Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NBEO Part 2 > Optic Nerve/ Neuro-ophthalmic Pathways/Blood Flow > Flashcards

Optic Nerve/ Neuro-ophthalmic Pathways/Blood Flow Flashcards

1
Q

Classic triad of Horner’s

A

PAM!!! PAM!!!
1. Ptosis (small, affects Muller’s muscle)
2. Anhidrosis (lack of sweat on one side)
3. Miosis (pupil constriction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Argyll Robertson pupil associated with what infectious disease?

A

Late-stage syphilis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Physiological anisocoria

A
  • Anisocoria equal under dim and bright conditions
  • no ptosis
  • confirm stability by referring to previous photos of patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Signs of pupil involving 3rd nerve palsy

A

Eye is down and out with dilated (blown out) pupil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Patient presents with diplopia, headache, eye is down and out with a blown out pupil, what is your A&P?

A

A. Pupil involving cranial nerve 3 palsy caused by aneurysm of the posterior communicating artery
P. Send to emergency room ASAP (EMERGENT!!!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Congenital Horner’s syndrome signs

A

Iris heterochromia (affected eye will have lighter iris)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Characteristics of tilted disc syndrome

A
  • Bilateral
  • optic nerve enters at an oblique angle superiorly
  • situs inversus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Signs of tilted disc syndrome

A
  • myopic
  • fundus ectasia
  • superior temporal VF defects that do not respect the midline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

A&P for Horner’s

A

A. Horner syndrome
1. isolated damage of 3rd order neuron
2. pre-ganglionic lesion

Plan
1. No further investigation
2. Refer for MRI of head and neck and a CT scan of thorax or chest x-ray (pancoast tumor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Right homonymous hemianopia is associated with stroke on which side of the brain? And can cause hemiparesis on which side of the body?

A

Cerebrovascular accident on left side of brain and patient likely has hemiparesis on right side of their body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pulfrich phenomenon

A

Pendulum is perceived as moving in a circular motion rather than laterally
* symptom of optic neuritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Ocular manifestation of multiple sclerosis

A

Optic neuritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Optic neuritis age demographic

A

18 to 45 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Uhthoff sign

A

Associated with MS

Symptoms worsen with increase in body temperature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

True or false
Horner’s syndrome can be caused by internal carotid artery dissection

A

TRUE
* 3rd order neuron damage from internal carotid artery dissection can cause Horner’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Patients suspected with Horner’s due to a pre-ganglionic lesion should be referred for what further testing?

A
  • MRI of head and neck
  • CT scan of thorax
  • chest x-ray (check for pancoast tumor)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Parietal lobe lesion will produce what VF loss?

A

Inferior incongruous or congruous VF loss (quadrantanopia)
* pie on the floor (parents put you down lesion in parietal lobe)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Lesion in temporal lobe produces what VF loss?

A

Superior quadrant VF defect, incongruous and wedge shaped, can also be complete
* superior quadrantanopia = pie in the sky

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Optic radiations traveling through ____ lobe carry visual information from the superior retina

A

Parietal lobe
* VF loss will be opposite therefore superior retina damage will cause inferior VF loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

3rd order neuron irregularities can be caused by?

A

Cluster headaches
Otitis media
Masses in cavernous sinus
Internal artery dissections
Nasopharyngeal tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Pancoast tumor can cause which order neuron irregularity in Horner’s?

A

2nd order neuron lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the most common cause of pupil sparing isolated 3rd nerve palsy?

A

Microvascular disease secondary to HTN &/or diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Blood supply to oculomotor nerve

A

Surface and pupillary fibers are supplied by pial blood vessels; internal fibers are supplied by the vasa nervorum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the common triggers of a classic migraine?

A
  • stress
  • coffee
  • chocolate
  • cheese
  • prolonged periods without food
  • bright lights
  • alcohol
  • severe fatigue
  • birth control
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Visual aura of a classic migraine would produce what type of visual field defect?

A

Homonymous hemianopsia
* start in center and enlarge in homonymous portions of the visual field
* HA located on contralateral side of field defect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Leber hereditary optic neuropathy is more common in males or females?

A

males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is Tilted Disc Syndrome?

A

A condition where the optic nerve enters the eye at an oblique angle, causing elevation of superior nerve tissue and ectasia of inferior/infero-nasal tissue

Typically observed bilaterally.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What visual field defects are often associated with Tilted Disc Syndrome?

A

Superotemporal defects

These defects may diminish or disappear with myopic astigmatism correction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are common symptoms of Tilted Disc Syndrome?

A

Majority are asymptomatic; some may report visual field defects or blurred vision

Symptoms can be caused by uncorrected astigmatism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What clinical signs indicate Tilted Disc Syndrome?

A
  • Obliquely inserted disc
  • Myopic astigmatism
  • Tilted optic disc with inferior ectasia
  • Superior elevation of nerve tissue
  • Situs inversus
  • Fundus ectasia
  • Superotemporal visual field defects

Visual field defects generally do not respect the midline.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the treatment for Tilted Disc Syndrome?

A

Visual correction to neutralize the associated refractive component

No additional treatment is required.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How often should patients with Tilted Disc Syndrome be evaluated?

A

Annually

Regular follow-up helps monitor any changes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Fill in the blank: Tilted Disc Syndrome is caused by an optic nerve that enters the eye _______.

A

[superiorly at an oblique angle]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

VF defects of tilted disc syndrome similar to what type of tumor VF defect?

A

Pituitary gland tumor —> bitemporal field defect
* neuroimaging required to establish concrete diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the primary function of the Circle of Willis in relation to the eyes?

A

The Circle of Willis provides collateral circulation to the brain, including areas that supply blood to the eyes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

True or False: The ophthalmic artery is a branch of the internal carotid artery, which is part of the Circle of Willis.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Fill in the blank: The Circle of Willis is located at the base of the ______.

A

brain

38
Q

Which arteries contribute to the Circle of Willis?

A

The internal carotid arteries and the vertebral arteries contribute to the Circle of Willis.

39
Q

Multiple Choice: Which of the following arteries is NOT part of the Circle of Willis? A) Anterior cerebral artery B) Middle cerebral artery C) Posterior tibial artery D) Posterior cerebral artery

A

C) Posterior tibial artery

40
Q

What are the main arteries supplying blood to the iris and ciliary body?

A

Long posterior ciliary arteries and anterior ciliary arteries

These arteries are branches of the ophthalmic artery.

41
Q

What is formed by the terminal branches of the long posterior ciliary arteries and anterior ciliary arteries?

A

The major arterial circle of the iris

This circle lies behind the root of the iris in the ciliary body.

42
Q

Where does the major arterial circle of the iris lie?

A

Behind the root of the iris in the ciliary body

It is formed by anastomoses of the long posterior and anterior ciliary arteries.

43
Q

What is the path of blood vessels from the major arterial circle?

A

They course around the circumference of the iris, from the periphery toward the pupil

This arrangement supports blood flow to the iris.

44
Q

What forms the minor arterial circle of the iris?

A

Centripetal branches of the major arterial circle

This minor circle is incomplete and lies just inside the pupillary border.

45
Q

What is the location of the minor arterial circle of the iris?

A

Just inside the pupillary border

It is involved in the initial signs of neovascularization of the iris.

46
Q

True or False: The minor arterial circle of the iris is responsible for the complete blood supply to the iris.

A

False

The minor circle is incomplete and primarily indicates neovascularization.

47
Q

Fill in the blank: The _______ arteries anastomose with the anterior ciliary arteries to form the major arterial circle of the iris.

A

long posterior ciliary

These arteries are crucial for the vascular supply to the iris.

48
Q

What is neovascularization of the iris associated with?

A

The minor arterial circle of the iris

Initial signs of neovascularization are observed in this area.

49
Q

What is papillophlebitis?

A

A rare condition observed in younger patients, usually under 50 years of age.

50
Q

What is the typical health status of patients with papillophlebitis?

A

Generally healthy.

51
Q

What are the clinical signs of papillophlebitis?

A

Sudden unilateral blurring of vision, disc edema, cotton wool spots, dilation and tortuosity of veins, and retinal hemorrhages restricted to the posterior pole.

52
Q

What age group is most commonly affected by papillophlebitis?

A

Patients under 50 years of age.

53
Q

What is the prognosis of papillophlebitis without treatment?

A

Typically good, unless chronic macular edema remains.

54
Q

Fill in the blank: Clinical signs of papillophlebitis include _______.

A

sudden unilateral blurring of vision, disc edema, cotton wool spots, dilation and tortuosity of veins, retinal hemorrhages.

55
Q

True or False: Papillophlebitis is more common in older patients.

A

False.

56
Q

What is aberrant regeneration in the context of cranial nerve palsy?

A

It occurs when third cranial nerve fibers misdirect to alternate muscles innervated by the same nerve.

57
Q

Which cranial nerve is involved in aberrant regeneration?

A

The third cranial nerve (oculomotor nerve).

58
Q

What muscles does the oculomotor nerve control?

A
  • Medial rectus
  • Superior rectus
  • Inferior rectus
  • Inferior oblique
  • Iris dilator muscle
59
Q

What causes aberrant regeneration of the oculomotor nerve?

A

Damage from trauma or compression.

60
Q

What is the pseudo-Graefe sign?

A

Elevation of the involved eyelid on downgaze or adduction.

61
Q

List the most common signs of aberrant third nerve regeneration.

A
  • Eyelid-gaze dyskinesis
  • Pupil-gaze dyskinesis
  • Constriction of the pupil on downgaze or adduction
  • Elevation of involved eyelid on downgaze or adduction
62
Q

True or False: Aberrant regeneration can lead to limitation of elevation or depression of the eye.

A

True.

63
Q

Fill in the blank: Aberrant regeneration may lead to _____ on attempted elevation or depression.

A

adduction

64
Q

What is a less common sign of aberrant third nerve regeneration?

A

Absent optokinetic nystagmus response.

65
Q

What is the cavernous sinus?

A

A large collection of thin-walled veins that create a cavity within the human head, bordered by the temporal and sphenoid bones

66
Q

How does the cavernous sinus receive blood?

A

Via the superior and inferior ophthalmic veins and the superficial cortical veins

67
Q

What channels drain the cavernous sinus?

A

The superior and inferior petrosal sinuses and into the jugular vein via the sigmoid sinus

68
Q

What major artery runs through each cavernous sinus?

A

The internal carotid artery

69
Q

Which cranial nerves are contained within the cavernous sinus?

A
  • Oculomotor nerve (CN III)
  • Trochlear nerve (CN IV)
  • Ophthalmic nerve (V1 branch of CN V)
  • Maxillary nerve (V2 division of CN V)
  • Abducens nerve (CN VI)
70
Q

How do the cranial nerves run within the cavernous sinus?

A

From superior to inferior within the lateral wall of the cavernous sinus

71
Q

Where does the abducens nerve (CN VI) run in relation to the cavernous sinus?

A

Through the middle of the sinus alongside the internal carotid artery

72
Q

Which cranial nerves pass through the cavernous sinus and enter the orbital apex via the superior orbital fissure?

A
  • CN III
  • CN IV
  • CN VI
73
Q

Where does CN V2 exit the cavernous sinus?

A

Through the foramen rotundum

74
Q

Where is the optic nerve located in relation to the cavernous sinus?

A

Just outside and superior to the cavernous sinus on each side, entering the orbital apex via the optic canal

75
Q

What is the typical result of lesions involving the cavernous sinus?

A

Dysfunction of several nerves due to their close proximity

76
Q

Which CN pass through the cavernous sinus and enter the orbital apex through the superior orbital fissure?

A
  • CN 3
  • CN 4
  • V1 of CN 5
  • CN 6
77
Q

Pt with pupil involving CN 3 palsy and has medical history of congenital heart defect and has a pace maker should NOT get what type of imaging done?

A

MRI
* pt should get CT and CTA instead to confirm diagnosis of intracranial arterial aneurysm

78
Q

If neuroimaging is negative for pt with pupil involving third nerve palsy what additional test should be considered next?

A

Lumbar puncture

  • to evaluate possible presence of blood in CSF, an inflammatory reaction, neoplastic infiltration or infection
  • blood in CSF = rupture of posterior communicating artery aneurysm
79
Q

What is the pupillary pathway responsible for?

A

The light reflex and the near reflex

The pupillary pathway involves several neurons responding to stimuli.

80
Q

What does sympathetic input cause in the pupillary pathway?

A

Mydriasis

Mydriasis refers to the dilation of the pupil.

81
Q

What does parasympathetic innervation cause in the pupillary pathway?

A

Pupil miosis

Miosis refers to the constriction of the pupil.

82
Q

What does the absence of a light reflex typically indicate?

A

Severe unilateral nerve damage

This absence suggests significant issues with the neural pathways.

83
Q

Which retinal photoreceptors mediate the response to light?

A

Retinal photoreceptors

These receptors conduct signals to the pretectal nucleus.

84
Q

Where do fibers from the nasal retina cross over?

A

In the chiasm

This allows signals to enter the contralateral pretectal nucleus.

85
Q

What happens to fibers from the temporal retina?

A

They do not decussate and send information to the ipsilateral pretectal nucleus

This contributes to the light reflex mechanism.

86
Q

What is the role of the Edinger-Westphal (EW) nuclei in the pupillary pathway?

A

They receive input from the pretectal nuclei and relay information

This process results in symmetrical pupil constriction when light stimulates one eye.

87
Q

What occurs after neurons leave the EW nucleus?

A

They synapse onto the ipsilateral ciliary ganglion

This is crucial for innervating the pupil sphincter.

88
Q

What is the effect of damage to the parasympathetic pathway?

A

Mydriasis of the pupil

Damage affects pupil constriction capabilities.

89
Q

Where does the first order neuron of the sympathetic pathway originate?

A

In the hypothalamus

This neuron travels down the spine to synapse onto the ciliospinal center of Budge.

90
Q

What is the pathway of the second order neuron in the sympathetic pathway?

A

Projects from the ciliospinal center of Budge upwards to the superior cervical ganglion

This ganglion is located in the neck.

91
Q

What does the third order neuron do in the sympathetic pathway?

A

Sends projections from the superior cervical ganglion along the internal carotid artery

This neuron ultimately reaches the ciliary body and dilator muscle of the pupil.

92
Q

What are the effects of damage to the sympathetic division of the pupillary pathway?

A

Pupillary miosis, ptosis of the upper lid, and elevation of the lower lid

Both Mueller’s muscle and lower lid retractors are innervated by the sympathetic system.

NBEO Part 2 (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions