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Optoprep/ODquestions Flashcards

1
Q

What does virgin cytotoxic T cells divide into?

A
  • effector T cells
  • memory T cells
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2
Q

What recognizes the MHC complex (antibody + MHC)?

A

cytotoxic T cells and virgin helper T cells

cytotoxic T cells divide into effector and memory T cells

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3
Q

What’s the function of effector T cells?

A

promote mitosis of T and B cells to help combat pathogens

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4
Q

What’s the function of helper T cells?

A

help direct the immune system to the appropriate cells

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5
Q

What’s the function of killer T cells?

A

inject chemicals to cause death in the target cell

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6
Q

What are the functions of B cells

A

upon activation by effector helper T cells and interleukins, begin mitosis and differentiate into memory B cells and effector B cells

new memory B cells are stored for future encounters

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7
Q

What produces antibodies?

A

B cells - serve to inactive the offending agent

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8
Q

What’s the vertex distance equation?

A

Fc = Fs/1-dFs

Fc = dioptric power of the corneal plane
Fs = dioptric power of the spec plane
d = vertex distance in m

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9
Q

What’s weber’s Law?

A

K = delta I/I

K = Weber’s constant
I = difference in threshold
I = original stimulus intensity

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10
Q

Goldmann 3 mirror

A

Trapezoid 73 degrees = eval retinal equatorial region

bullet mirror 59 degrees = assess ora serrata

square mirror 67 degrees = anterior equatorial retina and the ora serrata

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11
Q

What’s the color of the following wavelengths?

Red
Orange
Yellow
Green
Blue
Violet

A
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12
Q

What is the avg cell density of the endothelium

A

3000

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13
Q

cellular density count below ____ cells/mm2 is associated with what risk?

A

1000

high risk for corneal endothelial decompensation

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14
Q

Vitrosin

A

unique collagen that is capable of binding large amts of water (up to 200x its weight)
- contains hydroxyproline (specific to collagen)
- originates from the neruoectoderm

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15
Q

Where are hemoglobin and albumin found?

A

proteins found in blood

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16
Q

creatine

A

used as an energy source primarily by our muscles

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17
Q

xanthophyll

A

yellow appearance in the macula
- combination of zeaxanthin and lutein
- decrease the formation of free radicals
- not made in our body which is why we advise pts with macular degeneration to take oral supplements (AREDS)

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18
Q

What’s the avg IOP?

A

15 mmHg (+/- 2.57mmHg)

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19
Q

normal fluctuation of IOP?

A

3-5mmHg

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20
Q

Which glands produce oil?

A

MG and zeiss

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21
Q

Which glands are apocrine (sweat) glands?

A

Moll

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22
Q

Which glands produce the aqueous layer of the tear film?

A

Krause and Wolfring

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23
Q

Describe a stage 3 macular hole

A
  • FT macular hole (400um), smooth edge, small, surrounding, donut-shaped cuff of subretinal fluid
  • yellow deposits at the base of the neuroretinal defect, along with perifoveal cystic changes
  • operculum may be present but vitreofoveal separation has not occurred
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24
Q

A deficiency of which vitamin can lead to prolonged dark adaptation?

A

Vit A
- active form of Vit A is retinol which is important for the formation of rhodopsin
- rods most active in situations with dim illumination

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25
Q

Less rhodopsin means?

A

fewer rods being able to respond in low levels of light
- need Vit A for formation of rhodopsin

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26
Q

Neutral density filter equation

A

OD = log(1/T)

OD = optical density
T = transmission faction of the filter

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27
Q

Which CN innervates the follow EOMs?

SR
IR
MR
SO
IO

A

LR6SO4, everything else is innervated by CN3

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28
Q

The oculomotor nerve has 2 divisions

What does the super and inferior divisions innervate?

A

Superior = SR and Levator

Inferior = IR, IO, MR

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29
Q

The equation for total transmission of light

A

multiply the percentages of all the lens materials in which light passes through

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30
Q

What is the strongest predictor for diabetic maculopathy and PDR?

A

duration of diabetes

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31
Q

What’s optimal drop volume?

A

20uL

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32
Q

Rubeola

A
  • measles
  • seen in children btw the ages 5-15
  • VERY contagious
  • fever, bloodshot eyes, sore throat, coughing, maculopapular rash on the trunk, limbs, arms, face and neck
  • koplik’s spot (white spots inside the mouth or buccal area), conjunctivitis
  • self-limiting and tx is palliative in nature
  • use ocular lubricants, vasoconstrictor drops, sunglasses
  • there’s a vaccination for this
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33
Q

Parotiditis

A

infection or swelling of the salivary glands
- often seen in pts w/ mumps
- maculopapular rash

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34
Q

maculopapular rash

A

can be seen in a variety of viruses

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35
Q

What happens if a RBC is placed in 100% distilled water?

A

swells (cell contains higher concentration of solutes)
- distilled water is hypotonic to the cell

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36
Q

What if a RBC is placed in solution that contains higher concentration than the RBC?

A

cell shrinks and becomes crenated

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37
Q

What if the RBC and solution surrounding it has equal concentration?

A

isotonic (water will not leave or enter the cell)

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38
Q

Fluorescein angiography should be performed with caution when?

A
  • Pt is taking B-blockers (in the case that the pt does have anaphylaxis, it is more difficult to manage if the pt is taking meds)
  • Anaphylaxis
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39
Q

Visuoscopy is used to evaluate __

A

eccentric fixation

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40
Q

When is stereopsis present? when does it reach adult levels?

A
  • present at 3-5 months
  • adult-like levels at 5-7 years
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41
Q

non-granulomatous intraocular inflammation?

primarily what cells are present?
most common conditions that causes this?

A

WBC and protein
Idiopathic and ankylosing spondylitis (HLA-B27)

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42
Q

Most common cause of persistent decreased VA after a BRVO?

A

chronic macular edema
- neo, pre-retinal hemes or vit hemes, TRD can also develop

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43
Q

Sherrington’s law

A

when a muscle is stimulated to contract, its antagonist is inhibited

“SHER ONE EYE”

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44
Q

What happens if you see a break while neutralizing a lens?

A

that means that the lens possess astigmatism
with break = line appears to break at the same direction of rotation
against break = should exhibit 90 degrees away from with break

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45
Q

programmed cell death

A

apoptosis

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46
Q

premature death of living cells/tissues

A

necrosis

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47
Q

autolysis

A

destruction of a cell by means of its own enzymes.
- aka self digestion

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48
Q

Phagocytosis

A
  • ex. macrophage, neutrophils, dendritic cells
  • engulfs a particle forming and internal vesicle known as a phagosome
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49
Q

Prosopagnosia

A
  • lack of ability to recognize faces
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50
Q

Which part of the brain plays a role in facial recognition

A

IT cortex

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51
Q

Achromatopsia

A

inability to identify colors

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52
Q

color agnosia

A

a type of visual agnosia in which a person has difficulty associating colors with specific objects

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53
Q

Akinetopsia

which part of the brain is damaged?

A

cannot see mvmt in VF due to MT cortex (important for processing motion stimuli)

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54
Q

What medication is used to treat bronchospasm associated with COPD

A

Salmeterol (Serevent) = long acting beta agonist

should not be used in acute attacks!

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55
Q

Which medications are used for acute asthma attacks and COPD and emphysema?

A

Albuterol (Ventolin) and Pirbuterol (Maxair)

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56
Q

which medication is used for chronic asthma?

A
  • montelukast (Singulair)
  • used in chronic asthma prevention and maintenance
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57
Q

What is the 1st and 2nd most common cause of intermediate uveitis?

A
  1. idiopathic
  2. sarcoid
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58
Q

Is lime/plaster acid or alkali

A

alkali

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59
Q

Nucleobases

A
  • pyrimidine
  • cytosine
  • thymine (DNA)
  • uracil (RNA)
  • guanine
  • adenine
  • all composed of purine or pyrimidine ring structures
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60
Q

cytidine and deoxyguanosine

A
  • nucleosides which are composed of nucleobase joined with a sugar (ribose or deoxyribose)
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61
Q

Adenosine monophosphate

A
  • nucleotide, an nucleoside linked with one or multiple phosphate
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62
Q

What is a nucleotide composed of?

A

nucelobase, sugar (ribose or deoxyribose), phosphate
- ex. ATP, NAD+, coenzyme A, cAMP

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63
Q

Short-term escape and long-term drift are usually associated with which medication?

A

timolol
- short term escape = occurs within the first few days
- long term drift = within months of initiating tx

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64
Q

oral antivirals should be initiated when after an onset of an acute HZ

A

72 hrs

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65
Q

Doses of antivirals meds?

A

Oral acyclovir: 800 mg 5x/day 7-10 days
Famciclovir: 500 mg TID
Valacyclovir: 500mg TID

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66
Q

HSV vs HZV

A

HSV = has terminal end bulbs, stain centrally, dendrites larger than zoster lesions, improves with topical antiviral

HZV = only stain w/ rose bengal, small lesions, may not improve with antiviral meds

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67
Q

overall diameter of the posterior surface of the cornea

A

11.7, spherical

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68
Q

anterior cornea vertical and horizonal measurements

A

vertical 10.6, horizontal 11.7
elliptical

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69
Q

spatial summation of the scotopic system

A

high sensitivity and poor resolution

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70
Q

Chloramphenicol side effects

A
  • binds to 50S subunit
  • chloramphenicol very lipid- soluble and easily crosses the BBB
  • bone marrow depression, aplastic anemia, gray baby syndrome, optic neuropahty, teratogenesis, and enterocolitis
  • useful for staphylococcal brain abscesses and certain types of meningitis
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71
Q

Tamoxifen

A
  • tx breast cancer
  • crystallin deposits on the plexiform and NFL around the paramacular region
  • corneal deposits, CME, grey lesions in theRPE, retinal heme, optic disc edema
  • ocular toxicity associated with high dose 120 mg daily
  • standard daily dose is 20 mg
  • should have a baseline and yearly dilated eye examination with OCT of the macula
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72
Q

What type of fungi is used to culture fungi?

A

sabouraud’s agar

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73
Q

Metformin

A
  • biguanide
  • increase insulin sensitivity, molecular target is the AMP- dependent protein kinase (AMPPK)
  • activates AMPPK to block break down of fatty acids and inhibit hepatic gluconeogenesis and glycogenolysis
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74
Q

Biguanides

A

Metformin (Glucophage, fortamet, glumetza, Riomet)

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75
Q

A cls that is rotated from its proper axis shows how much of the original power in the OR

10 degrees
15 degrees
3 degrees

A

A cls rotated 10 deg away from proper axis will result in a manifestation of astig that is 1/3 of its original power in the OR

  • 10 degree = 1/3 the original power
  • 15 degrees = 1/2 the original power
  • 30 degrees = full amt of cyl power
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76
Q

Convert logMAR to snellen

A

20 x 10^(logmar)

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77
Q

Pretibila myedema is associated with which condition?

A

graves dz and hashimotos thyroiditis
- waxy, discolored, raised plaques of non-pitting edema of the skin

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78
Q

most common type of anterior scleritis

A

diffuse scleritis

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79
Q

What medication causes bulls eye maculopathy

A

chloroquine

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80
Q

Risk for toxicity is less with ___ for hydroxychloroquine

A

<5.0 mg/kg of body weight per day

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81
Q

Risk for toxicity is less than ___ chloroquine

A

<2.3 mg/kg body weight/day

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82
Q

What other ocular testing should you do for pt taking chloroquine

A
  • color vision
  • amsler grid
  • OCT mac***
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83
Q

Where is oxytocin and vasopressin (ADH) stored? Where is it made?

A

stored in the posterior lobe of the pituitary gland, made by the hypothalamus

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84
Q

What part of the vitreous is cloquet’s canal located?

A

primary vitreous

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85
Q

FDA classifies non-silicone hydrogel soft lens into 4 groups

A

Group 1: cls posess low water content, non-ionic
Group 2: high water content non-ionic
Group 3 low water content, ionic
Group 4 high water content, ionic

lens made from ionic compound tend to attract more protein, so a person who attracts more proteins should be fit in lenses in category 1

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86
Q

RGP lens guidelines

A
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87
Q

competitive inhibitor on a lineweaver-burk plot of an enzyme

A

increase slope

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88
Q

non-competitive inhibitor on a lineweaver-burk plot of an enzyme

A

decrease slope

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89
Q

digoxin

A
  • cardiac glycoside, prescribed for hearth failure and arrhthmias
  • xanthopsia (yellow/green tint to vision)
  • blurry vision and halos around bright lights
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90
Q

What does the schirmer tear strip test for?

A

tear production, specifically the aqueous portion

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91
Q

decompression sickness aka “the bends” while diving is caused by what?

A

rapid mvmt of nitrogen from tissues into the blood stream

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92
Q

Pt with advanced glaucoma should perform which VF test?

A

10-2

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93
Q

which anti-muscarinic meds are contraindicated in narrow angle?

A
  • treat asthma and COPD
  • Ipratropium (atrovent) and tiotropium (spirvia)
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94
Q

treatment for CMV retinitis

A

ganciclovir (Cytovene) implant

  • blurred vision, floater, scotoma ine one eye, mid peripheral heme “brushfire”
  • AIDS
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95
Q

scopolamine patch

A
  • induce mydriasis and reduce accommodation making it harder to read
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96
Q

Mooren’s lightening streaks

A

brief vertical light flashes typically seen in temporal VF at night that are elicited by acceleration of the head (vitreotraction)

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97
Q

most allergic reaction to anesthetic are due to

ester group
amide group

A

ester

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98
Q

bile is important for

A

break down of fat

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99
Q

Ester vs amide anesthetics

A

amide has 2 “i” in the generic name of the drug

ester has 1 “i”

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100
Q

contrast sensitivity function of an 80 yo will shift the curve to the __

A

left

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101
Q

What topical medications can cause hypoesthesia w/ chronic use?

A

NSAID
B-blockers
anesthetics
CAIs

cls wear can also cause hypoesthesia

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102
Q

Meissner’s corpuscle

A

found more superficially and detect low-frequency vibrations

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103
Q

end bulbs of krause

A

react to temps <20 deg C

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104
Q

ruffini endings

A

respond to constant pressure and touch as well as temps above 45 deg C

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105
Q

Pacinian corpuscles

A

located deeper in the dermis and sensitive to rapid presure changes related to vibration and touch
- also found in some internal organs that lie close to freely-movable joints

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106
Q

Chlorpromazine and thioridazine s/e

A

pigmentary changes/clumping in mid-periphery and posterior pole, focal/diffuse atrophy w/ chlorpromazine of the RPE and choriocapillaris

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107
Q

chloroquine and hydroxychloroquine

A

bulls eye maculopathy, pigment in the macula,

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108
Q

Canthaxanthin

A

crystallin retinopathy

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109
Q

which condition is assocaited with a chancre (painless ulcer)

A

syphilis found on the penis or vulva

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110
Q

inverse square law - amt of lumens falling on the surface decreases with square of the distance

A

E=I/d(squared)

E= illumination falling onto the surface
I = intensity of point source
d = distance between the surface and the light source

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111
Q

whats the minimum thickness of RGP?

A

0.12mm

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112
Q

Synergism

A

response elicited by combing drugs is greater than the response of the individual drug

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113
Q

Additive effect

A

response elicited by combing drugs equal to the combined response of an individual drug

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114
Q

Potentiation

A

drug which has no principal effect enhances the effect of a 2nd drug (ex. amoxicillin w/ clavulanate)

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115
Q

Antagonism

A

A drug inhibiting the effect of another drug

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116
Q

how often do we blink?

A

12-15 times a min

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117
Q

What eye drop is used to distinguish episcleritis vs scleritis?

A

phenylephrine, neosynephrine

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118
Q

how much ganglion cell axons are lost per year?

A

5,000

but more rapid with certain ocular dz like optic neuropathy.

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119
Q

Reye’s syndrome

A

-linked with aspirin
- most destructive to the brain and liver
- always associated with previous viral infection

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120
Q

whats the equation for center thickness?

A

ct = 0.023 x cls power +0.20

as radius of curvature is thickened ct increases

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121
Q

What’s the BP for the following?

Normal
elevated
stage 1 HTN
stage 2 HTN
Hypertensive crisis

A
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122
Q

ADH

A
  • distal tubules become more permeable to water
  • stored in the posterior pituitary
  • decr amt of fluid to be excreted as urine
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123
Q

volume of the vitreous

A

4ml

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124
Q

CME affects which retinal layers?

A

INL and OPL
- break down of capillary beds causing leakage of fluid

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124
Q

what’s the peak absorbency for the scotopic system/rhodopsin

A

507nm

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125
Q

increasing water of a soft (non-silicone) hydrogel cls will cause what?

A

increase dry eye symptoms

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125
Q

increasing water for silicone hydrogel will cause what?

A

decrease oxygen permeability

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126
Q

route of depolarization of the heart

A

SA node > AV node > Bundle of HIS > purkinje fibers

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126
Q

pacemaker of the heart

A

SA node

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127
Q

PMD vs KCN

A
  • reduced BCVA w/ glasses is lost typically younger in pts with KCN compared to PMD
  • protrusion of KCN occurs centrally or inf to the visual axis
  • protrusion of PMD occurs above the area of thinning
  • CT is reduced in KCN and normal in PMD
  • fleischer’s ring, apical corneal scarring, munson sign are you usually found in mod to severe stages of KCN
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128
Q

What secretes insulin?

A

beta cells of pancreas in response to elevated glucose

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129
Q

What are the target sites for insulin?

A

liver, adipose tissue, muscle cells

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130
Q

glucokinase and glycogen

A

activated by the liver which results in increase in uptake of glucose and synthesis of glycogen

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131
Q

what breaks down glycogen?

A

glycogen phosphorylase

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132
Q

lipoprotein

A

activated in adipose tissue to increase synthesis of triglycerides

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133
Q

which antibody can cross the placenta?

A

IgG

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134
Q

What antibody is first to respond during an immune response?

A

IgM

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135
Q

What is the basic unit used to measure retinal illumination?

A

trolands

T=LA

T = troland
L = luminance of the viewed surface
A = area of the pupil

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136
Q

what’s the unit for illuminance?

A

lux

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137
Q

whats the unit for luminous power?

A

lumens

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138
Q

what unit is used to quantify luminance?

A

foot-lamberts

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139
Q

Dalen-fuchs nodules are associated with which condition?

A

vogt koyanagi- Harada syndrome

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140
Q

loop diuretic

A

furosemide
- inhibit electrolyte reabsorption at the loop of henle

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141
Q

hydrochlorothiazide

A
  • thiazide diuretic
  • inhibit Na+ and cl- reabsorption in the distal renal tubule
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142
Q

spironolactone

A

K+ sparing diuretic
- inhibit Na+ excretion while sparing K

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143
Q

acetazolamide

A
  • CAI
  • inhibits CAI
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144
Q

mannitol

A

osmotic diuretic
inhibits Na+ and water reabsorption

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145
Q

what’s the minimum thickness for residual corneal bed?

A

250um

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146
Q

hypothyroidism

A
  • elevated levels of THS, low T4
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147
Q

what do these marking mean on a frame?

Z87-2
+
V
S

A

Z87-2 = successfully met the requirements for high-impact and high mass velocity
+ = passed high impact test
V = safety lens is photochromic
S = special purpose (ex. didymium lens worn by glass-blowers)

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148
Q

during saccadic mvmts why does the background not appear blurred as its moves across the retina?

A

selective suppression of the magno pathway

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149
Q

magno pathway

A

where pathway
- responds to quickly moving objects and high temporal frequencies = both occur in the background during a saccade

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150
Q

Ependymal cells

A

found lining cavities of the CNS as well as walls of the ventricle in the brain
- these cells form the epithelium of the choroida plexus which secretes cerebrospinal fluid

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151
Q

oligodendrocytes

A

non-neuronal cells of CNS and serve to coat axons in myelin sheath, which greatly increases the speed of conduction

wraps alot of axons at the same time

schwann cells insulate one to one cellular axons of the PNS

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152
Q

Astrocytes

A
  • most numerous and offer support and structure to the brain
  • play large role in formation of BBB, inhibits toxic substances from entering the brain
  • play an important role in removing NT from synaptic zone and removing excessive extracellular potassium
153
Q

microglia

A
  • type of macrophage that is capable of phagocytosis
154
Q

Humans can distinguish discrepancy in the alignment of dots at what amt?

A

3-5 sec of arc

155
Q

crystalline lens

A
  • proteins arranged in anti-parallel beta sheets
  • high water soluble protein
  • crystallin is important for maintaining clairty
  • oxidative damage causes formation of disulfide bonds bet methionine groups and cysteine side chains (both aa contain sulfur)
  • glutathione is a powerful reductant produced by the body - protects from damage by free radicals and breaks disulfide bonds
156
Q

Where does SO originate?

A

lesser wing, innervated by trochlear nerve

157
Q

Propamidine (Brolene)

A
  • mixed with neomycin
  • antiprotozoal drug
  • used for acanthamoeba
158
Q

Natacyn

A
  • used to tx candida and aspergillus infections
159
Q

Nizoral

A

found in antidandruff shampoos and antifungal drugs to prevent fungal and skin infections esp for immunocompromised pt such as those with AIDS or undergoing chemo

160
Q

Diflucan

A

tx fungal infections such as those caused by yeast
- also used to tx meningitis caused by fungi

161
Q

best method for measuring VA for amblyopic pt

A

bailey lovie

162
Q

basic amino acid contains

A

amine group
carboxylic acid group
alpha carbon

163
Q

central oil droplet opacities are a type of congenital cataract associated with what condition?

A

galactosemia

164
Q

christmas tree cataracts are associated with which condition?

A

myotonic dystrophy

165
Q

sunflower cataracts are associated with which condition?

A

wilson’s dz

166
Q

lax criterion will present with __ sensitivity and ___ threshold

A

high sensitivity and low threshold

167
Q

lax criterion

A

will report seeing a stimulus but unsure if they actually saw it

168
Q

a strict criterion will show __ threshold and ___ sensitivity

A

high threshold and low sensitivity

169
Q

strict criterion

A

will not respond seeing a stimulus unless they are sure they can see it

170
Q

SMILE

A
  • small incision lenticule extraction
  • no excimer use like PRK or LASIK
  • uses femtosecond laser to cut small incision to the cornea through which a small piece of corneal tissue is removed (called a lenticule)
171
Q

periochoroidal space

A

space between the lamina fusca of the sclera and the choroid which is continuous with the space between the choroid and CB

172
Q

acquired macular disease tend to produce what color defiency?

A

blue-yellow

173
Q

optic nerve dz tend to produce which color deficiency?

174
Q

MOA of rock inhibitor or rho-kinase

A

increase aqueous outflow through the TM

175
Q

which plaque composition will cause the great risk for CRAO or BRAO?

A

calcific
- these plaques occur 2’ to heart valves causing them to become brittle and break off
- very hard and do not change in shape or size causing ischemia

176
Q

Hollenhorst plaque

A
  • cholesterol and commonly disolve
  • refractile, appear larger than the vessel
  • commonly lodge at transiently at vessel bifurcations
177
Q

fibrinoplately plaques

A
  • composed of aggregations of fibrin and platelets
  • fibrinoplatelet plaques may dissolve on their one
178
Q

Talc emboli

A
  • seen in pts who inject drugs IV
  • may cause CRAO but do not pose great threat for an occlusion when compared to other plaque compositions
179
Q

Walled eye bilateral internuclear opthalmoplegia (WEBINO)

A

occurs due to a lesion involving the paired MR subnuclei of the third nerve

180
Q

Benedikt syndrome

A
  • involves the fasciculus as the fibers pass through the red nucleus
  • lesion in the tegmentum of midbrain and cerebellum or occulsion of cerebral artery
  • caused by infarction, heme, tumor, TB
  • pt will develop ipsilateral third nerve palsy w/ contralateral extrapyramidal signs (such as hemitremor)
181
Q

Weber syndrome

A

involves fascicular fibers as they pass through the cerebral peduncle
- lesion of the posterior cerebral artery
- signs include ipsilateral third nerve palsy with contralateral hemiparesis

182
Q

Nothnagel syndrome

A
  • involves superior peduncle and fasciculus
  • characterized by ipsilateral third nerve palsy as well as cerebellar ataxia
183
Q

Claude syndrome

A

combo of both benedik and nothnagel

184
Q

argyll robertson pupil

A

can accommodate but doesn’t respond to light

185
Q

Which conditions are associated with ipsilateral third nerve palsy?

A

Weber, Claude, Benedikt, Nothnagel

Webers the worst one!!
Benedikt = tremor ( lesion in the red nucleus)
Nothnagel = ataxia ( lesion in the sup cerebellar)
Weber = hemiplegia (corticospinal tract)
Claude = benedikt & nothnagel (RN and sup cerebellar lesion)

186
Q

WEBINO

A
  • wall eyed or exotropic bilateral internuclear ophthalmoplegia (EBINO)
  • Unilateral (lateral lesion) or Bilateral (MLF lesion)
  • Internuclear CN 6 - 3 (MLF communicates between 6 & 3)
  • ophthalmoplegia (paralysis/weakness of the eye muscles
  • LESION OF THE 6th nerve nucleus, MLF
  • in a young person think about demyelinating dz
  • in a older person could be stroke esp if its unilateral
  • PSUEDO INO is most likely caused by myasthenia gravis

Ex. eyes will look straight in primary gaze, but if the pt looks left
- right eye will have weak adduction or slower (adduction lag)
- left eye will have dissociated horizontal abducting nystagmus (nystagmus prominent towards left side)
- MLF can cause bilateral lesion, or bilateral from a medial lesion
- lateral lesion = unilateral

DO MRI ON THE MLF

187
Q

mvmt of sodium and K+ ions during one cycle of Na+/K+ ATPase pump

A

3 Na out
2 K+ in

188
Q

Systolic BP primarily results from contraction of which part of the heart?

A

ventricle
- measures greatest amt of pressure on blood vessel walls

189
Q

Diastole results from a contraction of which part of the heart?

A

heart relaxes and blood flows out of the aorta
- measures lowest amt of pressure on blood vessel walls

190
Q

major proteins found in the tears

A

albumin
lysozymes (bacteriostatic), lactoferrin, IgA (destroy bacteria), IgG, sceretory component, glycoproteins (proper mucous function), antiporteinases (inhibit hydrolytic enzyme produced by bacteria), tissue plasminogen activator (active plasmin needed for wound healing), epidermal growth factor (wound healing)

191
Q

Reis-bucklery dystrophy

A

dystrophy of bowmans layer and epithelial BM, replaced with fibrous tissue

192
Q

map dot dystrophy/EBMD

A

thickening of BM and absence of hemidesmosomes of basal epithelial cells

193
Q

Meesmans dystrophy

A

intraepithelia cyst

194
Q

Macular dystrophy

A

abnormal aggregations of glycosaminoglycans and unusually close packing of collagen fibrils in the corneal lamellae

195
Q

Granular dystrophy

A

abnormal hyaline dystrophy

196
Q

Avellino dystrophy

A

abnormal depositon of both amyloid and hyaline

197
Q

Gap junctions

A

open channels - allow quick transfer of ion or small molecules

found in heart or within the body where swift coordination is essential

198
Q

Maculae adherens and zonula adherens

A

weld cells together prevent stretching

zonulae adherens form bands or collars that encircle cells

199
Q

lipoproteins

A

transport lipids

Ex. chylomicrons are the largest lipoproteins and are used to transport dietary triglycerides from intestine to target tissues (addipose or liver)

200
Q

VLDL

A

shuttle lipids (mostly triglycerides) from the liver to other tissues

201
Q

LDL

A

moves cholesterol to various cells

202
Q

HDL

A

smallest and contain the most amt of protein
- transport cholesterom from peripheral tissues to liver to be broke down and excreted in bile
- Good cholesterol

203
Q

ER

A

main site for lipid synthesis

204
Q

Classification of ectropion

involutional
Paralytic
mechanical
Cicatricial
Congenital

A

involution = aging mostly over age 60

Paralytic = inability of a pralytic orbicularis
muscle to oppose the force of gravity

mechanical = large lesion

congenital = birth

205
Q

Describe this photo

A

Dark adaptation curve
- 1st 5 mins = cone regeneration (takes 10 mins)
- 10 mins = rod/cone break
- 2nd dip = rod regeneration (takes 35 mins for regeneration)

206
Q

Define True Postives

A

Pts test POSITIVE and has the dz

207
Q

Define true negative

A

Pts test NEGATIVE and does NOT have the dz

208
Q

False positives

A

Pt who test positive but does NOT have the dz

209
Q

False negative

A

Pt who test negative but DOES have the dz

210
Q

What age is the following considered well developed?

Visual fixation:
Blink response to visual threat:
Accommodation:
Stereopsis:
VA at adult level:
VA at adult level:
Snellen acuity at adult level:

A

Visual fixation: birth
Blink response to visual threat: 2-5 months
Accommodation: 4 months
Stereopsis: 6 months
VA at adult level (VEP): 6-12 months
VA at adult level (via preferential looking): 3 years
Snellen acuity at adult level: 2-5 years

211
Q

ACID

A

Hypersensitivity reaction
A - Allergic
C - cell mediated
I - immune complex deposition
D - delayed

212
Q

What is IgE bound to

A

mast cells and basophils

213
Q

What are some ex of type 1 hypersensitivity

A

anaphylaxis, angioedema, bronchospasm, urticaria, allergic conjunctivitis

214
Q

What are some ex of type 2 hypersensitivity?

A

destruction of RBCs in hemolytic anemia, thrombocytopenia, neutropenia, ocular cicatricial pemphigoid, wegener’s granulomatosis

215
Q

Type 2 hypersensitivity

A

antigen or hapten closely associated with a cell binds to antibody, leading to cell or tissue injury

216
Q

Type 3 hypersensitivity

A

Damage caused by deposition of antigen-antibody complexes in vessels or tissue. this deposition also causes complement activation and/or recruitment of neutrophils

217
Q

What are ex of type 3 sensitivity?

A

serum sickness, SLE, SJS

218
Q

Type 4 hypersensitivity

A

antigen exposure activates T cells, which then mediate tissue injury

219
Q

Ex. of type 4

A

contact dermatitis, TB, transplant rejection

220
Q

What’s the avg thickness of the sclera posterior to the insertion of the recti muscle

221
Q

What’s the average thickness of the thickest portion of the sclera

222
Q

What does this image show (green bracket)

A

recovery of light sensitivity of the cone

223
Q

Which of the following recovers “sensitivity” faster?

cones
rods

224
Q

slab off

225
Q

Reverse slab off

226
Q

Dissimilar segments

A

bifocal in the more plus lens to provide BD prism

227
Q

Brown syndrome

A

V pattern “Victor Brown”
- reduced elevation in the ADDuction of the involved eye
- widening of palpebral fissure on adduction
- restricted elevation on adduction with forced duction test

228
Q

Furosemide MOA

A

loop diuretic inhibits NACl reabsorption at the ascending loop of henle
- also increases calcium excretion

229
Q

Baileys Rule

A
  • will tell you at what distance the pt has to hold things

F = 1/Equivalent viewing distance

230
Q

an aneurysm greater than __ is concerning

231
Q

When does microvascular mononeuropathy of CN 3,4,6 resolve by?

232
Q

Which part of the eye mainly absorbs UVC?

A

Cornea
- excessive absorption can cause solar keratitis

233
Q

UVA and UVB are primarily absorbed by which part of the eye?

234
Q

which drops can aid in dx of horner’s syndome

A

cocaine and apraclonidine
- cocaine blocks the reuptake of NE (normal eye dilates)
- apraclonidine effect on alpha 2 receptor > alpha 1, constricts the normal eye

235
Q

If Anisocoria is greater in the dark, what are you suspecting?

A
  • Horner’s syndrome
236
Q

If anisocoria is greater in the light, what are you suspecting?

A

Adies tonic pupil
Third nerve palsy
Traumatic Iris damage
Pharmacological pupil dilation

237
Q

What drops are you using to check if it’s a pre or postganglionic horner’s syndrome? What are you expecting after using the drops?

A

1% hydroxamphetamine

Dilation w/ drops = Preganglionic
“PREDIL”
NO dilation = Postganglionic “POST NOD”

238
Q

What drops are you using to dx adies tonic pupil

A

0.125% pilo = CONSTRICTION = ADIES

** check for traumatic iris damage, may cause sluggish constriction**

239
Q

What if you see an anisocoria w/ no pupil constriction w/ 0.125% w/ pilo?

A
  • pharmacologic anisocoria
  • Third nerve palsy
240
Q

blurry vision due to a miotic is caused by which optical principle?

A

diffraction - similar to pinhole

241
Q

How does pilocarpine lower IOP?

A

stimulating contraction by longitudinal muscle of the CB which opens the TM via increased tension of the scleral spur

242
Q

What are the side effects of pilocarpine?

A

brow ache
induced myopia
increased risk of retinal tears and detachments, and epiphora

243
Q

Deuteranopia, tritanopia, and protanopia

A
  • stationary/non-progressive
  • normal VA
  • color deficient NOT color weak (deuteranmalous)
244
Q

What’s the most common type of congenital color deficiency?

A

Deuteranomalous - 5% of male population
- X-linked recessive pattern
- affect R/G hue discrimination
- can distinguish pure red from pure green (they are only “color weak”

245
Q

Whats the primary pathway for energy production of the lens?

A

anaerobic glycolysis

246
Q

monofixation syndrome

A
  • children who have their esotropia corrected - most common fusion state is monofixation syndrome
247
Q

Bailey-Lovie chart

A

log progression chart with equal letters and spacing on each line. each row is of equal difficulty

248
Q

sloan chart

A

progression chart that has 10 letters of equal legibility

249
Q

Lighthouse Distance VA

A

low vision pts
- modified ETDRS chart
- spaing btw letters and line gemoetrically consistent
- 5 letters for each line
- most commonly used at 10 ft

250
Q

Feinbloom

A

14x12 booklet of numbers that goes in small steps (beneficial for low vision pt
- one problem is that numbers differ in size substantially

251
Q

what axis is the polarizing filter placed? ** KNOW THIS**

A

90 degree/vertical to block horizontal glare

252
Q

Which drugs can increase IOP?

A

LSD
Ketamine

253
Q

Pulfrich phenomenon

A

illusion of an object moving perpendicular to a person’s line of isght is actually moving toward them or away from them
- described in pts following a bout of optic neuritis
- swinging pendulum describes this phenomenon
- reduction in retinal illumination results in corresponding delay in signal transmission
- Ex. ND filter is placed over OD, pendulum appears swinging closer to OD (w/ filter) and swing away from left (unfiltered eye. This looks like the pendulum is swinging counterclockwise

254
Q

What’s an example of “motion-after effect” phenomenon

A

waterfall illusion
- involves staring at the waterfall then shift gaze to a stationary object, stationary object will float upwards a bit
- neurons responsible for downward mvmt becomes less sensitive after chronic stimulation of the downward waterfall. thus causing an upwarward mvmt on the stationary object

255
Q

How long should a pt wait for YAG capsulotomy after a cataract sx? why?

A

3-6 months, decrease risk of PVD/RD

256
Q

Mitosis are divided into what 5 phases in order

A

Prophase - nucleolus and nuclear membrane disentegrate, centrioles/asters are at opposite poles

metaphase - centromeres attached to spindle fibers and lined up at the equator

anaphase - chromosomes move to opposite poles, cell membrane pinches in the center

telophase - cell membrane completes constriction, nuclear membranes form around separated chromosomes

cytokinesis - mitosis completed, cytoplasm of parental cell into 2 daughter cells

257
Q

What ocular dz are associated with corectopia?

A

colobomas, sector iris hypoplasia, ICE syndrome, axenfeld- Rieger syndrome and ectopia lentis

258
Q

What is the pathway for AH outflow?

A

uveal > corneaoscleral > JXT > schlemm’s > internal collector channel > external collector channels (main route for AH from schlemm’s canal into the episcleral veins

259
Q

Testing for syphilis

A
  • RPR, FTA-ABS (confirmatory)
  • VDRL (screening)

other test: darkfield microscopy, MHA-TP, TP-PA, TP-EIA,

260
Q

Myotonic dystrophy

A
  • muscle atrophy and wasting
  • difficulty releasing their grip from door handle
  • cardiac conduction defects
  • early balding and infertility in men
261
Q

gray line is also known as

A

muscle of riolan

“roll, tide, divide”

262
Q

axons from contralateral ON synapse in which layers of the LGN?

263
Q

axons from ipsilateral ON synapse in which layer of the LGN?

264
Q

What can cause SJS

A
  • sloughing & necrosis of epidermis
  • sulfonamides&raquo_space; penicillins > cephalosporins
  • antipsychotics and anti-epileptics (dilantin
  • antigoute meds
  • analegesics (piroxicam)
265
Q

What can penetrate intact corneal epithelium

A

CHANLS
- Corynebacterium
- Haemophilus Aegyptus
- Neisseria
- Listeria
- Shigella

266
Q

HLA-B51 is associated with which condition?

267
Q

*** ALMOST ALL structures of the eyeball are derived from which cells?

A

neural crest cells

Almost all structures of the eyeball are derived from neural crest cells except 10 structures. 5 from neuroectoderm and 5 from surface ectoderm

remember melanocytes

268
Q

Which 5 structures of the eye are from neuroectoderm

A

SOREE

SM of the iris: sphincter and dilator pupillae
Optic nerve
Retina
Epithelium of CB
Epithelium of iris

269
Q

Which 5 structures of the eye derived from surface ectoderm

A

LEEEG

epithelium of the cornea
epithelium of the skin of the eyelid
epithelium of the conj
lens
glands of eyelid, lacrimal gland

270
Q

What gives rise to the optic stalk?

A

Diencephalon

271
Q

What gives rise to EOMS?

A

mesoderm ( gives rise to muscles of the eye)

other ex include skeletal muscles of the eyelid, orbicularis oculi, and levator

272
Q

What are the 3 germinal layers? Which one does not contribute to ocular development?

A

Endoderm, ectoderm, mesoderm

Endoderm does not contribute to ocular development

273
Q

What does the ectoderm and mesoderm form?

A

Ectoderm = surface ectoderm, neuroectoderm, neural crest cells

mesoderm = mesencyme

they all contribute to ocular development

274
Q

Where does the blastoocyst implant?

A

endometrium

zygote > morula > blastocyst > embryo > fetus

275
Q

What is the equation for illuminance?

A

Illuminance = candle power of source/light source to surface distance^2

276
Q

What happens during contraction of the ventricles

A

mitral and triscupid close, atria relax, semilunar valves open

277
Q

Duane syndrome

A

Type 1: abnormal abduction (most common)
Type 2: abnromal adduction
Type 3: abnormal adduction and abduction

often bilateral

278
Q

Goldman 3 mirror

A

central lens = Hruby lens, 64D for viewing the posterior pole

bullet shaped mirror = examination of anterior structures (ora serrata), 59 deg

Square shaped mirror = anterior retina to equator (67 degrees)

trapezoidal mirror = equator to macula (73 degrees.)

279
Q

PR release __ in the dark

A

glutamate = inhibitory, (depolarization)

280
Q

PR ____ in the dark and ___ in the light

A

depolarize in the dark and hyperpolarize in the light

produce graded potential

281
Q

What would a dark adaptation curve look like for a pt with RP?

A

the rod section of the curve shows a prolonged regeneration time. The rod portion of the curve will also display its plateau at a higher-than-normal threshold

282
Q

Examples of monosaccharides

A

simplest form of sugar and building blocks of more complex carbohydrates such at starch and cellulose

  • ex. glucose, galactose, ribose, fructose
283
Q

pial blood vessels

A

blood vessels of the pia mater, supplies the parasympathetic pupillary fibers and surface of the oculomotor nerve

  • aneurysms, trauma, uncal herniation can affect the blood supply of the pupil
284
Q

vasa nervorum

A

supplies the internal fibers of the pupillary fibers and oculomotor nerve

ex. HTN, diabetes = SPARES the pupil

285
Q

Neural tube defects

A

affect brain and spinal chord (ex. spina bifida and anencephaly)

286
Q

lens placode

A

precursor to lens

287
Q

incomplete closure of the optic fissure

A

alters the development of the optic cup can lead to coloboma of the retina, CB, or iris

288
Q

label the structures

289
Q

Where does aneurysm occur on the circle of willis?

A

pupil sparing aneurysms occurs between PCA and ICA

290
Q

Magnocellular

A
  • Massive, large diameter axons
  • motion vision
  • largest perceptive field
  • rare in the fovea but numerous in the periphery
  • sensitive to light in scotopic condtions
291
Q

Parvocellular

A
  • petite, small diameter axon
  • small perceptive fields
  • more concentrated in the macula
  • 80% for all RGCs
  • responsible for color and fine detail vision
292
Q

Koniocellular

A

blue-yellow color and are preferentially activated by SWAP

293
Q

At what gestation week do eyelids begin to fuse?

294
Q

What’s the unit of radiant power? Whats the unit for luminous power?

A

Radiant power = Watts
Luminous power = lumens

Radiant power is the physical energy per second produced by a light source

295
Q

Photometry

A

how our visual system responds to electromagnetic radiation

296
Q

What are the 3 layers of the sclera?

A

episclera
stroma
lamina fusca (choroid binds here)

297
Q

What’s the predominant collagen for the following?

Basement membranes
lens
bowmans
stroma
sclera
vitreous
stromal wound healing

A

Type 4 = Basement membrane, lens

Type 1 = bowmans bones stroma sclera

Type 2 = vitreous

type 3 = stromal wound healing

298
Q

Willebrand’s knee

A
  • lesion causes a junctional scotoma
299
Q

Classic ocular signs of VKC

A
  • GPC
  • shield ulcer
  • Horner- trantas dots
300
Q

NF-1

A
  • lisch nodules on iris
  • cafe-au-lait spots (hypopigmented macules on skin)
  • mutation on genetic locus on chromosome 17
  • optic nerve glioma
301
Q

NF 2

A

AD
- mutation on chromosome 22
- bilateral vestibular schwannomas

302
Q

Spherical order aberration

A

occurs when peripherally refracted light rays are focused in front of the retina and central rays are focused on the retina
- 4th order aberration
- causes halos around point light sources, causes night myopia, and decreased CS
- most visually significant higher order aberration

303
Q

What are example of third order aberrations?

A

coma and trefoil

Coma
- coma sees a pt of light that resembles a comet (ex. w/ its tail)
- due to the eye at one edge of the pupil being focused more strongly than light rays entering the eye at the opposite edge of the pupil
- increase commonly occurs w/ decentered ablations, decentered corneal grafts, and keratoconus

Trefoil
- less visually significant compared to coma

304
Q

Ex of lower order aberration

A

myopia, hyperopia, regular astig

myopia (positive defocus)
hyperopia (negative defocus)

305
Q

Ex. of 4th order aberration

A

spherical aberration, secondary astigmatisms, tetrafoil

306
Q

which glaucoma drops utilizes corneal estrase activation of topically applied ester prodrugs

A

latanoprost and travoprost

307
Q

What’s the difference between schirmer 1 and 2 test?

A

Schirmer 1
- does not use anesthetic
- measure basal and reflex tearing

Schirmer 2 test uses anesthetic and measures only basal reflex tearing

308
Q

A normal baby begins making eye contact and react with facial expressions at what age?

309
Q

when should infants be interested in lights?

A

2-3 months

310
Q

cilioretinal artery is a branch from what?

A

posterior ciliary artery

311
Q

ganglion cells exit the globe behind the lamina cribosa and is myelinated with what?

A

oligodendrocytes

312
Q

Test of visual perception (TVPS; Gardner)

A

consist of 7 subtests
1. visual discrimination
2. visual memory
3. visual-spatial relationships
4. visual form constancy
5. sequential memory
6. Visual figure ground
7. visual closure

given to ages 4-18 (school ages)

313
Q

Congenital nystgamus

A

CONGENITAL

Convergence and eye closure dampen nystagmus
Oscillopsia is usually absent
Null zone present
Gaze position does not change the direction of nystagmus
Equal amplitude and frequency of nystagmus in each eye
Near acuity is good b/c convergence dampens the nystgamus
Inversion of optokinetic nystagmus occurs
Turning the head or abnormal head posture allows eyes to enter a null zone leads to better VA
Absent nystagmus during sleep
Latent nystagmus occurs

314
Q

Rod monochromatism inheritance pattern

A

AR

  • lacks cones
  • everything is seen as shades of gray
  • abnormal cone ERG
315
Q

Blue-cone monochromatism inheritance pattern

A

X-linked

  • has only S cones (blue) cones NOT L and M cones (red and green)
316
Q

Stereopsis reaches adult levels at what age?

317
Q

Which of the following screens for R/G color deficiency and which one screens for B/Y color deficiency

  1. Ishihara pseudoisochromatic plates
  2. Hardy Rand Rittler (HRR) plates
  3. Farnsworth Panel D-15
  4. Farnsworth-Munsell 100 hue test
A

Ishihara = R/G

HRR, Farnsworth panel/munsell 100-hue = B/Y AND R/G

319
Q

A lesion to the MLF is called?

A

internuclear ophthalmoplegia (INO) = slowed adducting saccadic velocity in one eye

common cause is MS

320
Q

MLF

A

connects 6th nerve nucleus on one side of the pons with medial rectus subnucleus of CN III on the contralateral side of the midbrain

MLF is involved in horizontal gaze allowing abduction of one eye to be coordinated with adduction of contralateral eye

321
Q

Where is the MLF lesion if the right eye does not adduct

A

right eye

lesion is ipsilateral to the eye that does NOT adduct

322
Q

What’s the 5 layers of bruch’s membrane

A

Basal lamina of RPE
inner collagenous layer
elastic layer
outer collagenous layer
Basal lamina of the inner choriocapillaris layer

323
Q

What is retinol important for?

A

formation of rhodopsin

324
Q

What’s located in the following layers?

OPL
NFL
INL
ELM

A

OPL = rods and cones synapse onto horizontal and bipolar cells

NFL = ganglion cell axons

INL = HBAM = Horizontal, bipolar, amacrine, mueller

ELM = inner segments of PR and their respective nuclei

325
Q

Describe the wave

A

P = atrial depolarization

QRS = ventricular depolarization

T = ventricular repolarization

** atrial repolarization occurs at the same time as QRS waves **

326
Q

What does DEM (Developmental eye motility) test for? What would the results look like for the following

Oculomotor dysfunction
Automaticity
Oculomotor dysfunction and automaticity

A

Test for eye movements and how pt process visual info and verbal task

Oculomotor dysfunction = abnormal horizontal, normal vertical
Automaticity = Abnormal vertical and horizontal
Oculomotor dysfunction and automaticity = increased vertical and even more increased time for horizontal

normal ratio but abnormal test = automaticity
abnormal ratio = both automaticity and oculomotor dysfunction

327
Q

size of the foveola

A

1DD = 1.5mm = 0.50mm = 500um

328
Q

monocular depth cues

A

Pictorial depth cues
- size
- linear perspective
- texture
- interposition
- clarity
- light/shadows

  • motion parallax
329
Q

Hirschberg test

A

shine a penlight directly at the pt and observe the corneal light reflexes of both eyes

1mm decentration = 22mm

330
Q

Hydroxamphetamine MOA

A

NE release from presynaptic vesicles of the post-ganglionic nerve terminal (3rd order neuron)

used to localize damage in horner’s (forces NE release on third order neuron)

dilates = 1st or 2nd horner’s syndrome
does NOT dilate = 3rd order

331
Q

Primary secondary and tertiary action of EOM muscles

332
Q

Avg depth of the AC

333
Q

What would you use to assess VA on a

1 year old infant
6 year old child
3 year old child

A

0-2: preferential looking, VEP

2-5 Allen cards, HOTV cards

5 yo = snellen

334
Q

Original AREDS formulation vs the new formulation of AREDS

A

C,E, beta carotene, zinc oxide, and cupric oxide

25% reduction of risk for progression to advanced AMD over 5 years

beta carotene in heavy smokers can cause higher risk of lung cancer

AREDS 2: C,E, addition of lutein/zeaxanthin, removal of betacarotene, reduction of zinc

335
Q

When does stereopsis first begin to develop? When does it reaches adult stage?

A

begins 3 months, reach adult levels at 6 months

336
Q

pinhole causes what type of aberration?

A

diffraction

337
Q

Know this - visual development

338
Q

Superior optic radiations

A

Superior optic radiations = MEDIAL LGN = superior retina = inferior VF
- superior optic radiations pass posteriorly by the parietal lobe of the brain
- parietal lobe lesion = inferior VF defect = left homonymous inferior quadrantanopia

Inferior optic radiation = LATERAL LGN fibers = inferior retina = superior VF
- course to temporal lobe

PITS
Parietal = inferior VF
Temporal = superior VF

339
Q

Brimonidine SE

A

dry mouth and follicular conjunctivitis (most common SE overall)

340
Q

Where does the lens zonule originate? what are lens zonules mainly composed of?

A

basal laminae of NPE of pars plana and pars plicata, mainly composed of fibrillin

Marfans can cause a defect fibrillin formation = ectopia lentis = superotemporal lens dislocation

341
Q

What systemic conditions are associated with ectopia lentis?

A

Marfans
homocystinuria

342
Q

What is the iris derived from?

A

neuroectoderm (epithelium of iris) and neural crest (NCC)

343
Q

What are the 5 layers of the iris?

A

ABL
stroma
muscular layer
anterior pigment epithelium
posterior pigment epithelium

344
Q

marcus-jaw winking

A

eyelid rises up and down while chewing

involves abnormal connection between CN 3 and V

345
Q

Which of the following passes through CTR?

A. superior ophthalmic vein
B. Trochlear nerve
C. Nasociliary nerve
D. Lacrimal nerve

A

C. Nasociliary nerve

346
Q

simultaneous contrast

A

perceived brightness of a stimulus depends on its surrounding background

(ex. light appears brighter against a dark background)

347
Q

Paracontrast

A
  • forward masking, mask and target are spatially next to each other
348
Q

metacontrast

A
  • backward masking
349
Q

simultaneous contrast

A

presence of one stimulus prevents you from perceiving a second simultaneous stimulus

350
Q

Wilson dz copper deposit occurs on which layer?

351
Q

What is this an image of?

A

Mach bands
- our visual system is insensitive to low spatial frequency stimuli
- phenomena is thought to be due to our visual system performing “fourier analysis” of visual stimuli
- our visual system is more sensitive to high spatial frequency stimuli (abrupt position btw 2 of these rectangles)
- lateral inhibition between neurons in the retina

352
Q

ex. of 3rd and 4th order aberration

A

3rd = coma and trefoil
4th = secondary astig and 4th order aberration

353
Q

what wavelength is rhodopsin most sensitive to?

A

507nm (green light)

353
Q

Label the image

353
Q

side effects of CAI

A

sulfa allergy, aplastic anemia, hypokalemia, bitter taste, paresthesias, and diuresis

alternative is methazholamide = contains sulfa but does not have the ring moiety

354
Q

lens zonules attach where?

A

pars plicata

355
Q

What muscles make up the annulus of zinn

A

SR, MR, IR, LR

356
Q

Carotid cavernous fistula (CCF)

A
  • abnormal connection between the carotid arterial system and the cavernous sinus
  • HBP, proptosis, chemosis, venous loops in sclera (cork screw vessels), increased IOP (from increased episcleral venous pressure), engorgement of EOM, CN palsies (3,4,6,V1,V2) that pass within the cav sinus, swooshing sound
357
Q

Developmental landmarks

walking
fixation on face, smiles at face
localizes sound, control head, distinguish between familiar and strangers
sit without support/protests separation from mother
stands, can say one or 2 words

A

walking 12 months
fixation on face, smiles at face 2-3 months
localizes sound, control head, distinguish between familiar and strangers 4-6 months
sit without support/protests separation from mother 7-9 months
stands, can say one or 2 words 12 months

358
Q

Blood supply to these different parts of the ON

NFL
prelaminar layer
laminar layer
retrolaminar layer

A

NFL = CRA, cilioretinal artery
prelaminar layer = SPCA, branches of zinn-haller
laminar layer = SPCA
retrolaminar layer = pial vessels SCPA, CRA

359
Q

Thickness of each corneal layer?

Epithelium
Bowmans
Stroma
Descemet’s membrane
Endothelium

A

Epithelium 50
Bowmans 8-14
Stroma 500
Descemet’s membrane 10-12
Endothelium 5

360
Q

Congenital glaucoma triad

A

photophobia, tearing, blepharospasm

CYP1B1 gene

361
Q

Amplitude of accommodation hofstetter’s formula

A

18.5 - (0.3)age

362
Q

W4D ***

2 red dots (top and bottom)
3 green dots (left, bottom, right dots)
4 dots
switching btw 3 and 4 dots
5 dots (2 red and 3 green)

A

red filter over OD

2 red dots (top and bottom) = left eye suppression
3 green dots (left, bottom, right dots) = right eye suppression
4 dots = 2 degree fusion
switching btw 3 and 4 dots = alternating supression
5 dots (2 red and 3 green) = diplopia

363
Q

What innervates the iris sphincter muscles vs dilator muscles?

A

Iris sphincter is under parasympathetic control via SPCN which arise from the CG

Sympathetic fibers also pass through the CG, but do not synapse there and ultimately end up innervating the iris dilator muscle via LPCN

364
Q

Define hypertelorism

A

increase the distance between the medial orbital walls

365
Q

The primary visual cortex has dual blood supply

A

PCA and MCA (macula of contralateral VF)

macula sparing = stroke

knock out both PCA and MCA = tumor

366
Q

Most common cause of unilateral AND bilateral proptosis

367
Q

TED

A
  • most common cause of unilateral and bilateral proptosis
  • eyelid retraction, diplopia dry eyes, inferior scleral show, SLK, compressive optic neuropathy
  • IMSLO (IR most commonly involved
  • EOM tendons are spared (unlike idiopathic orbital inflammation)
368
Q

EOM tendons are spared in which condtion

A

TED NOT idiopathic orbital inflammation

369
Q

Chronic corticoid steroid use

A
  • moon face/buffalo hump (cushingoid appearance)
  • weight gain
  • Diabetes
  • impaired immune system
  • PSC
  • ischemic heart disease and heart failure (lowers HDL, raise LDL)
  • Gastritis
  • Fluid retention
  • Menstrual irregularities
  • Osteoporosis
370
Q

Venous drainage

A

choroid > choroidal veins > SOV > cav sinus

371
Q

size of foveola

372
Q

What structures pass through superior to the annulus of zinn

A

LFTs

Lacrimal nerve
Frontal nerve
Trochlear nerve
SOV

373
Q

What structures pass within the annulus of zinn?

A

3N3 is 6 + CGs

  • superior and inferior CN3
  • Nasociliary branch of V1
  • sympathetic roots of CG
  • CN 6
374
Q

What passes inferior to the annulus of zinn

A

inferior ophthalmic vein

375
Q

Neural crest cells 1st, 2nd, and 3rd wave

A

1st = corneal endothelium

2nd= corneal stroma and sclera

3rd = iris and pupillary membane

376
Q

What does the TM develop from?

377
Q

Brown syndrome

A
  • deficient elevation in adduction (cant look up when they adduct)
  • (+) forced duction test
  • most cases are congenital
  • V-pattern since SO causes ABduction
  • in severe cases pt would turn face AWAY from affected eye to reduce amt of dperession of the involved eye, elevate chin to reduce diplopia
  • in acquired cases, there could be an issue with IO or SO muscle (trauma or orbital fracture, inflammation, RA, idiopathic)
378
Q

Levels of visual impairment

Normal
Near normal
Moderate visual impairment
Severe visual impairment
Profound visual impairment
Near total-blindness
Total blindness

A

Normal: 20/25 or better
Near normal: 20/30 - 20/60
Moderate visual impairment: 20/70 - 20/160
Severe visual impairment: 20/200 - 20/400 ( or VF 20 degrees or less)
Profound visual impairment: 20/500 - 20/1000 ( or VF 10 degrees or less)
Near total-blindness: > 20/1000 (or VF 5 degrees or less)
Total blindness: no light perception

379
Q

Vitamin A deficiency

A
  • night blindness
  • xerophthalmia (conj and corneal xerosis (dry), bitots spot, keratomalacia, retinopathy)
  • severe corneal scarring
380
Q

4 fat soluble vitamins

381
Q

9 water soluble vitamins

382
Q

ciliary body epithelium produces aqueous humor at a rate of

KMK (18 decks)

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