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Lecture 5 pupils Flashcards

1
Q

Normal pupils are (equal/unequal) members of a team

A

equal

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2
Q

The pupil control system is so important it has (two/three) “managers”

A

two

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3
Q

occurence of two simultaneous movements associated with one another is called a (synergy/synkinesis/triad)

A

synkinesis

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4
Q

T/F the pupils have not connection to the rest of the body

A

F. The pupils reflect the body they live in

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5
Q

(one/both) pupils dilate to allow in more light

(one/both)pupils constrict to allow better focus

A

both , both

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6
Q

If you illuminate one pupil (both/one) pupil will respond

A

both -it is consensual

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7
Q

when you are shinning the light to one pupil and checking that same pupil.that is called (direct/consensual)

A

direct

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8
Q

T/F both pupils are equal in size

A

T

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9
Q

both pupils will respond equally if a light stimulus is moved will respond (equally/unequally) if a light stimulus is moved from one eye to another

A

equally

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10
Q

Anisocoria is when the pupils are (equal/unequal)

A

unequal-its an anatomic defect

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11
Q 
What is the normal size of  pupils within each other in mm?
A)1.0
B)0.75
C)0.5
D)1.5
A

0.5

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12
Q

T/F the level of illumination will not change the amount of anisocoria

A

T

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13
Q

What are the two systems that control pupils?

A

para and sympathetic system

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14
Q

In charge of closing (miosis/pupil constriction)
Pupillary light reflex
Target is the iris sphincter
Neurotransmitter is acetylcholine
–is what the (parasympathetic/sympathetic) systems is in charge of

A

parasympathetic

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15
Q

About (half/all) the fibers cross over at the __(optic chiasm/brain/cerebellum)__ when light illuminates the retina and signals are carried by the nerve fibers to the brain

A

half

optic chiasm

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16
Q

Fibers of the pupil leave the optic tract adn enter teh _(brachium/midbrain) of the superior coliculus

A

brachium

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17
Q

pupil fibers head from the (cerebellum/midbrain) toe the pretectal nucleus

A

midbrain

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18
Q

The fibers of the pupil leave the optic tract and enter the brachium of the superior coliculus
The pupil fibers head for the midbrain to the pretectal nucleus

describes the pupillary light reflex it s (efferent/afferent) pathway

A

afferent

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19
Q

The (midbrain/pretecal/brachium) nucleus sends information to the Edinger-westphal nucleus on both sides
The signal travesl via CN (V / III)

A

pretecal

III

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20
Q

The pretectal nucleus sends information to Edinger-Westphal nucleus on both sides
The signal travels via CN III back to eye

describes the pupillary light reflex it s (efferent/afferent) pathway

A

efferent pathway

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21
Q
  • .The pretectal nucleus sends information to Edinger-Westphal nucleus on both sides
  • .Both pupils constrict!
  • .Synapse at the ciliary ganglion
  • .The signal travels via CN III back to eye
  • .End destination is the iris sphincter

-put these in the correct order

A
  1. The pretectal nucleus sends information to Edinger-Westphal nucleus on both sides
  2. The signal travels via CN III back to eye
  3. Synapse at the ciliary ganglion
  4. End destination is the iris sphincter
  5. Both pupils constrict!
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22
Q

After synapse happens at the ciliary ganglion what is the end destination?

A

iris sphincter

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23
Q

In charge of opening (mydriasis/dilation)
Normal alert person
Target is the iris dilator
Two neurotransmitters:
Preganglionic is acetylcholine
Post ganglionic is nor-epinephrine
–is what the (parasympathetic/sympathetic) systems is in charge of

A

sympathetic

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24
Q

Hypothalamus is in charge of (parasympathetic/sympathetic) impulses

A

sympathetic

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25
Q

Sympathetic pathway has a (two/three) neuron are

A

three

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26
Q

Name the three neuron arc:
___ order neuron
____order neuron
___order neuron

A

first, second, third

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27
Q

The (hypothalamus/hippus) give vermiform movement and rhythmic movement of pupils

A

hippus

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28
Q

the (hypthalamus/hippus) is responsible for the unstable equilibrium between teh sphincter and dilator

A

hippus

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29
Q

T/F hippus is controlled by both the para and sympathetic systems

A

T

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30
Q

Near triad includes what?

A

accommodation, convergence, miosis

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31
Q

The Near triad is (dependent/independent) of illumination
Decreased accommodative ability
Hyperopes accommodating at distance

A

independent

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32
Q

older pupils are (larger/smaller)

A

smaller

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33
Q

Pupils of diabetics are (smaller/larger)

34
Q

Pain or ocular inflammation (will/will not) constict the pupil

35
Q

pupils of chronic alcoholics are (large/small)

36
Q 
Step _:
Measure the size of the pupils
Bright illumination
Dim illumination
Step _:
Check the afferent system of each eye
Step _:
Check the direct light reflex
Check the consensual reflex
Step _:
Check the accommodative response
(write the correct number order of each step)
A 
Step 1:
Measure the size of the pupils
Bright illumination
Dim illumination
Step 3:
Check the afferent system of each eye
Step 2:
Check the direct light reflex
Check the consensual reflex
Step 4:
Check the accommodative response
37
Q

In step 1 you want to have pt look at a distance of 20/___ letter and have glasses (on/off)

38
Q 
you want to measure your pupil size to the nearest \_\_mm
A)1.0
B)0.75
C)0.5
D)1.5
39
Q

where do you want to put the light when you do a dim room illumination to measure the pupil in step 1

A

under the chin

40
Q

during step 1 , when dim light illuminate pupils (should/shouldn’t ) be asymmetric by more than 0.5mm

A

shouldn’t

41
Q

-Leave illumination dim
-Check direct response to illumination of OD:
Shine light into right eye _ seconds
At distance of 5-6 cm
-Check consensual response of OS:
Shine light into right eye _ seconds
At distance of 5-6 cm
A)1,1
B)5,5
C)2,2
D)1.5,1.5

42
Q

what does a 4 mean when checking pupillary response

A

brisk response

43
Q

When checking (afferent/efferent) integrity of pupil pathway you:

  • Turn off room illumination
  • Shine a bright light in OD for at least 3 seconds
  • Rapidly move the light to the OS
  • Hold it for at least 3 seconds
  • The normal pupils should stay equally constricted
  • Repeat for 2-3 cycles
44
Q

When checking the afferent integrity of the pupil normal pupils (should/shouldn’t) stay equally constricted

45
Q

T/F Check for the accommodative response only if the direct light response is abnormal/absent!

46
Q

Unilateral, fixed, dilated pupil

describes which type (anisocoria/amaurotic/hutchinson’s) pupil

A

hutchinson’s

47
Q

-Blind pupil
-No direct light reflex
describes which type (anisocoria/amaurotic/hutchinson’s) pupil

48
Q

-Pupil size difference of more than 0.5 mm
-Look for lid involvement
describes which type (anisocoria/amaurotic/hutchinson’s) pupil

A

anisocoria

49
Q
  • Horner’s syndrome
  • Argyll Robertson pupil
  • Long standing Adie’s pupil
  • all have which in common (anisocoria/amaurotic/hutchinson’s) pupil
A

anisocoria

50
Q
  • Defect along the sympathetic pathway
  • Ptosis: ipsilateral side
  • Miosis: More noticeable in the dark
  • Anhydrosis: ipsilateral side, occurs when lesion is before carotid bifurcation and superior cervical ganglion
  • —describes which disease (Horner’s syndrome/Argyll Robertson pupil/Long standing Adie’s pupil)
A

Horner’s syndrome

51
Q
  • Posterior hypothalamus to C8-T2
  • Most likely lesion is a CVA
  • Neck trauma
  • Multiple sclerosis
  • –is which type of order neuron (first/second/third) in horner’s syndrome
52
Q
  • Ciliospinal center of Budge (C8-T2)
  • Leaves spinal cord
  • Over apex of lung
  • Synapses at the superior cervical ganglion
  • Most likely lesion:
  • Pancoast’s tumor
  • TB
  • Metastatic breast cancer
  • Trauma
  • Thyroid neoplasm/ surgery
  • –is which type of order neuron (first/second/third) in horner’s syndrome
53
Q
  • Post ganglionic
  • Internal carotid
  • Two divisions:
  • Nasociliary to long ciliary nerves innervates the pupil dilator
  • Internal carotid dissection and aneurysm
  • Nasopharyngeal carcinoma

Along the ophthalmic artery to the eye lid muscle
migraines
—is which type of order neuron (first/second/third) in horner’s syndrome

54
Q

Horner’s syndrome is a defect along the (para/sympathetic pathway)

A

sympathetic

55
Q

ptosis in horner’s syndrom is (bilateral/ipsilateral)

A

ipsilateral

56
Q

(Acquired/congenital) Horner’s syndrome in children under 5 years of age might be due to neuroblastoma in (para/sympathetic) chain of chest and neck

A

acquired

sympathetic

57
Q

(Neuroblastoma/cataract) is a malignant (cancerous) tumor that develops from nerve tissue. It usually occurs in infants and children.

A

neuroblastoma

58
Q

T/F horner’s syndrome in children can come from a brachial plexus injury during birth

59
Q

T/F horner’s syndrome is always malignant and congenital

A

F it is benign and congenital

60
Q

(heterochromia/hetrophoria) having a different color iris in each eye

A

heterochromia

61
Q

T/F heterochromia is associated with horner’s sundrome

62
Q

-Trauma
-Adie’s tonic pupil
-Third nerve palsy
-Dilating drops
-Hutchinson’s pupil
all of these are associated with (anisocoria/amaurotic) pupil

A

anisocoria

63
Q

T/F in anisocoria only the sphincter is not working well

A

F it could be either the dilator or the sphincter

64
Q

in anisocoira the (dilator/sphincter) muscle does not work well when using:

  • Miotic drops
  • Iritis
  • Horner’s syndrome
  • Argyll Robertson pupil
  • Long standing Adie’s pupil
65
Q

in anisocoira the (dilator/sphincter) muscle does not work well when using:

  • Trauma
  • Adie’s tonic pupil
  • Third nerve palsy
  • Dilating drops
  • Hutchinson’s pupil
66
Q

Adie’s tonic pupil is a (para/sympathetic) disorder

A

para sympathetic

67
Q
  • Unilaterally dilated pupil
  • Poor reaction to light
  • Slow tonic re-dilation
  • Denervated ciliary ganglion
  • 80% unilateral
  • Becomes bilateral at 4% per year
  • Sectoral palsy of the iris sphincter
  • –describes which disease (Horner’s syndrome/Argyll Robertson pupil/Long standing Adie’s pupil)
A

andies tonic pupil

68
Q

Light-near dissociation is a (para/sympathetic) disorder

A

para sympathetic

69
Q

_______ dissociation Caused by midbrain lesions that are close to the pretectal synapse

A

light-near

70
Q 
in light-near dissociation accommodation fibers out number pupil fiber \_\_\_:1
A)30
B)75
C)25
D)15
71
Q

light-near dissociation is only diagnostically valuable if the direc) light relfex is (absent or abnormal/ present or normal)

A

absent or abnormal

72
Q
  • Adie’s tonic pupil
  • Argyll-Robertson pupil
  • Dorsal midbrain syndrome
  • Aberrant regeneration of CN III: miosis with -ADDuction
  • Amyloidosis
  • Diabetes
  • -all of these have what type of dissociation in common
A

light-near dissociation

73
Q

When checking for accommodative response:

  • -direct patient to the 20/___ letter at distance
  • -then switch gase to near card __ cm from their eyes
74
Q

When checking accmmodative response you want to recheck 2-3 looking for both ____ and ___

A

dilation , constriciton

75
Q
  • Both pupils are constricted and irregular
  • Near-light dissociation
  • Dilate poorly in the dark
  • Respond poorly to dilating agents
  • Commonly seen in:
  • Syphilis
  • Diabetes
  • Chronic alcoholism
  • Multiple sclerosis
  • Sarcoidosis
  • –describes which disease (Horner’s syndrome/Argyll Robertson pupil/Long standing Adie’s pupil)
A

argyll roberton pupils

76
Q

which test checks for the afferent pupillary defect?

A

swinging fashlight test

77
Q

The eye with the afferent defect will (dilate/constict) when directly illuminated

78
Q

T/F Eye with 20/20 acuity and normal visual fields can have an APD!

79
Q

If a pupil constricts initially but then dilates you want to trace (RAPD/APD)

80
Q

If a pupil dilates after a few second then you want to write (1-2+/3-4+)

81
Q

pupil dilates immediately then you write (1-2+/3-4+)

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