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NMSP > EYE CONT > Flashcards

EYE CONT Flashcards

1
Q

as the light passes through the corena and the lens the image is ?

A

inverted and reversed

and refracted

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2
Q

emmetropia is normal _

light waves reflected from _ sources are focused on the retina

focal length equals the _ length of the eye

A

refraction

distant

acial

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3
Q

hyperopia is _

the eye is too _ for refractive power of cornea and lens, light focused behind the _

is corrected with a _ lens

A

far sightedness

too short

behind the retina

convex lens

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4
Q

myopia is _

the eye is too _ for the refractive power of the corena and the lens

light is focused _ of the retina

is corrected with a _ lens

A

near sightedness

long

in front of the retina

concave

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5
Q

astigmatism is the abnormal curvature of the _ and different _ powers at different axes

corrected with a _ lens

A

cornea

refractive

cylindrical

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6
Q

presbyopia is a _ related loss of the ability to focus on _ objects caused by _ of the lens

A

age

nearby

hardening

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7
Q

lens dislocation is _ of the lens due to trauma but does have association with systemic diseases like _ and _

A

displacement

marfan syndrome and homocystinuria

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8
Q

cataracts are painless _ of the lens. Age releated _ cataract is the most common type and it invloves slowly progressive yellowing and clouding of the lens nucleus

A

opacifications

nuclear

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9
Q

nuclear sclerosis cataracts increases lens _ and increases _ and decreases _.

patients may experiences _ sight with nuclear sclerosis such as being able to read without glasses/

A

refraction

myopia

hyperopia

second sight

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10
Q

senile cortical cataract features _ like opacities

A

radial

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11
Q

what are the two types of cataracts

A

nuclear sclerosis

cortical

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12
Q

what increases risk for cataracts

A

diabestes (sorbitol under lens), glucoroticoids (nasal), excessive sunlight

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13
Q

the longterm use of corticosteroids frequently causes a _ _ cataract that involves abberant migrating lens epithelial cells.

A

posterior subcapsular

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14
Q

symptoms of a cataract

A

light glare during night driving

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15
Q

_ _ contains cilliary procesess, _ from the ciliary processes produces aqueous humor

A

pars plicata

epithelium

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16
Q

parts of the ciliary body

A

pars plicata

pars plana

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17
Q

both parts of the ciliary muscle contains smooth muscle innervated by CN _ and _ receptors

A

CN III

M3 receptors

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18
Q

anterior chamber of the eye is the space between the _ and _

A

cornea and iris

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19
Q

posterior chamber of the eye is the space betweem the _ and _

A

iris and lens

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20
Q

contraction of the ciliary muscle pulls the scleral spur _ to open the _ canal

this explains why drugs causing ciliary muscle contraction decreased _

A

posteriorly

schlemm canal

IOP it allows for the aqueous humor to get out

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21
Q

what are the two route for aqueous humor flow and describe them

A
  1. trabecular route (main)- from the posterior chamber to the pupil to the trabecular meshwork at the angle of the anterior chamber (iridocorneal angle) to schlemms canal to the episcleral veins
  2. uterosclaral routs - posterior chamber to the pupil to a uveral meshwork beyween ciliary muscle fibers to the suprachoroidal space, to the episcleral veins
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22
Q

2 parts of the optic disc

A

pale/pink rim and center excavation cup

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23
Q

size of center excavation/cup is relative to the sive of the _ nerve

cupt to disc ration N=0.1-0.?

A

optic

O.1-O.4

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24
Q

increased intraocular pressure in glaucoma can cause

A

optic nerve compression leading to cupping

compression of vessles leading to optic nerve ischemia and pallor

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25
Q

galucoma 1st visual field loss

A

superonasal

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26
Q

optic nerve cupping pathophysiology

A

the sclara turns into the lamina cribrosa at the axons exit site and the increased IOP will push at the LC weak point and pushed the sclara back together with ganglion cells axon

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27
Q

glaucoma is a group of diseases with a characteritic optic _ with _ leadiing to specific _ _ defects overtime caused by obstruciton of _ _ drainage. Most of the cases leads to elevation of _

A

neuropathy

with cupping

visual field

aqueous humor draingae

intraocular pressure

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28
Q

glaucoma leads to excavation aka _ and this proceeds the visual field loss so optic nerve examination is critical. Progressive optic nerve _ is a feature in all forms of glaucoma.

open angle glaucoma is when the _ _ has access to the trabecular meshwork but there is resistance to flow in the _ _. This is considered the silent thief of sight. there is no pain unless _ is very high.

Anfge closure glaucoma is when the _ overlies the trabecular meshwork and impedes the egress of _ from the eye

A

cupping

cupping

aqueous humor ; trabecular meshwork; IOP

IRIS; Aqueous humor

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29
Q

primary glaucoma is when the angle is _

A

opne (most common form)

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30
Q

secondary glaucoma is caused by?

A

psuedo exfoliation
pigmentary
corticosteroid induced

NEOVASCULAR

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31
Q

what is psuedoexfoliation secondary glaucoma

A

there is deposition of fibrillary material throughout the anterior segment causing impedndence of AH IOP and cupping

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32
Q

what is neovascular secondary glaucoma

A

this is a characteristic of type 2 diabetes in the proliferative stage of their diabetic retinopathy ( causes a closure of the angle)

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33
Q

angle closure glaucoma has _ _ shallowing. It shows _ which are small anterior subscapular opacities.

there are _ atrophies secondary to _ _ of acute angle closure glaucoma

A

anterior chamber

gleukomflecken

iris atrophy

prior episodes

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34
Q

the acute attack of angle closure glaucoma has increased _ the pupil is _ and _ and there is eye _, headache, N/V, and decrease in vision.

A

IOP

irregular and dilated

eye ache (not dependent on movement of the eye)

*nausea due to the trigeminal nerve being so close to the vagus and PSNS being activated)

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35
Q

between attacks of acute angle glaucoma there is normal _ and what are the symptoms

A

IOP

shallow AC, iris atrophy, slight dilation (from paralysis of the muscle to constrict pupil)

myadriasis (pupil dilation), glaukomflecken and NO pain

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36
Q

anterior uveitis ( inflammation of the uvea)

2 parts:

A

iritis (inflammation of iris)

iridocyclitis (iris and ciliary body inflmmation)

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37
Q

posterior uveitis

A

chorioditis

there is a continous layers of the uvea and can spread to involve all the laters

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38
Q

iris shape in uveitis

A

miosis, irregular in shape

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39
Q

uveitis has _ which is purulence in the anterior chamber

A

hypopyon

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40
Q

uveitis has _ injection

AACG has _ injection

A

ciliary

mixed ( connjunctiva and iris)

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41
Q

iridocyclitis vs AACG

A

iridocyclitis: ciliary injection (redness), ciliary pain (touch ciliary body=pain), MIOSIS, syncechiae (iris is stuck to the lens)

AACG: mixed injection, sudden pain, MYADRIASIS (dilation), glaukomflecken, increased IOP

42
Q

uveitis is associated with _ _ diseases

A

systemic inflammator diseases

**sacrcoidosis

43
Q

sarcoidosis is 10 times more frequent in _ , check for in patients if they have recurrent bilateral _ . Uveitis can proceed pulmonary symptoms by several years. There can also be orbital and eyelid non caseating granulomas.

A

aferican americans

uveitis

HLA B27

44
Q

sarcoidosis eye exam

A

candle wax dripping

45
Q

pathophysiology of rental detachement

  1. seperation of the _ retina from the _
  2. loss of _ blood supply causing hypoxia
  3. degeneratio of _
A

neurosensory retina from the retinal pigment epithelium

choroidal BS

photoreceptors

is a surgical emergency

46
Q

rhegamatogenous

A

retinal detachement due to a retinal tear

47
Q

non-rehemategenous

A

retinal detachement that is due to tractional or exudative fluid accumulation

48
Q

retinal detachment patient history revolves around _ and _ due to posterior vitreous detachement

if it develops futher there will be _ loss with the curtain drawn _

on fundoscopy there will be _ of the retina nd chanfe in the trajectory of retinal _. The retina will _ or loos transparent (usually the red is due to the vessels in the chorioid)

A

floaters and flashes

vision

dwon

crinkling
vessels

opacify

49
Q

hypertensive retinopathy from long time hypertension

mild signs:
retinopathy

moderate signs: choridopathy

severe signs: optic neuropathy

A

mild: narrow aterioles, AV nicking, ateriolar thickening with copper/silver wiring

moderate: flame shapped hemorrages, hard exudates, cotton wool spots

severe: papilledema from optic disc swelling, macular star

50
Q

Hypertensive retinopathy pathophysiology

if arterioles thicken they get shiny brownish reflec called _ wiring or if they get occuldes they get _ wiring

thickened arterioles compress the venules if they cross above them termed _ _

the exudate accumulates between the RPE and retinal layers and this is seen as _ _ _

exudation of blood gives you rentinal _

exudation of lipids gives you _ _

as hypertensive retinopathy continues exudate accumulated in the _ givining you a macular star

severe HTN can lead to increased intracranial pressire causing optic nerve _ and _

A

copper

silver

AV nicking

cotton wool spots

hemorrhages

hard exudates

macula

ischemia and papilledema

51
Q

if we see papilledema and histor of HTN it is urgent to ?

A

reduce BP

52
Q

central vein occlusion

A

“blood and thunder”

blood can enter the eye but cannot exir leading to vein dilation and hemorrhage

blurry vision and subacte panless vission loss

(floaters)

53
Q

treatment of central vein occlusion depends on the presence of absence of _

if present treat with _

A

edema

edema present- bevacizumab

54
Q

central artery occlusion

A

cherry red macular and retinal atery attenuation

+sudden and painless vision loss

blood cant get into the eye; pallor around the macula

55
Q

pathophysiology of diabeteic retinopathy

  1. glycation
  2. earliest microscopic sign: _ loss; usually provide vascular satibility and controls endothelial proliferation
  3. inflammatory _activation
  4. reduction in _ nerve axons
A

pericyte

glial

optic

56
Q

glycation of the capillary wall has two effects: _ and _

A

pericyte loss/BM thickening

and increased permeability

57
Q

pericyte loss and BM thickening leads to

A

capillary occlusion and microanurysems

non proliferative stage

58
Q

increased permeability of vessles leads to

in diabetic retinopathy

A

macular edema, dot hemoorhages, lipid lead

non proliferative stage

59
Q

in the proliferative stage of diabetic neuropathy

there is chronic _ that leads to _ which has 2 effects; what are they

A

ischemia

neovascularization

2 effects: creation of new capillaries and traction leading to retinal detachment

block the AC angle and increased introcular pressure causing secondary neovasular glaucoma with eye pain

60
Q

treatment of non proliferative diabetic retinopathy

A

glucose control

61
Q

treatment of proliferative diabetic retinopathy

A

anti vegF injections (neovasularization)
photocoagulation
watch IOP

62
Q

what is retinitis pigmentosa

A

this is a hereditary disorder that has rod selected cell death there will be lacy black intra retinal pigment at the periphery and narow vasculature. The macula is normal!

good central vision- poor peripheral vision

**night vision (nycaltopia) and constricted peripheral vision

63
Q

fundus of eye is a mirror of the _

A

brain

64
Q

the optic nerve is an extension of the brain it is sutronded by _ and _

A

meninges and csf

65
Q

importantto understand the papilledema is an increase in IOP and _

A

ICP

66
Q

central retinal artery runs in the center of the optic nerve and supplies the _ part of the optic nerve

A

posterior

67
Q

the _ _ arteries supply the optic disc (anterior part)

A

posterior cilliart

68
Q

papliedema is increased _ pressure in the subarachnoid space which compresses the optic nerve fibers. The causes edema of the _ nerve aka papilla

A

optic nerve

both eyes are effected, little to no cision loss, blurry vision *difference between the degree of swelling and vision problem

69
Q

optic neuritis

A

inflammation of the optic disc due to demyelination and increased hyeremia (increase in blood supply)

70
Q

papilledema

A

swellingof the optic disc (main cause is ICP)

71
Q

optic nerutitis is usually in the _ part of the optic nerve (central retinal artery supplies this part) and the most common type is _ neuritis

A

posterior part
retrobulbar neuritis

72
Q

optic neuritis is typically _ocular and presents with _ vision loss, there is moderate eye pain.

A

monoocular

subacute

73
Q

in 60 % of CN II involvement in Multiple sclerosis (more common in middle aged women) there is _ optic neuritis affecting the posterior part of the nerve (there is a _ optic disc apperance on fundoscopy

_ vision accopnained development of partial _ blindness

attacks resolve _ and and involves one eye and next time the other eye

baseline _ is important to diagnose and presict the future risk of MS

_ is important treatment for acute attacks

A

retrobulbar neuritis

normal

blurry; color

spotaneously

MRI

glucocorticoids

74
Q

what is the leading cause of blindness in the world

A

age related macular degeneration

75
Q

what is age related macular degeneration and the two forms

A

damage to the macular (center vision)

metamorphosia is the earliest sign

-dry form and wet form

76
Q

what is the dry form of AMD

A

non neovascularitization and gradual vision loss due to drusen bodies

77
Q

what are drusen bodies

A

these are small dotted deposts between the bruch membrane and the retinal pigmented epithelium

78
Q

drusen bodies cause geopgraphic _ of the reitnal pigmented epithelium

A

atrophy

79
Q

what is wet AMD

A

rapid decrease in vision due to choroidal bleeding and neovascularization

the vessels penetrate through the bruch membrane beneath the RPE

80
Q

treatment of dry AMD with drusen -

treament of wet type AMD with neovascularization-

A

dry: antioxidants and multivitamins

wet type- intravitreal injections of vascular endothelial growth factors and VEGF antagoinsits

81
Q

what is retinopathy of prematurity (ROP)

risk factors?

A

a pathological condition of immature retinal tissue that may lead to RETINAL DETACHMENT, VISUAL LOSS, BLINDNESS

risk: premature infants, LBW, respiratory distress, exposure to hyperoxia

82
Q

ROP pathogenesis

at birth vessels on the periphery are _. in terms of babies with no excess of O2 and vessels grow supplying o2. In _ the growth of vessels stop.

After O2 is no longer supplied this causes _ of the retina to form becuase the periphery vessels are underdeveloped and this causes _ to start.

These new vessels are incompetents and can leak leading to traction and _ _

leak cytokines, proteins, contract the vitreous body

A

underveloped

Hyperoxia

hypoxia

neovascularization

retinal detachment

83
Q

what can mimic ROP

A

infecitons, retinoblastoma

84
Q

retinoblastoma is the most common _ tumor in children

it is caused by a germinal mutation on chromosome _

60% of cases are _ and 40% are _

most often the parent first detects the symptoms of RB with _ or _.

Be alert to the possibility of new _ development before the age of 1

there is spread to the brain, bone marrow, and lungs

_ is a sensitive method to detect calcification in a tumor and the intraocular extent even if calcification is absent

_ is good to evalute retinoblastoma compared to ultrasound and MRI

A

children

13q14

sporadic

iherited

leukocria (white pupil) or strabismus

tumor

CT

optical coherence tomography (OCT)

85
Q

RB histology

A

white, encephaloid (brain)apperance with chalky calcifications

small hyperchromatic cells, necrosis and calcifications

RB depends on blood supply, necrosis is found in avascular regions

86
Q

RB gene predisposes to the RB high risk of _ tumors, extracranial _ and melanoma

A

pineal

sarcomas

87
Q

RB can arise from fully matured nerves in the retina called _ _

A

horizontal interneurons

88
Q

conjunctival melanoma is in what age group?

risk factors?

if you suspect conjunctival melanona refer to a specialist without a _ as this may shed malignant cells

A

middle aged/elderly

chronic sun exposure

biopsy

89
Q

risk factors for uveral melanoma

A

light skin
freckles and welding

90
Q

if uveal melanoma is large and affects the macula what are the symptoms

A

reduced vision, scotomas, flashes and floaters

91
Q

spread of metastasis for uveal melanoma

A

hematogenous to the liver

92
Q

ciliary body melanona tends to be a _ diagnosis it may cause a _ _ _ _ due to displacemnt of the lens and iris

developing a dilated _ episcleral vessel overlying the tumor is common

A

late

secondaru angle closure glucoma

tortuous

93
Q

what is uveal choridal melaoma

A

an elevated dome shaped gray brown lesion of the choiroid with irredular fuzzy marigins

it has a classic mushroom shape

94
Q

uveral choroidal melanomas tend to be more than _ mm thick

it damages the _ and its vasular supplu as a result subretinal fluid accumulated causing an exudative detachment of the retina

they lie close to the _ _

often orange _ accumulated over the surface of melanoma

A

2 mm

retinal

optic disc

lipfuscin

95
Q

the three common cells in uveal melaonma

A

type a and B spindle shaped melanocytes (spindle cells) with elongated nuclei

epitheloid cells

96
Q

epitheliod cells in uveal melanoma can _ easilt and are considered the makeup of more _ risk lesions and _ prognosis

A

mestatasize

high

worse

97
Q

uveal melanoma has _ mimicrcy

A

vascular

98
Q

what is vascular mimicy

A

formation of spaces connected to blood vessels

they transport plasma and blood to the tumor. (worse prognosis)

99
Q

diagnosis of choroidal melanona

A

clinical features on funduc exam

ancillary tests: fundus autoflouresence, B scan ultrasound (primary diagnositc test) color dopple ultrasound

100
Q

color dopple ultrasound to diagnoise choriodal melanoma shows

A

pulsatile blood flow at the tumor base (not seen in nevi)

101
Q

risk factors for a nevus to transform into a melanoma

A

thickness greater than 2mm

subretinal fluid (greatest indicator)

flashes, floaters

orange lipofuscin

close to optic disc (3mm)

DRUSEN ABSENCE
HALO ABSENCE

102
Q

halo of dipigmentation around the pigmented choridal lesion is more commonly seen in _

the depigmentation respresents a _ infiltrate and correlated with the stability of a nevus

A

nevi

lymphohistiocytic infiltrate

NMSP (13 decks)

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