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Blitz Ana Surg > Off-tah > Flashcards

Off-tah Flashcards

1
Q

Involuntarily blink

A

Pretarsal

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2
Q

Involuntarily blink

A

Preseptal

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3
Q

Forced lidclosure

A

Orbital

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4
Q

Involuntary blinking/closure of eyelids–– Functionally disabling Treatment: Botox injection

A

Blepharospasm/Hemifacial muscle)

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5
Q

Serves as an anatomic barrier between preseptal and orbital structures

A

Orbital Septum

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6
Q

common infection of the eyelid and periorbital soft tissues

A

PreseptalCellulitis

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7
Q

Involvement posterior to the septum

RAPD, Proptosis, Limited EOMs, ChemosisTreatment: Intravenous antibiotics,

A

Orbital Cellulitis

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8
Q

Opening of the eye

A

Can 3 + sympha

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9
Q

Closing the eye

A

Cn7

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10
Q

Dense plates of connective tissue that gives structure and serves as a fibrous skeleton to the eyelids

Contains Meibomian glands

Holocrine gland

A

Tarsus

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11
Q

Lining of conjunctiva

A

Nonkeratizing squamous epithelium

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12
Q

Contains mucin secreting Goblet cells and accessory glands of Krausse and Wolfring
> Glands of Krause are found in the Glands of fornices
> glands of Wolfring found in the nonmarginal tarsal are borders
»Basal tear secretion

A

Conjunctiva

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13
Q

Small abscess, caused by acute staph infant of a las follicle and associated gland of Zeus or moll.

A

External hordeulum

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14
Q

Chronic.non infective lipogranulomatous in inflammation caused by blockage of meibomian gland orifice and stagnation of sebaceous secretions

A

Chalazion (painless)

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15
Q

Arterial Supply

A
  1. Ophthalmic
  2. E-CA
    1. Marginal arterial arcade

4.Peripheral arterial arcade

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16
Q

Lymphatic Drainage of eye

A

Submandibular lymph nodes medially

Superficial preauricular nodes and deep cervical nodes laterally

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17
Q

Excess preseptal skin

A

Dermatochalasis

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18
Q

main protractor of eyelid

A

Orbicularis Oculi Muscle

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19
Q

Weakness or inability to close eyelids (lagophthalmos ) Complications: exposure keratopathy

A

Facial Nerve Palsy

Bell’s Palsy

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20
Q

Involuntary blinking/closure of eyelids––

Functionally disabling
To: Botox injection

A

Blepharospasm/Hemifacial spasm overactive muscle)

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21
Q

Lower lid laxity

A

ectropion and entropio

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22
Q

Medial canthal laxity/ disinsertion

A

ectropion/telecanthus

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23
Q

Muscles of retraction in upper eyelid

A
  1. LevatorPalpebrae Superioris Muscle(40mm)
  2. Levator Aponeurosis(14-20mm)
  3. SuperiorTarsal Muscle (Muller’s muscle)

All except SuperiorTarsal Muscle (Muller’s muscle) are innervated by CN 3 . The later is sympathetic.

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24
Q

Muscles of retraction in lower lid

A
  1. Capsulopalpebral fascia - CN 3

2. Inferior tarsalmuscle - sympathetic

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25
Q

It is a small abscess caused by an acute staphylococcal infection of meibomian gland

  • more painful than stye
A

Internal horduelum

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26
Q

suspends the levatoraponeurosis & part SOtendon

A

Whitnal’s Ligament:

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27
Q

thinnest bone of orbit and covers the ethmoid sinus)

A

lamina papiracea

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28
Q

Blowout” Fracture s/s

A

Symptoms:––
Diplopia (Entrapment of Inferior Rectus) Unable to look up
( Entrapment of Inferior Rectus )
Loss of sensation of the skin of the cheek and gum on the same side (Infraorbital nerve involvement)

Most common wall involved?Orbital Floor into the (the maxillary orbital fat sinus ) explod

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29
Q

What structure opens to Supraorbital notch (Foramen ):

A

the supraorbital nerve

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30
Q

What structure opens to Infraorbital groove and and canal

A 
Ans : Infra orbital  nerve 
Nasolacrimal canal 
>Located anteriorly  on  the  medial 
>It communicates  with  the inferior meatus of the nose 
>transmits the nasolacrimal duct
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31
Q

Inferior orbital fissure

A

maxillary nerve and its zygomatic branch,the inferior ophthalmic vein, and sympathetic nerves

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32
Q

Superior orbital fissure

A

lacrimal nerve, the frontal nerve, the trochlear nerve, the oculomotor nerve(upper and lower divisions), the abducent nerve, the nasociliary nerve, and the superior ophthalmic vein

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33
Q

Optic canal

A

optic nerve , ophthalmic artery

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34
Q

loss and of vision, chemosis, exophthalmos (bulging eyes), headaches, and paralysis of the cranial nerves which course through the cavernous sinus

A

Cavernous Sinus Thrombosis

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35
Q

Receives sensory nerve supply from the lacrimal nerve , a branch of the ophthalmic nerve (CN 1

Both autonomic and sensory innervation

A

Lacrimal Gland

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36
Q

Uncommon consequence of nerve regeneration after – Bell’s palsy or other damage to the facial nerve .
Efferent fibers of the superior salivary nucleus become improperly connected to the nerve axons of the lacrimal glands
“Crying when salivating or smelling food”

A

Crocodile Tears Syndrome–

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37
Q

Muscles that Constricts pupil

A

Sphincter papillae of iris

Innervation - Parasympathetic viaoculomotor nerve

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38
Q

Dilates pupil

A

Dilator papillae of iris

Innervation:

Sympathetic

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39
Q

Controls shape of lens; inaccommodation, makes lens more globular

A

Ciliary muscle

Innervation :

Parasympathetic via oculomotor nerve

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40
Q

Eyelid closure

A

Orbicularis

Innervation:

Facial Nerve (CN VII)

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41
Q

Eyelid opening

A

Levator palpebrae superioris

Innervation:

CN III, Sympathetic

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42
Q

2/3 of the refractive media of the eye; Transmits light rays; Corneal deturgescense

A

Cornea

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43
Q

protective layer/tunic of the eye

A

Sclera

44
Q

Nourishment layer/tunic

A

Choroid

45
Q

Contains receptors cells for light perception (sensory layer/tunic)

A

Retina

46
Q

1/3 of the refractive media; Accommodation

A

Lens

47
Q

Pupillary reflex; Controls amount of light entering the eye

A

Iris

48
Q

Accomodation

A

PARASYMPATHETIC RESPONSE CN III

49
Q

The “Near” triad :

A

The “Near” triad :––Accomodation
Miosis
Convergence

50
Q

Non- accommodated lens

A
  1. Ciliary body relaxes
  2. Zonular tension increases
  3. Anterior lens capsule flattens
  4. Lens more oval ,Lesser AP thickens
  5. Less diopteric power

*accommodated is the opposite

51
Q

Helmholtz theory of accommodation

A 
With accommodation
- ciliary muscle = contracts 
-zonular tension = decreases 
-lens shape = more spherical
Lens equatorial diameter = decreases
Central anterior lens capsule curvature = steepens 
Lens dioptric power = increases
52
Q

the loss of accommodation elasticity of the lens

A

Presbyopia

40-45 year = more common

Tx : Reading adds

53
Q

near-sightedness

Image focused in FRONT of retina

A

Myopia

Tx : DIVERGING/CONCAVE/MINUS lenses

54
Q

“Farsightedness lenses ”

Image focused at the BACK of the retina

A

Hyperopia

Tx : CONVERGING/CONVEX/PLUS lenses

55
Q

Occurs when the cornea (or Lens) has an irregular curvature

A

Astigmatism

Tx : Cylindrical/ Toric Lenses

56
Q

Intraocular Pressure

A

Normally 10-20 mmHg
Meaured by the Applanation Goldmann Tonometer
»> A Relative increase increases the risk of developing Glaucomatous optic neuropathy

57
Q

leaves the eye at a point 3 mm medial to and slightly above the posterior pole of the (seen in direct ophthalmoscopy as the globe optic disc )

A

Optic nerve

58
Q

blind spot

A

Since there are no visual receptors over the disk, this area of the retina does not respond to light and is known as the

59
Q

Near the posterior pole of the eye, there is a yellowish pigmented spot

A

macula

60
Q

Center of the macula; it is a thinned-out rod free portion of the retina in humans and other primates

A

fovea

the fovea is the point where visual acuity is greatest

61
Q

-Organized into layers containing different types of cells and neural processes
Contains the Photoreceptors (Rods and Cones)

A

Retina

  • Light rays must pass through the ganglion cell and bipolar cell layers to reach the rods and cones.
  • The pigment epithelium absorbs light rays, preventing the reflection of rays back through the retina
  • Ganglion cells retina with are the only output neuron of the their axons forming the optic nerve
62
Q

Dark Adaptation / Night vision
Contrast sensitivity
- more dense peripherally

A

Rods

63
Q 
Color  vision (Red,  Green,  Blue) 
More dense centrally
A

Cones

64
Q

The key to initiation 11of the visual cycle is the availability of

A

cis retinaldehyde (vitamin A)

In deficiency, both the time taken to adapt to darkness and the ability to see in poor light are impaired
“From CIS to TRANS”

65
Q

PIE on the SKY

A

PIE-rietal lesion

66
Q

Pie on the floor

A

Temporal lesion

67
Q

Macular Sparing

A

Occipital lesion

68
Q

PARASYMPATHETIC response

On Ciliary nerves

A

1) Ciliary : muscle that controls focusing of the eye lens

(2) Sphincter of the iris constricts the pupil

69
Q

SYMPATHETIC response

A

(1) Origin:
Intermediolateral horn cells of the T1 segment of the spinal cord which enter the sympathetic chain and pass upward to the superior cervical ganglion
(2) Postganglionic sympathetic fibers innervate the radial fibers of the iris,as well as several extraocular muscles of the eye

70
Q

visualizes the back of the eye; ERECT image, MAGNIFIED view

A

Direct Ophthalmoscope

71
Q

visualizes the back of the eye; INVERTED image, WIDER view

A

Indirect Ophthalmoscope

72
Q

Creates an optical section of retina to view its layers for any pathology

A

Optical Coherence Tomography

73
Q

Fluorescent the dye is injected into bloodstream.

Highlights the blood vessels in the back of the eye so they can be photographed

A

Fluorescein angiography

74
Q

For QUANTITATIVE

measurement of the visual field

A

Visual field Perimetry

75
Q

Invasive bacteria that CAN PENETRATE an intact corneal epithelium? CHaNeLS

A 
Corynebacterium
Haemophilus 
Neisseria
Listeria 
Shigella
76
Q

ADULT with history of red, painful eye, hyperacute purulent conjunctival discharge ?

A

Gonococcal Conjunctivitis
Gram (-) intracellular diplococci

• Tx : Ceftriaxone , treat partner, treat coexisting chlamydial infection with Azithromycin

77
Q

Condition where there is progressive corneal thinning seen in young adults?

A

Keratoconus
History of allergies, chronic eye rubbing, Marfan’s, Down
Very high myopia and astigmatism
Frequently changes glasses

Tx–EOR correction
Corneal transplant

78
Q

Farmer/Seaman gradually enlarging wingshaped conjunctival mass encroaching the cornea?

A 
Pterygium
UVlight  exposure 
Elastotic Degeneration 
Stocker’s line : Iron deposits at the head  of the pterygium
Tx :  Excise
79
Q

Farmer/Seaman gradually enlarging Yellow white deposits at the limbal amorphous interpalpebral conjunctiva

A 
Pingeucula 
UVlight  exposure 
Elastotic Degeneration 
Does  not encroach cornea 
Tx :  Excise

*** Elastotic Degeneration

80
Q

Patient with painful Red eye Cement with history of splashing into the eye

A

Chemical Injury–Cement is alkaline Liquefactive necrosis
Can cause corneal perforation
Tx : IRRIGATION until pH is neutral!!

81
Q

Patient with painful Red eye muriatic acid with history of splashing into the eye?

A

Chemical Acid Injury

Coagulative necrosis Causes lesser damage than alkaline injury Tx : IRRIGATION until pH is neutral!!

82
Q

Patient with history of blunt trauma. Diffuse conjunctival redness

A

Subconjunctival hemorrhage
-bleeding from a small blood vessel in the outer layer of the eye
DOES NOT cause a decrease in vision Associated with trauma or high blood pressure Self limiting

83
Q

Patient with history of blunt eye trauma just a few hours ago. Complains of diplopia , and limited eye movement • Impression?

A

• Orbital wall fracture
Posteromedial Floor : MC wall involvement
Inferior rectus : MC entrapped muscle
Needs urgent repair if with nerve/muscle involvement .

84
Q

Adult with Diplopia, Bulging eyes , cant look up. Impression?

A

Thyroid Eye Disease (TED)

Can occur even in euthyroid or hypothyroid state

MC Cause of unilateral bilateral and proptosis in ADULTS
Inferior Rectus: MC involved EOM

Imaging: Tendon sparing Muscle hypertrophy
Tx : Steroids, Immunosuppressants , Surgery

85
Q

Painful red eye with ciliary injection

Photophobia, Blurred vision, Presence of cells/flares • in the anterior chamber. Diagnosis?

A

Acute Anterior Uveitis

Associated with autoimmune diseases i.e. JIA, RA, SLE, Sarcoidosis

To steroids

86
Q

Sudden headache, blurred vision with halos of light. Fixed dilated pupil with hazy cornea ?

A 
Acute  Angle Glaucoma closure
 Pupillary  block mechanism 
High  IOP!! 
Initial Tx : Acetazolamide
Definite Tx : Laser iridotomy
87
Q

Visual field defects characteristic of glaucomatous optic nerve damage?

A

Respects the HORIZONTAL midline
Arcuate scotomas
Corresponds to the retinal nerve fiber layer

88
Q

Visual field defects that are of neurologic origin?

A

Respects the VERTICAL midline

May have other signs such as weakness

89
Q

Young female, Sudden BOV , Pain on eye movement very poor color vision , but VA is 20/30

A

Optic neuritis
May or may not have coexisting Multiple sclerosis

2/3 with normal looking nerve; pale nerve : 1/3

MRI can be done to check for demyelinating white matter lesions

Tx Observe , Oral steroids (Optional)

90
Q

Young Obese , enlarged blind woman, Severe spot, headache Bilateral Papilledema but normal BP diplopia • • •

A

Idiopathic Intracranial Hypertension increased detectable ICP without cause ( Pseudotumor cerebri)

Dx Test:Lumbar puncture ,MRI is normal
Tx : Weight loss, Acetazolamide, Optic nerve fenestration / CSF diversion

91
Q

Elderly, Severe headache , Bilateral Papilledema, Retinal hemorrhages and h igh BP •

A

Hypertensive Retinopathy
Always check BP in cases of bilateral disc swelling
Tx : Control BP, Refer to IM

92
Q

Adduction deficit with contralateral abduction nystagmus . Where is the lesion?

A 
Internuclear Ophtalmoplegia (INO) 
Medial  longitudinal Fasciculus  (MLF)  Lesion ipsilateral  to  adduction deficit 
Can  be bilateral (WEBINO)
93
Q

Blurred vision plus history of anosmia, infertility, menstrual changes, mood changes. Where is the lesion?

A

Pituitary Adenoma / Chiasmal tumor Bitemporal hemianopsia
Initially involves superior fields
Tx: Bromocriptine
Surgical decompression

94
Q

Elderly Caucasian, sudden loss of vision with severe headache, pain on chewing and combing his hair.

A 
Giant  Cell Arteritis 
Hallmark: Jaw claudication 
Can  cause  bilateral blindness 
Labs: Elevated CRP/ESR 
Dx : Temporal  artery  biopsy 
-granulomatous  inflammation of medium  to large  sized vessels 
Tx : Steroids
95
Q

Anisocoria greater in DIM light?

A 
Horner’s  syndrome 
Problem  in sympathetic pathway
 Triad––Miosis,Ptosis,Anhidrosis 
Dx : Cocaine test 
Causes:
Children:  Brachial  plexus injury 
Adults: Pancoast tumor,  Carotid artery  Dissection,  Stroke
96
Q

Anisocoria greater in BRIGHT light?

A

Adie’s tonic pupil

Parasympathetic : response is impaired Dx Pilocarpine test

97
Q

Patient with diplopia and ptosis that occurs later on the day and sometimes improves spontaneously

A

Ocular Myasthenia Gravis
Variable fatiguiability
Tx :Steroids

98
Q

Young adult with sudden diplopia and ptosis,Headache,dilated pupil on one side. Impression?

A 
CN 3 Palsy involving pupil
 “Down and  out”  Eye 
Posterior  communicating Artery  Aneurysm  until proven  otherwise! 
Dx : CTA,  MRA 
Tx : Surgery i.e • clipping
99
Q

Elderly diabetic with poor vision and a very opacified lens.

A

Diabetic Cataract
Sorbitol: Sugar accumulating in the lens Aldose Reductase : limiting step of the reduction rate of glucose to sorbitol
Water goes inside lens via osmosis and gets trapped “Sugar Cataract”

100
Q

Lens is dislocated or not centered? • •

A 
Lens  Subluxation  / Ectopia Lentis Associated  conditions–
Marfan’s 
Homocystinuria 
Aniridia 
Weill-Marchesani syndrome 
Sulfite  oxidase  deficiency
101
Q

Adult with Sudden Painless loss of vision . You see cherry red spot retina?

A 
-Central  retinal  artery occlusion •Irreversible loss  of vision  after 90  min Other causes  of  cherry red spot 
Taysachs 
Niemann Pick 
Sandhoff disease 
GM1  and  GM2 gangliosidoses
102
Q

Newborn with a Cats eye reflex

A
  • Retinoblastoma

- Long arm of Chromosome 13 Pathology: Flexner wintersteiner cells

103
Q

Patient underwent uncomplicated cataract surgery . A few days later developed painful red eye and loss of vision

A

Postoperative Endophthalmitis
MC Etiology: Staph Epidermidis
Signs: Hypopyon , red eye, hazy cornea, Cells/flares
Tx : Intravitreal Antibiotics, Vitrectomy

104
Q

Antiglaucomadrugs:

Increase outflow:

A

Latanoprost , Pilocarpine

105
Q

Decrease aqueous production •

A

Timolol , Acetazolamide

106
Q

Decrease vitreous volume •

A

Mannitol, glycerol

107
Q

Both decrease production and increase outflow •

A

Brimonidine

Blitz Ana Surg (2 decks)

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