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BOARDS 2 > export_nbeo anatomy > Flashcards

export_nbeo anatomy Flashcards

1
Q

what is telecanthus?

A

abonormally wide distance between medial canthi

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2
Q

which cranial nerve palsy can cause ectropion?

A

VII

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3
Q

which portion of the orbicularis muscle is used for reflex blinking?

A

palpebral

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4
Q

which portion of the orbicularis muscle is used for forced blinking?

A

orbital

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5
Q

what muscle keeps the eyelid tight against the globe?

A

muscle of riolan part of the palpeberal portion of the orbicularis

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6
Q

what is the function of the orbital septum? (2)

A

prevents fat from falling down into lid margins prevents infections moving into orbit

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7
Q

is the lacrimal sac protected by the orbital septum?

A

no, orbital septum is behind the lacrimal sac

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8
Q

what is the periorbita?

A

loosely covers the orbital bones, continous with orbital septum and fuses with dura of the optic nerve

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9
Q

where does the superior palpebral levator muscle originate from?

A

lesser wing of the sphenoid main retractor of upper lid continuous with the levator aponeurosis

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10
Q

what is whitnall’s ligament?

A

fulcrum for the palpebral levator muscle attaches to zygomatic

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11
Q

what is the muscle of muller?

A

sympathetic muscle in eyelids minor retractor of upper lid

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12
Q

which cranial nerve opens the eye? Which closes it?

A

CN III open CN VII closes

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13
Q

where are goblet cells located?

A

epithelial layer of the conj. most numerous in the infernonasal fornix

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14
Q

function of glands of zeis?

A

lubrication of eyelashes

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15
Q

function of glands of moll?

A

modified sweat glands in eyelid

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16
Q

function of the glands of krause?

A

accessory lacrimal glands=maintenance tears located mostly in the fornices (Krause=crease)

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17
Q

function of the glands of wolfring?

A

accessory lacrimal glands =maintenance tears more prevalent than krause mostly located on tarsal conj.

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18
Q

what are the holocrene glands of the eyelid?

A

meibomian zeis (cell ruptures releasing contents)

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19
Q

What are the apocrine glands of the eyelid?

A

moll goblet secretions bud off of cell plasma

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20
Q

what are the merocrine glands of the eyelid?

A

wolfring krause cell products are emptied into a duct by exocytosis

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21
Q

which nerves supply the sensory portion of the eyelids?

A

CN V V1 (ophthalmic)=superior lid V2 (maxillary)=lower lid

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22
Q

what supplies blood to the deep layers of the eyelids?

A

internal carotid feeds into the palpebral arcades superficial supply from external carotid

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23
Q

where do the conjunctival lymph nodes drain into?

A

lateral=parotid (preauricular) medial=submandibular

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24
Q

what are the muscles of the eyebrow? (3)

A

frontalis= surprise/attention corrugator= concentration/sorrow procerus=menace/aggression all innervated by CN VII

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25
Q

where are the only lymph glands of the orbit located?

A

lacrimal gland

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26
Q

which nerve innervates the lacrimal gland and causes lacrimation?

A

CN VII parasympathetic

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27
Q

what is dacryoadenitis?

A

inflammation/infection of the lacrimal gland

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28
Q

which muscle controls the canaliculi?

A

muscle of horner assists in tear drainage

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29
Q

what is dacryocystitis?

A

infection of the lacrimal sac

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30
Q

where is the lacrimal sac located?

A

in a fossa formed by the lacrimal bone and the maxillary bones

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31
Q

where is the lacrimal gland located?

A

in a fossa of the frontal bone

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32
Q

what is the valve of hasner?

A

located at the end of the nasolacrimal duct prevents backflow

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33
Q

which EOMs originate in the common tendinous ring?

A

all rectus muscles and superior oblique

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34
Q

what is the origin of the superior oblique?

A

lesser wing of the sphenoid bone and the CTR physiologic origin=trochlea

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35
Q

where does the inferior oblique originate?

A

ANTERIOR at the maxillary bone

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36
Q

what does the superior lateral branch of the ophthalmic artery supply?

A

SR LR SO

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37
Q

what does the inferior medial branch of the ophthalmic artery supply?

A

MR IR IO

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38
Q

where is the pituitary gland located?

A

sella turcica of the sphenoid bone

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39
Q

where does CN V2 enter the orbit?

A

foramen rotundum

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40
Q

which bone contains the optic canal (optic nerve and ophthalmic artery)?

A

lesser wing of the sphenoid

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41
Q

what passes through the common tendinous ring and the superior orbital fissure? (3)

A

NOA Nasociliary nerve (V1) Oculomotor nerve Abducens nerve

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42
Q

what passes through the superior orbital fissure and ABOVE the common tendinous ring? (4)

A

superior ophthalmic vein frontal verve lacrimal nerve trochlear nerve “SOV FLighT”

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43
Q

what passes through the inferior orbital fissure and passes under the common tendinous ring? (1)

A

inferior ophthalmic artery

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44
Q

which bones make up the roof of the orbit? (2)

A

FRONT-LESS frontal (majority) lesser wing of the sphenoid

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45
Q

what bones make up the floor of the orbit? (3)

A

*My Pal gets his Z’s on the FLOOR” maxillary (majority) palatine zygomatic

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46
Q

which bones make up the medial wall of the orbit? (4)

A

ELMS maxilla ethmoid lacrimal body of the sphenoid

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47
Q

which bones make up the lateral wall of the orbit? (2)

A

Great Z greater wing of the sphenoid zygomatic

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48
Q

what supplies the blood to the IR and SO EOMs?

A

infraorbital branch of the maxillary artery (branch of external carotid) (also lacrimal sac and lower lid)

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49
Q

what supplies blood to the inner 2/3rd of the retina?

A

central retinal artery (branch of ophthalmic artery)

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50
Q

what supplies blood to the LR, SR, SO EOMs?

A

superior branch of the ophthalmic artery (also levator)

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51
Q

what supplies blood to the MR, IR, IO EOMs?

A

inferior medial branch of the ophthalmic artery

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52
Q

what supplies blood to the optic disc?

A

circle of zinn (from short posterior ciliary arteries->ophthalmic artery)

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53
Q

what supplies blood to the major circle of the iris? (2)

A

long posterior ciliary arteries (from ophthalmic artery) anterior ciliary arteries

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54
Q

what feeds into the cavernous sinus?

A

superior and inferior ophthalmic veins middle & inferior cerebral vein

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55
Q

what does the cavernous sinus drain into?

A

internal jugular vein

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56
Q

what passes through the cavernous sinus? (6)

A

CN III CN IV CN I CN VI CN V2 internal carotid artery “3,4,6, V1, V2… V3 and 7 do not go through”

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57
Q

what is the average length of an emmetropic eye?

A

24mm

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58
Q

what is the thickness of the cornea?

A

.55mm in the center .67mm at periphery

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59
Q

what is the greatest refractive surface of the eye?

A

tear/air interface greatest change in index of refraction

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60
Q

what are the layers of the cornea? (6)

A

epithelium basement membrane bowman’s layer stroma descemet’s membrane endothelium

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61
Q

what would happen if you performed tonometry off of the corneal center?

A

abnormally high readings

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62
Q

4 layers of the corneal epihelium?

A

surface layer wing cells basal layer stem cells

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63
Q

where do corneal stem cells originate from?

A

palisades of vogt around the limbus

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64
Q

what is bowmans layer?

A

type 1 collagen does not regenerate NOT a basement membrane

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65
Q

what is the only mitotic layer in the cornea?

A

basal layer

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66
Q

what makes up the corneal stroma? (3)

A

keratoctyes collagen fibrils (type 1) ground substance (GAGs)

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67
Q

what is the glycocalyx?

A

sugar layer makes surface bind well with mucin layer of tears

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68
Q

what is the predominate GAG within the cornea?

A

keratin sulfate

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69
Q

what is descemet’s membrane?

A

type 4 collagen produced by endothelium can regenerate

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70
Q

how many cells thick is bowmans layer?

A

zero! it is acellular

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71
Q

what is the function of corneal endothelium?

A

NA+/K+ pumps maintain hydration and transparency do not replicate

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72
Q

which layer of the corneal stroma is more likely to have edema?

A

posterior

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73
Q

what happens when corneal endothelial cells die?

A

other cells change shape (pleomorphism) or size (polymegathism) to compensate

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74
Q

what is the main source of oxygen for the cornea?

A

tear film when the eye is open conjunctival blood vessels when the eye is closed

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75
Q

what innervates the cornea?

A

CNV1 only anterior stroma, bowmans and epithelium have nerves enters mid-stroma

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76
Q

what are the two layers of the conjunctiva?

A

stratified non-keratinized epithelial layer submucosa (lymphoid and fibrous layers)

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77
Q

what is continuous with descemet’s membrane?

A

schwalbes line

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78
Q

what are the 3 parts of the lens?

A

capsule epithelium cortex

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79
Q

what are the two methods for aqueous outflow? which is pressure independent?

A

corneoscleral: pressure dependent 80% uveoscleral: pressure independent 20%

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80
Q

what is the function of the plica semilunaris?

A

provides slack for the movement of conjunctiva

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81
Q

where do the lens zonules attach to the lens?

A

lens capsule

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82
Q

where is the germinal zone of the lens?

A

anterior to the lens equator

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83
Q

what is the index of refraction of the lens?

A

nucleus=1.41 anterior=1.38

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84
Q

what produces the lens zonules?

A

non-pigmented ciliary epithelium in the pars plana and pars plicata

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85
Q

what is the thickest part of the sclera?

A

1mm at posterior pole

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86
Q

what is the function of alpha crystallins in the lens?

A

molecular chaperones, keep other crystallins separated by correct distance keeps lens clear

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87
Q

what is the thinnest part of the sclera?

A

.3mm under the recti tendon insertions

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88
Q

what are the layers of the sclera? (4)

A

episclera sclera lamina fusca tenon’s capsule

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89
Q

what is the difference between sclera and episclera?

A

episclera is LOOSE CT and HIGHLY vascular sclera is DENSE CT and AVASCULAR

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90
Q

which areas of the sclera contain elastin? (2)

A

scleral spur lamina cribrosa

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91
Q

what are the 2 parts of the trabecular meshwork?

A

uveoscleral (inner) corneoscleral (outer)

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92
Q

where is the iris thickest?

A

collarette thinnest at iris root

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93
Q

what are the two parts of the iris?

A

ciliary zone pupillary zone divided by the collarette

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94
Q

what are the layers of the iris? (4)

A

anterior border layer stroma anterior epithelium/dilator posterior pigmented epithelium

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95
Q

how is iris color determined?

A

the amount of melanin inside of the melanocytes NOT # of melanocytes

96
Q

in which layer of the iris is the sphincter muscle located?

A

stroma

97
Q

which layer of the iris gives it its color?

A

anterior border layer

98
Q

in which layer of the iris is the dilator muscle located?

A

anterior epithelium/dilator muscle layer

99
Q

what forms the blood-aqueous barrier? (3)

A

iris vessels ciliary body endothelium of schlemms

100
Q

what is the canal of hanover?

A

area filled with aqueous between the anterior and posterior lens zonules

101
Q

what is the canal of petit?

A

the retrolental space between the zonules and the vitreous

102
Q

what are the valleys of kuhnt?

A

regions between the ciliary processes in pars plicata

103
Q

what is the pars plicata?

A

anterior portion of ciliary body produces aqueous

104
Q

where is the aqueous humor produced?

A

in the non-pigmented ciliary body epithelium in the pars plicata

105
Q

what is the flow of aqueous humor? (5)

A

pars plicata-> posterior chamber-> pupil -> anterior chamber-> trabecular meshwork

106
Q

where is the major circle of the iris found?

A

in the ciliary body

107
Q

where do the lens zonules originate in the ciliary body?

A

pars plana

108
Q

how is aqueous humor formed?

A

plasma that escapes the blood stream in the fenestrated capillaries of the major circle of the iris

109
Q

where is the choroid the thinnest?

A

ora serrata

110
Q

in which layer of the ciliary body is the major arterial circle of the iris found?

A

stroma

111
Q

what innervates the choroid?

A

sympathetic nervous system causes vasoconstriction

112
Q

whihc layer of the choroid contain the long posterior ciliary nerves?

A

suprachoroid lamina

113
Q

what are the layers of the choroid? (4)

A

suprachoroid lamina stroma choriocapillaris bruch’s membrane

114
Q

what are the two vessel layers in the choroidal stroma?

A

Hallers (Huge) Sattler (small)

115
Q

which layers of the choroid are vascular?

A

stroma choriocapilaris

116
Q

where are fenestrated capillaries found in the eye? (2)

A

choriocapillaris major arterial circle of the iris

117
Q

which layer of the choroid contains vortex veins?

A

stroma specifically hallers layer

118
Q

what is the function of bruch’s membrane? (2)

A

passage of nutrients from choriocapillaris to retina waste products from inner retina pass through to choriocapillaris

119
Q

which layer of bruchs membrane can have angiod streaks?

A

elastic layer

120
Q

where are drusen located?

A

between the inner collagenous layers of bruch’s and the BM of the RPE

121
Q

what supplies blood to the choroid?

A

long & short posterior ciliary arteries

122
Q

what is the patellar fossa?

A

depression in the vitreous where the lens sits

123
Q

what is the type of collagen found in the vitreous?

A

type II

124
Q

what makes up the vitreous?

A

water (98%) type II collagen hyaluronic acid (GAG)

125
Q

what are the attachment sites of the vitreous from strongest to weakest? (5)

A

vitreous base posterior lens optic disc macula retinal vessels

126
Q

where is the vitreous base attached?

A

ora serrata

127
Q

what is the ligament of weiger?

A

the attachment between the vitreous and the posterior lens and zonules

128
Q

what is cloquet’s canal?

A

former site of the hyaloid artery

129
Q

from what embryonic tissue is neural retina derived?

A

neural ectoderm

130
Q

what is a epicapsular star?

A

hyaloid remnant on anterior lens capsule

131
Q

where does lipofuscin accumulate?

A

inside of RPE cells

132
Q

what is a mittendorfs dot?

A

hyaloid remnant on posterior lens capsule

133
Q

what does the myoid portion of the photoreceptor do?

A

Makes protein

134
Q

which layer of the retina stores vitamin A?

A

RPE

135
Q

what does the elipsoid region of the photoreceptor do?

A

Energy lots of mitochondria

136
Q

where is rod density the greatest?

A

5mm around the fovea rod ring

137
Q

what is located in the inner segment of the photoreceptor? (3)

A

myoid (makes protein) Ellipsoid (has mitochondria) cilium (connects to outer seg)

138
Q

what is located in the outer segment of photoreceptors?

A

discs

139
Q

how many discs are in a rod? how many in a cone?

A

600-100 per rod 1000-1200 per cone

140
Q

which photoreceptor has a spherule?

A

rods

141
Q

which photoreceptor has a pedicle?

A

cones

142
Q

which photopigment is found in rods?

A

rhodopsin (507nm)

143
Q

which cone photopigment absorbs blue light?

A

cyanolabe (440nm)

144
Q

which cone photopigment absorbs green light?

A

chlorolabe (535nm)

145
Q

which cone photopigment absorbs red light?

A

eryhtrolabe (565nm)

146
Q

what synapses with rod spherules?

A

1 to 4 rod bipolar cell dendrites horizontal cell dendrites

147
Q

which layer of the retina receives blood supply from both the choroid and the retina?

A

outer plexiform layer

148
Q

where is the space formed during retinoschisis?

A

outer plexiform layer

149
Q

which layer are hard exudates found in?

A

outer plexiform layer

150
Q

what is the function of bipolar cells?

A

carry information directly from rods/cones to ganglion cells

151
Q

what is the function of horizontal cells?

A

lateral inhibition

152
Q

what is the function of interplexiform cells?

A

carry signals between OPL and IPL

153
Q

what is the function of amacrine cells?

A

carry information laterally between bipolar, interplexiform, ganglion and other amacrine cells

154
Q

what is the function of muller cells?

A

most common glial cell in the retina structural and nutritional support

155
Q

which retinal cells provide inhibitory signals?

A

amacrine and horizontal

156
Q

where do the ganglion cells of the retina synapse?

A

LGN

157
Q

what is the most common type of ganglion cell?

A

midget ganglion (p1) a type of parvocellular cell with only one dendrite that synapses with one foveal bipolar cell

158
Q

what is affected first in glaucoma, M-cells or P-cells?

A

M-cells

159
Q

which ganglion cells are responsible for fine vision?

A

mideget ganglion cells (p1) because they only carry information from a single foveal cone

160
Q

where are cotton wool spots located?

A

NFL

161
Q

where are splinter/drance/flame hemorrhages located?

A

NFL

162
Q

where are dot and blot hemorrhages located?

A

inner nuclear layer

163
Q

____ million photoreceptors-> ____ million bipolar cells-> ____ million ganglion cells

A

128 million photoreceptors-> 35 million bipolar cells-> 1.5 million ganglion cells

164
Q

where is excess glucose stored in the retina?

A

muller cells

165
Q

in which layers of the retina are muller cells found?

A

ELM to ILM

166
Q

what % of the population has a cilioretinal artery?

A

15-20%

167
Q

how large is the macula?

A

5.5mm

168
Q

which retinal layers are found in the foveola? (6)

A

RPE photoreceptor ELM ONL henle’s fiber layer ILM

169
Q

what is Henle’s fiber layer?

A

layer in the fovea that contains axons of photoreceptors NO bipolar cells or ganglion cells are located in the fovea

170
Q

what is the thickest portion of the retina?

A

parafovea

171
Q

in a CN XII lesion, which way will the tongue deviate?

A

towards the lesion

172
Q

in a CN X palsy, which way will the uvula deviate?

A

away from the lesion

173
Q

what is the purpose of the pretectal nucleus?

A

pupil innervation

174
Q

what connect CN III to CN IV, VI and VIII?

A

medial longitudinal fasiculus

175
Q

what is the purpose of the superior colliculus? (2)

A

reflex eye movements saccades

176
Q

which part of CN III projects to a contralateral EOM?

A

superior rectus

177
Q

what are the three destinations for CN II fibers?

A

LGN Pretectal nucleus Superior colliculus

178
Q

what is innervated by the superior division of CN III? (3)

A

superior rectus superior levator mullers muscle

179
Q

what is innervated by the inferior division of CN III? (4)

A

medial rectus inferior rectus inferior oblique pupil

180
Q

what is indicated by a CNIII palsy that involves the pupil?

A

since pupillary fibers are on the outside of CN III, its is likely and posterior communicating artery aneurysm

181
Q

what is indicated by a CNIII palsy that spares the pupil?

A

since pupil fibers on on the outside, its is likely microvascular think diabetes or hypertension

182
Q

which cranial nerve leaves from the dorsal side?

A

CN IV

183
Q

which way would a patient with a right CN IV palsy tip their head?

A

same side as the lesion (but opposite side from the affected EOM) right head tilt

184
Q

what do the long posterior ciliary nerves (division of V1) innervate? (4)

A

cornea (s) iris (s) ciliary muscle (s) dilator muscle (M)

185
Q

what do the short posterior ciliary nerves (division of V1) innervate? (3)

A

cornea (s) iris (s) ciliary muscle (s)

186
Q

branches of CN V1?

A

nasociliary frontal lacrimal

187
Q

which division of CN V supplies the eyelids?

A

upper=V1 lower=V2

188
Q

what is the sensory innervation to the inferior medial eyelid?

A

nasociliary branch of V1

189
Q

which type of aneurysm should you suspect with a CN VI palsy?

A

internal carotid

190
Q

which cranial nerve is responsible for taste in the posterior 2/3 of the tongue?

A

VII

191
Q

which cranial nerve stimulates lacrimation?

A

VII V is sensory

192
Q

which CN innervates the orbicularis oculi?

A

zygomatic branch of CN VII

193
Q

what is the ocular difference between bells palsy and a stroke?

A

a patient with a stroke can still voluntarily close their eyelids, a bells palsy patient cannot bells palsy can cause exposure keratopathy from lagopthalmos

194
Q

what are the parasympathetic innervations of the eye?

A

CN III=iris sphincter and ciliary body (miosis and accommodation) CN VII=lacrimal gland (lacrimation)

195
Q

where is the damage in a stroke? bells palsy?

A

stroke: supranuclear Bells palsy: lower motor neurons

196
Q

why do patients with optic neuritis experience pain on eye movements?

A

because the optic nerve sheath is attached to the SR and MR muscles

197
Q

what is the vidian nerve?

A

sympathetic innervation of the lacrimal gland makes you NOT cry

198
Q

what is the internal limiting membrane of elsching?

A

the astrocytes that cover the optic disc

199
Q

what is the border tissue of jacoby?

A

separation of the optic nerve fibers from the choroid

200
Q

which parts of the eye can autoregular blood supply? (2)

A

optic nerve retina

201
Q

what is the intermediary tissue of kuhnt?

A

ring of glial tissue that separates the optic nerve fibers from the retinal tissue

202
Q

what is the border tissue of elsching?

A

scleral collagen fibers that surrounds the glial tissue of the optic nerve

203
Q

where does myelination of the optic nerve begin?

A

posterior to the lamina cribrosa oligodendrocytes

204
Q

what are the anterior knees of wilbrand?

A

inferior nasal fibers from contralateral eye loop back to opposite optic nerve

205
Q

what are the anterior knees of wilbrand?

A

superior nasal fibers from contralateral eye loop back to opposite optic nerve

206
Q

which layers of the LGN are magno? parvo?

A

1, 2=magno 3,4,5,6=parvo

207
Q

what % of optic nerve fibers go to the LGN?

A

90%

208
Q

which layers of the LGN are crossed? uncrossed?

A

crossed= 1(m) 4,6 (p) uncrossed= 2 (m) 3,5 (p)

209
Q

the inferior optical radiations move through which part of the brain?

A

temporal lobe

210
Q

where do superior fibers go in the LGN? inferior?

A

SMILe Superior: medial Inferior: lateral

211
Q

the superior optical radiations move through which part of the brain?

A

parietal lobe

212
Q

what separates the cuneus and lingual gyrii?

A

calcarine fissure

213
Q

where do the superior retinal fibers terminate?

A

cuneus gyrus

214
Q

where do the inferior retinal fibers terminate?

A

lingual gyrus

215
Q

what is meyer’s loop?

A

pathway taken by inferior optic radiations that go around the tip of the lateral ventricle before reaching the occipital lobe

216
Q

where do the optic radiations synapse with the neurons of the striate cortex?

A

layer 4 of the primary visual cortex

217
Q

which layer of the primary visual cortex sends signals to the superior colliculus?

A

layer 5

218
Q

of the primary visual cortex sends feedback to the LGN?

A

layer 6

219
Q

where does binocular visual processing first occur along the visual pathway?

A

primary visual cortex

220
Q

what is the blood supply to the primary visual cortex? (2)

A

posterior cerebral artery middle cerebral artery

221
Q

where is a lesion in a homonoymous VF defect?

A

post-chiasmal

222
Q

what will cause a “pie in the sky” VF defect?

A

temporal lobe lesion PITS= parietal/inferior temporal/superior

223
Q

what will cause a “pie on the floor” VF defect?

A

parietal lobe lesion PITS= parietal/inferior temporal/superior

224
Q

what will cause a macular sparing homonymous hemiopsia?

A

a stroke to either posterior or middle cerebral artery

225
Q

what causes macula only homonymous hemianopsia?

A

compressive lesion (tumor)

226
Q

which muscle helps drain tears?

A

muscle of horner

227
Q

how much does the superior levator muscle retract the eyelid?

A

15mm

228
Q

how much does mullers muscle retract the eyelid?

A

1-3 mm

229
Q

what muscle would be paralyzed in a large ptosis? small ptosis?

A

large: levator small: mullers

230
Q

what type of tears are produced by the main lacrimal gland? (2)

A

reflex emotional

231
Q

which forehead muscle will fatigue with ptosis?

A

frontalis

232
Q

what is the tertiary action of the superior/inferior rectus muscles?

A

adduction

233
Q

what is the tertiary action of the oblique muscles?

A

abduction

234
Q

where does CN V3 enter the orbit?

A

Foramen Ovale

235
Q

what is the thinnest orbital bone? weakest?

A

thinnest: ethmoid weakest: maxillary

236
Q

what causes vision loss in GCA?

A

loss of blood supply to the short posterior ciliary arteries NOT JUST TEMPORAL ARTERY DISEASE

237
Q

what is a cavernous sinus fistula?

A

abnormal connection between arterial and venous blood supply in cavernous sinus painful red eye, orbital bruit, proptosis

BOARDS 2 (3 decks)

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