First Aid pg 480-484 Neuro Flashcards
What primarily renal drug affects aq humor? how?
carbonic anhydrase inhibitors, dec formation
Which drugs dec the production of aq humor?
BB (timolol, other non sel BB), alpha agonists, carbonic anhydrase inhibitors
Which drugs inc out flow of aq humor?
Prostaglandin F2 alpha (+)’r - latanoprost, travoprost
Cholinomimetics - pilocarpine, carbachol
Where is the light focused, in terms of retina, in the case of hyperopia and myopia?
In hyperopia, light focused behind retina, and in myopia light is focused in front of the retina
Why does presbyopia happen?
dec lens elasticity, dec collagen IV
How does DB lead to lens opacification?
Inc gluc in the lens –> sorbitol via aldose reductase, and also to fructose. Both fructose and sorbitol will stimulate water influx –> osmotic cell injury, lens becomes opaque
Which drug can lead to cataracts?
Long term corticosteroid use
Which enzyme def leads to cataracts?
galactokinase, galactose 1 phosphate uridyltransferase
Which of the trisomies can lead to cataracts?
all of them
What AD disease of chromosome 22 can lead to juvenile cataracts? What other tumors come with?
NF2 - comes with bilat acoustic schwannomas, meningiomas, ependymomas
What AD disease of chr 15 lead to cataracts and also have a frontal fold closure issue?
Marfan syndrome
What disease leads to nephritis, hearing problems, and cataracts later in life? What molecule is affected?
Alport syndrome, collagen IV
Optic disc atrophy with cupping?
Glaucoma
Open angle glaucoma is more common in which patient population?
African American
Cause of secondary closed angle glaucoma?
Hypoxia from retinal disease, like DB or vein occlusion - induces vasoproliferation in iris that contracts angle
Why not give epi in acute closure glaucoma?
Mydriasis makes it worse
halos, rock hard eye, frontal headache
Glaucoma - acute closure
Most common cause of conjunctivitis?
viral is most common, esp adenovirus
Extra ocular symptom of viral conjunctivitis?
swollen preauricular node
Diseases associated with uveitis?
systemic inflammatory disorders - sarcoidosis, rhematoid arthritis, juvenile idiopathic arthritis, PAIR (HLA-B27) arthritides
What causes metamorphopsia and loss of central vision?
Age related macular degeneration - distortion and scotomas
Two types of DB retinopathy and describe them
Non proliferative - damaged capillaries leak blood –> lipids and fluid seep into retina –> hemorrhages and macular edema
Proliferative - chronic hypoxia result in new blood vessel formation with then traction on the retina
Tx for Non-prolif DB retinopathy?
blood sugar control, surgery
Tx for Proliferative DB retinopathy?
Peripheral retinal photocoag, surgery, anti-VEGF (Bevacizumab)
What causes retinal v occlusion?
compression from nearby arterial atherosclerosis
What are the signs of retinal v occlusion?
Retinal hemorrhage, venous engorgement, edema in affected areas
Which two layers of the retina separate in retinal detachment?
Seperation of the rods and cones layers (neurosensory layer) from the outer pigmented epithelium
How does retinal detachment look on fundoscopy ?
crinkling of retinal tissue and changes in vessel direction
Why the vision loss in retinal detachment?
Due to degeneration of photoreceptors
Retinal breaks are more common in patients with a history of what?
high myopia or history of head trauma
First symptoms that indicate retinal detachment?
“flashes” and “floaters” (from posterior vitreous detachment) and monocular loss of vision - like a “curtain drawn down”
secondary causes of retinal detachment?
retinal breaks, DB traction, inflammatory effusions
Retina cloudy with attenuated vessels and “cherry-red” spot at fovea
Central retinal artery occlusion
Diseases with cherry red spots
Tay Sachs, Neimann Picks
Painless, progressive vision loss beginning with night blindness (rodsaffected first). (Inherited)
Retinitis Pigmentosa
Bone spicule–shaped deposits around macula
Retinitis Pigmentosa
Infections associated with retinitis?
CMV (HHV5) (HIV/immunocompromised), Toxoplasmosis (congenital), HSV, VZV
Retinal edema and necrosis leading to a scar?
Retinitis
Treatment for congenital chorioretinitis?
Sulfadiazine + pyrimethamine
Treatment for CMV retinitis?
Foscarnet, Cidofovir - if gancilovir fails
Enlarged blind spot and
elevated optic disc with blurred margins
Papilledema
Pathway of Miosis
1st neuron: Edinger-Westphal nucleus to ciliary ganglion via CN III
2nd neuron: short ciliary nerves to pupillary sphincter muscles
Pathway of Mydriasis
1st neuron: hypothalamus to ciliospinal center of Budge (C8–T2)
2nd neuron: exit at T1 to superior cervical ganglion (travels along cervical sympathetic chain
near lung apex, subclavian vessels)
3rd neuron: plexus along internal carotid, through cavernous sinus; enters orbit as long ciliary
nerve to pupillary dilator muscles.
Sympathetic fibers also innervate smooth muscle of eyelids (minor retractors) and sweat glands of forehead and face.
Disease with Marcus Gunn Pupil
MS
What is a Marcus Gunn pupil?
DEC bilateral pupillary constriction when light is shone in affected eye relative to unaffected eye
How does one test for Marcus Gunn pupil?
Swinging flashlight test
Symptoms of SNS denervation of face?
Ptosis (slight drooping of eyelid: superior tarsal muscle) Anhidrosis (absence of sweating) and flushing of affected side of face Miosis (pupil constriction)
Horner’s seen with which diseases?
Any lesion of spinal cord above T1 –> Pancoast tumor, Brown Sequard, Late stage syringomyelia,
Also seen with cluster headaches, Lung cancer, PICA injury, Cavernous sinus syndrome,
Chronic closure glaucoma - sx?
Mostly asymptomatic, but over time can lead to CN II issues, especially loss of periph vision
Bacteria causing conjunctivitis?
H. influ, Chlamydia(follicular type), N gon
Causes of Neonatal conjunctivitis?
N. gonorrhea, HSV-1, Measles ( the 3Cs coryza, conjunct., cough) Reactive arthritis.(Reiter syndrome)
Cause of retinal occlusion?
Atrial fib
