Fundamentals and Principles Flashcards
1
Q
Used preoperatively for prevention of PG-mediated pupillary miosis during ocular surgery
A
Topical NSAID drops such as flurbiprofen 0.03% and suprofen 1%
2
Q
bilateral “snowflake” cataract
A
True diabetic cataract is a rapidly developing cataract that appears in the lens cortex of patients with poorly controlled type 1 DM.
3
Q
Smooth muscle of the iris and ciliary body is derived from what germ layer?
A
neuroectoderm
4
Q
A, B, C, D?
A
A - anterior TM
B- posterior TM
C - scleral spur
D - ciliary body band
5
Q
Eyelid anatomy in asian versus other races?
A
non-Asian” orbital septum insterts onto the levator aponeurosis ABOVE the tarsus
Asian: orbital septum inserts into the levator aponeurosis between the eyelid margin and the superior border of the tarsus. Superior eyelid fold is minimal or absent.
6
Q
Substance is combined with and activates fibrinogen to form athe sealant in a fibrin-based tissue adhesive
A
thrombin (used to control intraocular hemorrhage during vitrectomy)
7
Q
What is the ratio of optic nerve axons that cross at the optic chiasm compared to those that do not cross?
A
53:47
8
Q
A
9
Q
Largest water-soluble lens protein
A
alpha-crystallins - function to keep other crystallins from denaturing
10
Q
Krause and Wolfring are this type of gland?
A
exocrine
11
Q
3 layers of trabecular meshwork
A
Uveal meshwork, corneoscleral meshwork, pericanalicular tissue
12
Q
Mechanism of retrocorneal fibrous membrane (RCFM)
A
Infiltration of polymorphonuclear leukocytes in resonse to severe corneal injury induces endothelial cells to become fibroblastic and synthesize RCFM
13
Q
Inner nuclear layer cell is nonneural and plasy a supportive role to the neural tissue extending from the inner segments of the photoreceptors to the ILM which is formed by their end-feet
A
glial cells (Muller cell)
14
Q
In what ocular process does melanin participate?
A
retinal development and neuronal migration
15
Q
Where is the germative zone of the lens epithelium located?
A
immediately anterior to the lens equator
16
Q
Which cranial nerve also carries innervation to the pupillary sphincter muscle?
A
CN III
17
Q
Most common collagen in descemet membrane
A
Type IV collagen
18
Q
Cell population that increases with the use of topical cyclosporine 0.05%
A
goblet cells
19
Q
Characteristic of Rb that suggests familial condition
A
FHx of Rb or stationary retinal tumors (retinomas) or enucleations.
20
Q
Convert 1% solution to g/mL and mg/mL
A
1% solution = 1g/100mL or 1000mg/100mL
21
Q
Stains devitalized epithelial cells
A
rose bengal
22
Q
Most common collagen in vitreous
A
Type II collagen
23
Q
Syndrome caused by loss of both alleles of a locus within human chromosome band 13q14
A
retinoblastoma
24
Q
Location of the ciliary ganglion
A
1 cm in front of the annulus of Zinn on the lateral side of the ophthalmic artery between the ON and lateral rectus muscle
25
Darkening of the iris and periocular skin and hypertrichosis of the eyelashes
latanoprost - increases the number of malnosomes within melanocytes
prodrug of prostaglandin F2a
26
Component of aqueous that is always higher than concentration in aqueous than in plasma
lactate
27
PAX6
Aniridia
28
Ciliary ganglion receives thes 3 roots
1. **Long sensory root** - from nasociliary branch of CN V1. 10-12 mm long and contains sensory fibers from cornea, iris, ciliary body
2. **Short motor root** - (only one to synapse) from inferior division of CN III - inferior oblique, postganglionic fibers carry parasympathetic axons to supply the iris sphincter
3. **Sympathetic root** - from plexus of internal carotid, innervates ocular blood vessels and dilator muscle of the pupil
29
What morphogen interacts with intracellular receptors to regulate gene expression during eye development
**RETINOIC ACID**
30
Examples of mutations of mtDNA-encoded tRNA
30% of cases of CPEO, mitochondrial encephalopathy, lactic acidosis, stroke like episodes (MELAS), myoclonic epilepsy with ragged red fibers (MERRF)
31
Components of aqeuous
Na+ 163 mmol/kg H20
Cl- 134 mmol/kg H20
HCO3-3 (20 mmol/kg H20)
Glucose (3 mmol/kg/H20) (70% plasma)
Ascorbate (1.06 mmol/kg H20)
32
Cranial nerves that directly innervate the eye?
6 of the 12 CN (CN II-VII)
33
Genetic disorder causes a pigmentary retinopathy and may be partially managed with a phytanic acid-restricted diet.
Refsum disease
34
Clinical effect do of direct-acting muscarinic agents
**Increases range of accommodation**
constrict the pupillary sphincter and ciliary muscle - results in increased myopia and decreased central anterior chamber
35
another name for retinoblastoma
Long arm 13 deletion (13q14) syndrome
36
outline corneal and conjunctival epithelial defects
Fluorescein and lissamine green
37
What kind of mitochonrial DNA disorder produces CPEO of the Kearns-Sayre variant?
**a large rearrangement of mtDNA (deletions and insertions)**
38
Difference between brimonidine and apraclonidine
Brimonidine is more lipophilic than apraclonidine. Penetrates cornea and blood-brain barrier better.
39
Age-related degeneration of the connective tissue of the Tenon capsule can lead to what condition?
Acquired strabismus
40
Volume of the vitreous cavity
**5.0 - 6.0 mL**
Largest compartment within the globe; more than 2/3 volume of the eye
41
caused by mutations of mtDNA-encoded ribosomal RNA
Maternally inhertied sensorineural deafness and aminoglycoside-induced deafness
42
What medication may cause increased pigmentation of the iris and periocular skin?
bimatoprost
43
How many extraocular muscles are innervated by cranial nerve III?
5: Superior division of CN III supplies the SR and levator muscles. The inferior division supplies the IR, IO, MR muscles
44
These cells seal off the subretinal space by forming the external limiting membrane (ELM)
Muller cells (glial cells)
45
What is the smallest water-soluble lens protein?
gamma-crystallins
46
Collagen type of the corneal stroma responsible fro forming the anchoring fibril of the epithelium
**type VII collagen**
47
Uveal tract is firmly attached to the sclera at only 3 sites:
Scleral spur
Exit point of the vortex veins
Optic nerve
48
What portion of DNA coding sequence is removed as part of synthesis of messenger RNA?
intron
49
Pigment within RPE responsible for signal generated in fudnus autofluorescence imaging
**lipofuscin** - granules arise from the discs of photoreceptor outer segments and represent residual bodies arising from phagosomal activity
50
Genetic inheritance pattern for blepharophimosis?
Autosomal dominant
51
Best option to reduce intraocular pressure for patient with severe ocular surface disease and intolerance to multiple previously prescribed eye drops
**Tafluprost**
available in preservative-free single-use containers
52
Name of the PAS-positive lamina resulting from the fusion of the basal laminae of the RPE and choriocapillaris of the choroid?
Bruch membrane
53
What is the uveal tract?
Main vascular compartment of the eye - iris, ciliary body, choroid
54
Achromatopisa (complete color blindness) with myopia is seen commonly here
South Pacific island of Pingelap
55
The en grappe innervation of what specific type of muscle fibers unique to the extraocular muscles is useful for smooth pursuit movements of the eyes?
**tonic-type muscle fibers**
multiple grapelike nerve endings that are useful for smooth purusit
56
What bone makes up part of the orbital roof and the medial wall of the orbit?
lesser wing of the sphenoid bone
57
What systemic side effect might result from treatment with oral carbonic anhydrase inhibitors?
**M**etabolic acidosis
**I**mbalance
**S**omnolence
**H**ypokalemia
**Aplastic anemia**
**A**norexia
**P**aresthesias
**w**eight loss
**k**idney stones
'MISHAP WK'
58
Approximate distance from the Schwalbe line to the ora serrata
6 millimeters
59
Patient with very light hair and skin color, mild chronic photosensitivity and blurring OU. Recent dental procedure with excessive bleeding. Sister with similar history. Diagnosis?
**Hermansky-Pudlak syndrome**
Common puerto Rican but also india, japan UK, western europe
AR
Normal platelet counts but abnormal platelet aggregation
60
Structures that run through the cavernous sinus
* Internal carotid artery (ICA) and sympathetic carotid plexus
* CN III, IV, VI
* Ophthalmic and maxillary divisions of CN V
61
Muscles that originate from the annulus of Zinn
lateral rectus
Superior, inferior, medial, lateral rectus
62
Medication implicated in outbreaks of contamination-related infectious endophthalmitis?
bevacizumab
63
Embryonic cell line that the iris sphincter muscles dervied from?
mesodermal cells
Others: dilator muscles, extraocular muscles
64
Embryologic origin of the pigmented pupillary ruff?
neural ectoderm
pupillary pigmented ruff is brief anterior extension of the posterior pigmented layer of the iris onto the anterior border of the iris stroma
65
3 affected males connected through an unaffected female suggest this mode of inheritance.
X-linked recessive
66
The anterior layer of the tear film is secreted primarily by the meibomian glands but secondarily by what other glands?
Glands of Zeis (sebaceous) located at eyelid margin close to eyelash roots secrete lipid
67
Rb gene
long arm of chromosome 13
Of people who inherit the gene mutation, 90% will develop Rb (90% penentrance)
68
Mechanism of skin darkening
increased number of melanosomes (increased melanin content, or melanogenesis) within melanocytes.
69
Expected serum electrolyte effects of acetazolamide?
Hypokalemia and metabolic acidosis
70
Mechanism of action of moxifloxacin?
inhibits bacterial DNA replication (topoisomerase, enzyme needed to separate bacterial DNA)
active against both gram-positive and gram negative bacteria
71
NSAIDs block prostaglandin biosynthesis by inhibition of what enzyme?
cyclo-oxygenase
72
What mechanism results in the random oxidation of lipids?
auto-oxidation
Inhibited by free-radical scavengers such as vitamin E
73
Receptor that mediates medication naphazoline and tetrahydrozoline?
alpha-1
(oxymetazoline, phenylephrine hydrochloride topical drops to cause temporary vasoconstriction)
74
Fibers from which of the 3 roots recevied by the ciliary ganglion actually synapse in the ganglion?
Short motor root
75
Fungal-derived peptide emulsion approved by the FDA for treating the inflammatory component of dry eye syndrome
cyclosporine A
76
What condition can cause tear film dysfunction as a result of alteration of the tear mucin component?
**Giant papillary conjunctivitis** - (excessive in number)
77
inactivation of 1 X chromosome in every somatic cell in females
lyonization
78
Type of mutation in Leber hereditary optic neuropathy (LHON) and neuropathy, ataxia, and retinitis pigmentosa (NARP)
missense and nonsense mutations
79
How to convert a % solution. For example a 0.01% solution is
0.01g/100mL or 10mg/100mL
80
First developmental site of malanogenesis in the body?
Retinal pigment epithelium
81
The disruption of what corneal layer in laser subepithelial keratomileusis (LASEK/PRK) is thought to be the cause of increased risk for visual complications postoperatviely due to central cornea haze?
**Bowman layer** (prevents exposure of stromal corneal keratocytes to growth factors secreted by corneal epithelial cells and take on fibroblastic behaviors)
82
Process by which oxygen is activated electronicaly by light to form singlet oxygen
photo-oxidation
83
What part of the ocular outflow apparatus is in closest proximity to the anterior chamber?
Uveal meshwork - internal most portion of the TM and is closest proximity to the AC.
84
Class of medications that may decrease the facility of aqueous outflow through the TM in some patients.
Corticosteroids
(sulfa derivatives do not affect aqeuous outflow)
85
Exam finding that would help distinguish a lesion isolated to the cavernous sinus from one extending to the orbital apex
relative afferent pupillary defect (RAPD) - optic nerve (CN II) does not travel through the cavernous sinus
86
What are the first cells that differenitate in the embryonic retina?
**ganglion cells**
87
The arterial blood supply to the whole uveal tract, the sclera, the margin of the cornea, and adjacent conjunctiva is provided by what arteries?
posterior ciliary arteries
88
Role of glycoproteins and glycolipids of cornea epithelium?
protoming stability of tear film and wettability of cornea surface
aid in pathogenesis of infection by acting as attachment sites for microbes
89
1 mL of a 1:10,000 dilution
1 g of drug in 10,000 mL
90
Corneal clouding and prominent Descemet folds
91
Retrocorneal fibrous membrane (RCFM) forms at what location in the cornea
between Descemet membrane and the endothelium
92
Mechanism of vitreous liquefaction
loss of shielding of type II collagen by type IX collagen
Syneresis or vitreous liquefaction is the breakdown of thin (12015 nm) collagen fibrils into smaller fragments
93
What creates the force that holds the flap in place after LASIK?
endothelial pump
94
In what area are the nerve fibers of the optic nerve first noted to be myelinated?
retrolaminar area
95
Topically administered interferon speeds the recovery of what viral disease?
herpes simplex keratitis - interferon + acyclovir or trifluridine
96
This layer of the tear film contributes to the optical properties of the tear film because of its postiion at the air-tear film interface
lipid layer
97
Function of the aqueous layer of the tear film
**maintain a constant electrolyte composition over the ocular surface epithelium**
supply oxygen
antibacterial/antiviral defense
wash away dibris
smooth irregularities
