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FRACP short case > Eyes > Flashcards

Eyes Flashcards

1
Q

Causes of anosmia?

A 
URTI
Meningioma of the olfactory groove
Ethmoid tumours
Head trauma
Meningitis
Hydrocephalus
Congenital
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2
Q

Explain the light reflex

A

Constriction of the pupil in response to light is relayed via the optic nerve and tract –> the superior quadrigeminal brachium –> the edinger-westphal nucleus –> ciliary ganglion

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3
Q

Explain the accommodation reflex

A

Originates in the cortex and is relayed via parasympthatic fibres in the third nerve

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4
Q

Causes of absent light reflex but intact accommodation reflex?

A

Midbrain lesion
Ciliary ganglion lesion
Parinaud’s syndrome
Bilateral anterior visual pathway lesions

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5
Q

Causes of absent convergence but intact light reflex?

A

Cortical lesions

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6
Q

Causes of constriction?

A 
Horner's syndrome
Argyll Robertson pupil
Pontine lesions
Narcotics
Old age
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7
Q

Causes of dilation?

A 
Mydriatics, atropine, cocaine
Third nerve lesion
Adie's pupil
Iridectomy
Post trauma
Congenital
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8
Q

Causes of Horner’s syndrome?

A 
Carcinoma of the lung apex
Neck - malignancy or trauma
Carotid artery lesion
Brain stem lesion
Retro-orbital lesions
Syringomyelia
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9
Q

What is Adie’s syndrome

A 
Caused by lesions in the efferent parasympathetic pathway - infection or inflammation
YOUNG WOMEN
Dilated pupils - atonic
Decreased reaction to light
Slow accommodation to light
Decreased tendon reflexes
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10
Q

Signs of Argyll Robertson Pupil?

A

Small, irregular, unequal pupil
No reaction to light
Reaction to accommodation
LOOKS FOR ASSOCIATED TABES

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11
Q

Causes of Argyll Robertson Pupil?

A

Syphilis
DM
Alcohol
Other midbrain lesions

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12
Q

Causes of Papilloedema?

A 
Space occupying lesions
Hydrocephalus
Idiopathic intracranial HTN
HTN
Central retinal vein thrombosis
GBS
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13
Q

Causes of ptosis with normal pupils?

A 
Senile ptosis
Myotonic dystrophy
FSH dystrophy
Ocular myopathy
Thyrotoxic myopathy
Myasthenia gravis
Congenital
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14
Q

Causes of ptosis with constricted pupils?

A

Horner’s syndrome

Tabes dorsalis

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15
Q

Causes of ptosis with dilated pupils?

A

Third nerve lesion

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16
Q

Clinical features of a third nerve palsy?

A

Complete ptosis
Divergent strabismus - eye down and out
Dilated pupils that are unreactive to light and accommodation

17
Q

How to exclude a fourth nerve palsy with a third nerve palsy?

A

Get patient to look down and across to the opposite side of the lesion - LOOK FOR INTORTION
Superior oblique muscle –> intortion

18
Q

Central causes of a third nerve palsy?

A 
Vascular
Tumour
Demyelination
Trauma
Idiopathic
19
Q

Peripheral causes of a third nerve palsy?

A

Compression - aneurysm, raised ITP, cancer. Tolosa-hunt syndrome, meningitis
Infarction
Trauma
Cavernous sinus lesions

20
Q

Sings of a sixth nerve palsy?

A

Failure of lateral movement
Affected eye is deviated inwards
Diplopia

21
Q

Causes of a bilateral sixth nerve palsy?

A

Trauma
Wernickes encephalopathy
Raised ITP
Mononeuritis multiplex

22
Q

Causes of a unilateral sixth nerve palsy?

A 
Vascular
Tumour
Wernickes
MS
DM
Idiopathic
Raised ITP
23
Q

What is one and a half syndrome?

A

Caused by loss of the MLF and abducens nucleus on the same side.
Only movement is abduction of the contralateral eye

24
Q

Causes of horizontal nystagmus?

A

Vestibular lesion
Cerebellar lesion
Internuclear opthalmoplegia

25
Q

Causes of vertical nystagmus?

A

Brain stem lesion:

  • Upbeat = floor fo the 4th ventricle
  • Downbeat = foramen magmun lesion

Toxic

26
Q

What is internuclear opthalmoplegia>

A

Disorder of the MLF
When an attempt is made to gaze contralaterally (relative to the affected eye), the affected eye adducts minimally.
The contralateral eye abducts, however with nystagmus.
Convergence is generally preserved.

27
Q

Causes of INO?

A

MS

Stroke

28
Q

Features of PSP?

A 
Loss of down and up gaze
Psuedobulbar palsy
Long tract signs
Extrapyramidal signs
Dementia
Neck rigidity
29
Q

Features of paranaud’s syndrome?

A

Caused by compression of the vertical gaze centre
Loss of vertical upgaze
Convergence-retraction nystagmus
Pseudo Argyll-Robertson pupils

30
Q

Causes of paranaud’s syndrome?

A 
MS
Vascular
Trauma
DM
Idiopathic 
Raised ITP

FRACP short case (11 decks)

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