral geniculate nucleus (LGN)
ID the major landmarks
There are two main refractive structures in the eye, the _ and _
There are two main refractive structures in the eye, the cornea and lens
The _ is the air- tear film interface and it has the greatest refractive power
The cornea is the air- tear film interface and it has the greatest refractive power
If light is refracted too heavily or the eye is too long, the result is _
If light is refracted too heavily or the eye is too long, the result is myopia (near-sightedness)
If light is not refracted enough or the eye is too short, the result is _
If light is not refracted enough or the eye is too short, the result is hyperopia (far sightedness)
_ is an irregular refraction due to ocular surface or lens aberration
Astigmatism is an irregular refraction due to ocular surface or lens aberration
_ occurs with age as the lens becomes stiff and loses accommodation
Presbyopia occurs with age as the lens becomes stiff and loses accommodation
The 1’ neuron of the hypothalamospinal pathway begins at the _ and synapses at _
The 1’ neuron of the hypothalamospinal pathway begins at the hypothalamus and synapses at C8-T2
The 2’ neuron of the hypothalamospinal pathway extends from C8-T1, through the _ and synapses at the _
The 2’ neuron of the hypothalamospinal pathway extends from C8-T1, through the sympathetic chain and synapses at the superior cervical ganglion
The 3’ neuron of the hypothalamospinal tract is the _ nerve
The 3’ neuron of the hypothalamospinal tract is the long ciliary nerve –> dilator pupillae
Parasympathetics to the eye originate at the _ nucleus and travel alongside CN III before synpasing in ciliary ganglion, where _ innervates the pupillary sphincter
Parasympathetics to the eye originate at the edinger-westphal nucleus and travel alongside CN III before synpasing in ciliary ganglion, where short ciliary nerve innervates the pupillary sphincter
The near reflex (which allows us to focus on close objects) requires (3) phenomenon:
The near reflex (which allows us to focus on close objects) requires (3) phenomenon:
1. Lens accommodation
2. Miosis
3. Convergence
In order for the lens to accomodate to close objects, _ must contract and _ must relax
In order for the lens to accomodate to close objects, ciliary muscles must contract and suspensory ligaments must relax
* This makes lens more spherical
In order for the lens to focus distant objects, the ciliary muscles must _ and the suspensory muscles must _
In order for the lens to focus distant objects, the ciliary muscles must relax and the suspensory muscles must stretch
* This makes the lens flatten
Optic neuropathy or severe midbrain dysfunction may result in loss of the _ reflex
Optic neuropathy or severe midbrain dysfunction may result in loss of the light reflex
Aqueous humor gets produced by _ on the ciliary body
Aqueous humor gets produced by non-pigmented epithelium on the ciliary body
* This ciliary body is in the posterior chamber
The dilator muscle on the iris has [receptors]
The dilator muscle on the iris has a1 receptors
The sphincter muscle of the iris has [receptors]
The sphincter muscle of the iris has M3 receptors
90% of aqueous humor gets drained through the _
90% of aqueous humor gets drained through the trabecular meshwork –> canal of schlemm –> episcleral vasculature
10% of aqueous humor gets drained into the _
10% of aqueous humor gets drained into the uvea and sclera (uveoscleral outflow)
Glaucoma is a neurodegenerative disease that results in vision loss starting in the _
Glaucoma is a neurodegenerative disease that results in vision loss starting in the periphery
* Type of optic neuropathy that causes progressive vision loss
* Intraocular pressure plays a significant role
Glaucoma is associated with [phenomenon] of the optic nerve/disc
Glaucoma is associated with cupping of the optic nerve/disc
Acute angle _ glaucoma is a vision threatening emergency; treat by _
Acute angle-closure glaucoma is a vision threatening emergency; treat by reducing intraocular pressure (laser peripheral iridotomy)
_ involves degeneration and opacification of the crystalline lens
Cataracts involves degeneration and opacification of the crystalline lens
Cataracts are most commonly due to increased _ and _
Cataracts are most commonly due to increased age and UV exposure
* Can be congenital or related to metabolic disorders
How does cataract present?
Cataracts present with gradual vision loss, glare, color dulling, myopic shift
* Myopic shift happens because of increase in AP diameter and increased optic power of the lens
Macular degeneration begins with [region] vision loss
Macular degeneration begins with central vision loss
Dry macular degeneration is associated with _ deposits, leading to atrophy and slow vision loss
Dry macular degeneration is associated with drusen deposits, leading to atrophy and slow vision loss
Wet macular degeneration involves _ and can be a more rapid loss of central vision
Wet macular degeneration involves neovascularization and can be a more rapid loss of central vision
Macular degeneration begins in the center due to the highest density of _ here
Macular degeneration begins in the center due to the highest density of photoreceptors here
* Photoreceptors are particularly vulnerable to oxidative stress
We treat dry macular degeneration with _
We treat dry macular degeneration with multivitamins
We treat wet macular degeneration with _
We treat wet macular degeneration with anti-VEGF
The _ layer supports the neurosensory retina by regulating oxidative stress
The retinal pigment epithelium (RPE) layer supports the neurosensory retina by regulating oxidative stress
Retinal detachment occurs when fluid separates the neurosensory retina from the _
Retinal detachment occurs when fluid separates the neurosensory retina from the retinal pigment epithelium
* May involve detachment or preservation of macula
Retinal detachment is preceded by [signs]
Retinal detachment is preceded by flashes, floaters, progressive dark curtain over vision
Pathogenesis of diabetic retinopathy:
Pathogenesis of diabetic retinopathy:
glycosylation of proteins in capillary walls –> poor vascular integrity –> leakage and ischemia
Clinical signs of diabetic retinopathy:
Clinical signs of diabetic retinopathy:
* Microaneurysms
* Dot-blot hemorrhage
* Cotton wool spots (infarts)
* Neovascularization
Can be nonproliferative or proliferative (NV)
Treat with glycemic control or anti-VEGF
Chronic increased blood pressure and IOP can cause _
Chronic increased blood pressure and IOP can cause hypertensive retinopathy
Clinical signs of hypertensive retinopathy:
Clinical signs of hypertensive retinopathy:
* Copper or silver wiring: arterioles are thickened so more reflective on exam
* AV nicking: arteriole crosses vein
* Later stage: retinal venous obstruction
Treat with BP control
Retinitis pigmentosa is [aquired/inherited] retinal disease with progressive loss of photoreceptors
Retinitis pigmentosa is aninherited retinal disease with progressive loss of photoreceptors
Retinitis pigmentosa vision loss begins in [region]
Retinitis pigmentosa vision loss begins in periphery
* Peripheral –> central
Retinitis pigmentosa will begin with [vision deficit]
Retinitis pigmentosa will begin with night blindness –> peripheral vision loss –> central
“Bone spicule pigmentation” =
“Bone spicule pigmentation” = retinitis pigmentosa
Babies born prematurely will have _ retinas due to incomplete vascularization; this triggers an increase in _ release
Babies born prematurely will have ischemic retinas due to incomplete vascularization; this triggers an increase in VEGF release –> retinal neovascularization
* Can treat with anti-VEGF or laser
_ commonly occurs when tiny oil glands near the base of the eyelashes become clogged, causing irritation and redness.
Blepharitis commonly occurs when tiny oil glands near the base of the eyelashes become clogged, causing irritation and redness
* These glands are called Meibomian glands
* Dysfunction of gland –> dryness, itching
Blepharitis is most commonly caused by [pathogen] or [pathogen]
Blepharitis is most commonly caused by staph or demodex
Treatment for blepharitis includes _
Treatment for blepharitis includes lid hygiene, warm compress
Styes are defined simply by _
Styes are defined simply by glandular obstruction +/- inflammation
_ is a style usually caused by bacteria with significant inflammation
Hordeolum is a style usually caused by bacteria with significant inflammation
_ is a stye caused by a blocked oil gland without much inflammation
Chalazion is a stye caused by a blocked oil gland without much inflammation
Bacterial conjunctivitis is usually treated with _
Bacterial conjunctivitis is usually treated with topical antibiotics
* Chlamydial or gonococcal infection treated with systemic abx
_ is infection of the conjunctiva, while _ is infection of the cornea
Conjunctivitis is infection of the conjunctiva, while keratitis is infection of the cornea
Diagnosis?
Keratitis
Diagnosis?
Herpes simplex keratitis featuring dendritic ulcer
Anterior inflammation of the uveal tract is called _
Anterior inflammation of the uveal tract is called iridocyclitis
* Can be caused by disruption of blood aqueous barrier or sometimes primary (autoimmune)
Posterior inflammation of the uveal tract is either _ or _
Posterior inflammation of the uveal tract is either choroiditis or retinitis
* Can be caused by disruption of blood retinal barrier or sometimes primary (autoimmune)
Name (3) major categories of glaucoma drugs that decrease aqueous humor production
Name (3) major categories of glaucoma drugs that decrease aqueous humor production
1. Beta blockers
2. Carbonic anhydrase inhibitors
3. a2 agonists
Name (4) major categories of glaucoma drugs that increase aqueous humor outflow
Name (4) major categories of glaucoma drugs that increase aqueous humor outflow
1. a2 agonists (fall into both categories)
2. Prostaglandin analogs
3. M3 agonists
4. RHO kinase inhibitor
Brimonidine works by [mechanism] and [mechanism]
Brimonidine works by inhibiting aqueous humor production and increasing outflow
* Indirect mechanism by inhibiting ciliary blood flow
Both beta bockers and a2 agonists block sympathetic signaling to the _ , resulting in reduced aqueous humor
Both beta bockers and a2 agonists block sympathetic signaling to the ciliary body , resulting in reduced aqueous humor
Acetazolamide helps treat glaucoma via [mechanism]
Acetazolamide helps treat glaucoma via inhibiting aqueous production at the nonpigemented epithelium on ciliary body
Prostaglandin analogs like latanoprost increase _ outflow of aqueous humor
Prostaglandin analogs like latanoprost increase uveoscleral outflow of aqueous humor
Prostaglandin analogs have toxicities of _ and _
Prostaglandin analogs have toxicities of iris discoloration and increased eyelash length
M3 agonists, carbachol and pilocarpine increase AH outflow via [mechanism]
M3 agonists, carbachol and pilocarpine increase AH outflow via ciliary muscle contraction –> opens the canal of schlemm
* Direct M3
Indirect M3 agonists, _ and _ also help to contract the ciliary muscle, open the canal of schlemm, and increase AH outflow
Indirect M3 agonists, echothiophate and physostigmine also help to contract the ciliary muscle, open the canal of schlemm, and increase AH outflow
Toxicities of M3 agonists include _ and _
Toxicities of M3 agonists include miosis and loss of night vision
