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Opthalmology > Neurophthalmology > Flashcards

Neurophthalmology Flashcards

1
Q

Length of optic nerve

A

3.5-5.5 cm

5cm

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2
Q

Parts of the optic nerve

A

Intraocular (shortest-1mm)
Intraorbital (longest-30mm)
Intracanalicular
Intracranial

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3
Q

What runs in the optic foramen

A

Optic nerve and ophthalmic artery

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4
Q

What passes through the superior orbital fissure

A

L-lacrimal
F-frontal
T-trochlear
(CN 4)

In annulus of Zinn (origin of 4 recti)
Superior division of CN 3
Nasociliary nerve 
Abducens nerve (CN 6)
Inferior division of CN3
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5
Q

Muscles of eye supplied by

A 
LR6
SO4
Rest 3
LPS,SR- superior division of CN3
MR,IR,IO-inferior division of CN3
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6
Q

Lesion of optic nerve

A

Ipsilateral blindness

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7
Q

Lesion at chi Asma

A

Bitemporal hemianopia

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8
Q

Left sided optic tract lesion

A

Right homonymous hemianopia

Shows wernicke’s hemianopic pupil

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9
Q

What is wernicke’s hemianopic pupil

A

Person sitting in dark room
Torch shown in one direction
Normal reaction

Shown on opposite direction
No reaction

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10
Q

Optic radiation lesions in temporal lobe causes

A

Temporal lobe (inferior fibres-loop around temporal horn-Meyer’s loop)

Pie in the sky/superior quadrantopia

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11
Q

Optic radiation lesion in parietal lobe

A

Parietal lobe (inferior fibres-baum’s loop)

Pie in floor
Inferior quadrantopia

opposite side

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12
Q

What is junctional scoring of traqair

A

Caused in pituitary adenoma
(Lesion of junction of ON and chiasma)

Central scotoma and *superotemporal quadrantopia

*(Inferior nasal fibres of opposite side-willibrand’s knee)

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13
Q

Posterior junctional syndrome

A

Involves macular fibres

Hetronymous macular

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14
Q

Lesion of posterior cerebral artery in visual cortex causes (ocular)

A

Macular sparing hemianopia

Key hole vision (if both gone)

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15
Q

Middle cerebral artery block in visual cortex causes what ocular lesion

A

Macular homonymous hemianopia
(But not complete as some posterior cerebral artery fibres supply the macula)

MCA block usually occurs due to trauma of tip of visual cortex

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16
Q

What is the primary visual cortex area number and secondary visual cortex area number

A 
Area 17 (primary)
Area 18,19 (secondary)
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17
Q

How many layers of area 17 and thickest layer

A

6 layers

Thickest layer 4 - (contains a,b,calpha and cbeta)

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18
Q

Maximum fibres of optic radiation terminate at which layer of visual cortex (area 17)

A

Layer 4

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19
Q

Layers of lateral geniculate body and what layers have contralateral and ipsilateral supply

A

1,2,3,4,5
1,2-magnocellular layer
3,4,5,6-parvocellular layer

1,4,6-contralateral supply
2,3,5-ipsilateral supply

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20
Q

Visual cortex Lesions

Congruous or incongruous

A

Congruous

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21
Q

What is psycho sensory reflex

A

Dilatation due to anxiety
Iris sphincter-parasympathetic supply
Dilator pupillae-sympathetic supply

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22
Q

Pupillary light reflex pathway (from where to where)

A

Retina to pretectal nucleus

Then to edinger Westphal nucleus

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23
Q

What structure in the light reflex pathway explains consensual light reflex

A

Edibger westphal nucleus

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24
Q

Efferent pathway of pupillary reflex

A 
CN 3
Inferior division of third nerve 
Nerve to inferior oblique 
Shitt ciliary nerve 
Iris sphincter
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25
Q

Abnormal pupillary reactions

A

RAPD
eg Marcus Gunn pupil
Optic neuritis/RBN

TAPD-optic atrophy
Pupillary reactions absent

ARP-Argyll Robertson pupil
Cause-neurosyphilis
Light bear disassociation present
Due to lesion of pretectal nucleus

Holmes adie tonic pupil
Know this xD

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26
Q

Holmes-adie tonic pupil features and etiology

A

Almost absent light reflex
Sluggish accommodation reflex
Tendon reflex sluggish

Etiology-lesion in ciliary ganglion
Denervates hypersensitivity to parasympathetic fibres

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27
Q

Anatomical classification of optic neuritis

A

Papillon is
Retrobulbar neuritis
Neuroretinitis

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28
Q

Main feature of papillon is

A

Blurry disc margins

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29
Q

Main feature of RBN

A

RAPD
pain on elevation of eye
FUNDUS NORMAL

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30
Q

Neuroretinitis main features

A

Blurred disc margins

Macular star

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31
Q

Why pain in eye in RBN

A

Superior recurs fibres attached to myelin sheath of optic nerve

SR pulls on the nerve

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32
Q

Etiological classification of optic neuritis

A 
Inflammatory 
Degenerative 
Autoimmune 
Ischemic
Hereditary
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33
Q

Causes of degenerative optic neuritis

A

Multiple sclerosis

Toxic amblyopia

34
Q

Drugs causing toxic amblyopia (optic neuritis)

A 
Tobacco 
Ethambutol/isoniazid
Chloroquine
Ethyl alcohol
Methyl alcohol 
Digoxin
35
Q

Field defect in tobacco amblyopia

A

Centrocaecal scotoma

36
Q

Why is methyl alcohol poisoning more dangerous than ethyl alcohol

A

Methyl alcohol directly damages the ganglion cell

Acute damage

37
Q

How does ethyl alcohol cause chronic damage to eyes

Treatment

A

Causes vit B12 deficiency which causes optic neuritis

Treatment- hydroxycobalamine injections

38
Q

What all does chloroquine cause (ocular probe)

A

PSC
Optic neuritis
Bulls eye maculopathy
Vortex keratopathy/cornea verticellata (deposition of drug in a whorl like manner)

39
Q

Ciliary artery supply to Iceland tissue

A

Anterior-muscular branches
Posterior-
Long-2
Short-10-20

40
Q

Blockage of what causes AION

A

Blockage of posterior ciliary artery

41
Q

Etiology of arteritic AION

A

Giant cell arteritis

42
Q

Common symptoms of both arteritic and non-arteritic AION

And disctinct ones

A

Both-RAPD,VFD-altitudinal,low VA

Arteritic-painful,amaurosis fugax

Non-arteritic-painless,dyschromatopsia

43
Q

Risk factors for non-arteritic AION

A

Hypertension

Small size optic disc

44
Q

Common signs and differences between arteritic and non-arteritic AION

A

Blurred disc margins present(papillitis),flame shaped haemorrhages

Arteritic-pallor of disc

Non-arteritic-no pallor (hyperaemic disc present)

45
Q

Treatment of AION

A

steroids

46
Q

What is leber’s hereditary optic neuropathy

A

Genetic disease involving mutation of maternal mitochondrial DNA

Causes B/L ON involvement

47
Q

Papilloedema what

A

Oedema around the disc

48
Q

Clinical features of papilloedema

A 
VA normal
PR normal
Colour normal 
Brightness normal
VFD PRESENT(enlargement of blind spot)
49
Q

Examination findings in papilloedema

A 
Venous dilatation (first sign)
Blurring of disc margin
50
Q

Etiology

Intraocular causes for papilloedema

A

(Any cause for hypotonia)
Trauma
Surgery
Chronic uveitis (ciliary shutdown)

51
Q

Etiology- intraorbital cause of papilloedema

A

(Any increases pressure in the orbit)
Tumour
Inflammation
Thyroid disease

52
Q

Etiology-intracranial causes for papilloedema

A 
(Any increase in ICT)
Tumour 
Encephalitis
Abscess 
Benign intracranial HTN
53
Q

Benign intracranial HTN aka

A

Pseudo tumour cerebri

54
Q

Etiology of pseudotumour cerebri

A

Obesity
Hypervitaminosis
Tetracycline
OCPs

55
Q

Systemic cause of papilloedema

A

Malignant HTN

Severe anemia

56
Q

Classification of optic atrophy and optic disc features

A

Primary - chalky white,clear margin
Secondary - dirty white,blurred disc
Consecutive - pale waxy disc
Glaucomatous -cupping of disc

57
Q

Causes in the particular classification of optic atrophy

A

Primary- (brain)
Multiple sclerosis,neurosyphilis

Secondary - (optic nerve)
Papillitis,papilloedema

Consecutive-(retina)
Retinitis pigmentosa ,diffuse chorioretinitis

Glaucomatous-glaucoma

58
Q

Horners syndrome

A

Lesion of sympathetic chain

59
Q

Clinical features of horners syndrome

A 
Miosis 
Ptosis (mullers)
Enophthalmos
Anhydrosis
Loss of ciliospinal reflex (pinching of nape of neck causes dilatation of pupil)
60
Q

What is characteristic of congenital horners syndrome

A

Hererochromia iridis

61
Q

Causes of horners syndrome

A

Central - brain stem disease,spinal cord tumour

Preganglionic-pan coast tumour,carotid aortic aneurysms

Post ganglionic-atherosclerosis of ICA,neuropharyngeal tumour,cavernous sinus pathology

62
Q

Nuclei in the midbrain (eyes)

A

EW
SR,IO,IR,MR
LPS
CN 4

63
Q

2 nuclei from the Brian supply the opposite sides

Which one

A

SO (CN4)

SR

64
Q

What is the crossing of 4th nerve nucleus and what does its lesion cause

A

Anterior medullary velum

Both SO palsy

65
Q

What happens to eye in midbrain lesion

A

B/L ptosis
C/L SR palsy
Rest same side palsy (IO,IR,MR)

66
Q

What are yoke muscles

A

Contralateral synergist
Eg. for right LR
Left MR is yolk muscles

67
Q

PPRF lesion

A

Ipsilateral Horizontal gaze palsy

Know the diagram or else you won’t understand

68
Q

FEF lesion

A

Contralateral horizontal gaze palsy

69
Q

MLF lesion

A

Internuclear ophthalmoplegia

Know what happens (check diagram)

70
Q

PPRF lesion aka (2)

A

Frontal lobe lesion of that side

Supranuclear lesion

71
Q

Doll’s reflex

A

Oculocephalic reflex
Supranuclear lesion present- but no muscle palsy
Nuclear lesion absent

72
Q

1 and a half syndrome

A

Same side lesion of PPRF and MLF

73
Q

Nystagmus not in this

A

Have you done it!! 😲

74
Q

Components of vertical gaze syndrome

A

Interstitial nucleus of Cajal
Rostral interstitial MLF
Posterior commissure

75
Q

Weber syndrome

A

3rd nerve palsy and contralateral hemiplegia

76
Q

Benedicts syndrome

A

3rd nerve palsy and contralateral hemitremors

Red nucleus affected

77
Q

Millard gubler syndrome

A

6th nerve palsy and contralateral hemiplegia

78
Q

Foster Kennedy syndrome

A

I/L optic atrophy

C/L papilloedema

79
Q

Pseudo foster Kennedy syndrome

A

Non arteritic AION
One eye-blurring of disc margin
Other eye- optic atrophy

80
Q

Where are the first second and third order neutrons of optic nerve

A

First-bipolar cells of retina
Second- ganglion cell layer of optic nerve
Third-LGB

Opthalmology (10 decks)

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