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Ophthalmology SIM > OS 212 - Ophtha Flashcards > Flashcards

OS 212 - Ophtha Flashcards

1
Q

orbit shape

A

pear

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2
Q

orbit volume in adults

A

30 cc

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3
Q

barrier between eyelid and orbit

A

orbital septum

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4
Q

bones forming roof of orbit

A

frontal, sphenoid (lesser wing)

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5
Q

bones forming lateral wall of orbit

A

sphenoid (greater wing), zygomatic

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6
Q

bones forming floor of orbit

A

maxillary, zygomatic, palatine

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7
Q

bones forming medial wall of orbit

A

ethmoid, lacrimal, frontal, maxillary, sphenoid

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8
Q

wall of the orbit comprised of the most bones

A

medial wall

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9
Q

entry site of all nerves and blood vessels to the eye

A

orbital apex

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10
Q

structures passing through lateral SOF

A

superior ophthalmic vein, lacrimal, frontal, trochlear nerves

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11
Q

structures passing through medial SOF

A

superior and inferior oculomotor nerve, abduscens and nasociliary nerves

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12
Q

structures passing through optic canal

A

optic nerve, ophthalmic artery

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13
Q

supplies retina

A

central retinal artery

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14
Q

supplies lacrimal gland

A

lacrimal artery

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15
Q

supplies upper eyelid

A

lacrimal artery

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16
Q

supplies ciliary body

A

long posterior ciliary arteries

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17
Q

supplies sclera, episclera

A

anterior ciliary arteries

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18
Q

supplies limbus

A

anterior ciliary arteries

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19
Q

supplies conjunctiva

A

anterior ciliary arteries

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20
Q

supplies choroid

A

short posterior ciliary arteries

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21
Q

supplies eyelids

A

medial palpebral arteries

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22
Q

drainage of the eye

A

superior and inferior ophthalmic veins

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23
Q

drains into ophthalmic veins

A

vortex veins, anterior ciliary veins, central retinal vein

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24
Q

analogue of nictitating membrane

A

semilunar fold of bulbar conjunctiva

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25
Q

location of accessory lacrimal glands

A

fibrous layer of conjunctival stroma

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26
Q

accessory lacrimal glands

A

glands of Krause and Wolfring

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27
Q

layer of the conjunctival stroma not present at birth

A

adenoid layer

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28
Q

source of conjunctival arteries

A

anterior ciliary and palpebral arteries

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29
Q

innervation of conjunctiva

A

CN V1

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30
Q

fibrous membrane covering globe from limbus to optic nerve

A

Tenon’s capsule

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31
Q

parts of Tenon’s capsule at limbus

A

conjunctiva, Tenon’s capsule, episclera

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32
Q

suspensory ligament of Lockwood

A

IR + IO + Tenon’s capsule

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33
Q

thinnest portion of sclera

A

at insertion of recti muscles, 0.3mm (half as thick)

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34
Q

contains BV that nourish sclera

A

episclera

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35
Q

T/F: The cornea is thicker at the periphery

A

T

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36
Q

T/F: The cornea is wider vertically

A

F, wider horizontally (11.75mm)

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37
Q

five layers of the cornea

A

epithelium, Bowman’s membrane, stroma, Descemet’s membrane, endothelium

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38
Q

comprises 90% of corneal thickness

A

stroma

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39
Q

modified corneal stroma

A

Bowman’s membrane

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40
Q

basal lamina of corneal epithelium

A

Descemet’s membrane

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41
Q

maintains corneal deturgescence

A

endothelium

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42
Q

effect of disruption of corneal endothelium

A

corneal edema

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43
Q

T/F: Corneal endothelium is highly mitotic

A

F, has minimal capacity for cell division

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44
Q

mechanism of corneal endothelial repair

A

hypertrophy and sliding, NO mitosis

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45
Q

innervation of cornea

A

CN V1

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46
Q

attributed to corneal transparency

A

deturgescence, uniform structure, avascularity

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47
Q

comprises uveal tract

A

iris, ciliary body, choroid

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48
Q

middle vascular layer of eye

A

uvea

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49
Q

characteristic of iris capillaries

A

non-fenestrated

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50
Q

controls amount of light entering eye

A

pupil (dilates and constricts accordingly)

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51
Q

responsible for pupillary constriction

A

parasympathetic CN III

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52
Q

innervation of iris

A

fibers of ciliary nerve

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53
Q

2 zones of ciliary body

A

pars plicata, pars plana

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54
Q

part of ciliary body with ciliary processes

A

pars plicata

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55
Q

produces aqueous humor

A

ciliary processes in pars plicata of ciliary body

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56
Q

types of fibers of ciliary muscles

A

longitudinal, circular, radial

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57
Q

internal portion of choroid

A

choriocapillaries

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58
Q

nourishes outer portion of retina

A

choroid/choriocapillaries

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59
Q

structure/shape of lens

A

biconvex, avascular

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60
Q

normal lens thickness

A

4 mm

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61
Q

normal lens diameter

A

9 mm

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62
Q

connects lens to ciliary body

A

zonules

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63
Q

liquid compartment anterior to lens

A

aqueous humor

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64
Q

liquid compartment posterior to lens

A

vitreous humor

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65
Q

T/F: Lens cortex is harder than the nucleus

A

F

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66
Q

T/F: Lamellar fibers of the lens are poorly mitotic, thus leading to poor eyesight in old age

A

F, its continuous production causes the lens to become larger and less elastic

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67
Q

water content of lens

A

65%

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68
Q

T/F: The lens can feel pain

A

F, there are no pain nerve fibers on the lens

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69
Q

volume of aqueous humor

A

230 uL

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70
Q

rate of aqueous humor production

A

2.5 uL/min (subject to diurnal variation)

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71
Q

aqueous humor pathway

A

ciliary processes -> posterior chamber -> pupil -> anterior chamber -> trabecular drainage -> Schlemm’s canal -> venous system

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72
Q

main anatomic structures of anterior chamber angle

A

Schwalbe’s line, trabecular meshwork, scleral spur

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73
Q

demarcated by Schwalbe’s line

A

end of corneal endothelium

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74
Q

anterior extensions of retina

A

ora serrata

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75
Q

parts of retina without subretinal space

A

disc, ora serrata (other areas prone to retinal detachment)

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76
Q

10 layers of the retina

A

retinal pigment epithelium (inner layer of ciliary Bruch’s membrane), photoreceptor layer, external limiting membrane, outer nuclear layer (photoreceptor bodies), outer plexiform layer (photoreceptors to bipolar and horizontal cells), inner nuclear layer (bipolar, amacrine, horizontal cell bodies), inner plexiform layer (amacrine and bipolar cells to ganglia), ganglion cell layer, nerve fiber layer, internal limiting membrane

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77
Q

T/F: Retina is thicker at the posterior pole than anterior (ora serrata)

A

T, 0.56mm thick posteriorly and 0.1 mm thick anteriorly

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78
Q

location of macula

A

center of posterior retina

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79
Q

location of fovea

A

center of macula

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80
Q

retinal avascular zone in fluoroscein angiography

A

foveal reflex

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81
Q

photoreceptors in foveola

A

cones only

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82
Q

blood supply of retina

A

outer 1/3 - choriocapillaries, inner 2/3 - central retinal artery

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83
Q

sole blood supply of fovea

A

choriocapillaries

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84
Q

T/F: The fovea is able to repair itself after macular detachment

A

F, damage is irreparable

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85
Q

characteristic of retinal blood vessels

A

non-fenestrated, forms inner BRB

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86
Q

location of outer BRB

A

level of RPE

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87
Q

location of macula with respect to OD

A

temporal

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88
Q

part of retina first hit by light

A

inner limiting membrane

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89
Q

comprises 2/3 eye volume and mass

A

vitreous humor

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90
Q

outer surface of vitreous

A

hyaloid membrane

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91
Q

attachment of vitreous base

A

pars plana, immediately behind ora serrata

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92
Q

T/F: Vitreous attachment to optic nerve and lens capsule persists throughout life

A

F, formed early in life but soon disappears

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93
Q

origin of recti muscles

A

annulus of Zinn

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94
Q

longest and thinnest EOM

A

SO

95
Q

only EOM not originating from orbital apex

A

IO

96
Q

spiral of Tillaux

A

connects recti insertions to sclera (MILS)

97
Q

blood supply of EOM

A

branches of ophthalmic artery

98
Q

additional blood supply to LR

A

branch of lacrimal artery

99
Q

additional blood supply to IO

A

branch of infraorbital artery

100
Q

hairless prominence between eyebrows

A

glabella

101
Q

layers of the eyelid

A

skin, orbicularis oculi muscle, areolar tissue, tarsal plates, palpebral conjunctiva

102
Q

main support of eyelid

A

tarsal plates

103
Q

closes eyelid

A

orbicularis oculi (palpebral)

104
Q

innervation of orbicularis oculi

A

CN VII

105
Q

length of lid margin

A

25-30 mm

106
Q

width of lid margin

A

2 mm

107
Q

parts of anterior lid margin

A

eyelashes, glands of Zeis (modified sebaceous glands), glands of Moll (modified sweat glands)

108
Q

contains meibomian glands

A

posterior lid margin

109
Q

passage of tears for drainage

A

lacrimal punctum (medial end of posterior lid margin)

110
Q

number of lacrimal punctum per eye

A

2 (superior and inferior)

111
Q

opens upper eyelids

A

levator palpebrae superioris, Muller’s muscle (superior tarsal)

112
Q

opens lower eyelids

A

inferior rectus, inferior tarsal

113
Q

innervation of lacrimal gland

A

lacrimal nerve (CN V1 – sensory), great superficial petrosal nerve (secretory), sympathetic nerves

114
Q

drains lacrimal gland

A

ophthalmic vein

115
Q

tear drainage pathway

A

lacrimal gland -> lacrimal puncta -> canaliculi -> common canaliculus -> lacrimal sac -> nasolacrimal duct -> nasal meatus

116
Q

number of axons in optic nerve trunk

A

1.2M from ganglia of retina

117
Q

types of optic nerve fibers

A

80% visual, 20% pupillary

118
Q

visual fibers vs. pupillary fibers

A

pupillary fibers bypass lateral geniculate body towards pretectal area

119
Q

T/F: Ganglial cells are capable of regeneration

A

F, being part of CNS, they can’t

120
Q

color with shortest wavelength

A

violet (380 microns)

121
Q

color with longest wavelength

A

red (760 microns)

122
Q

visible spectrum

A

380-760 microns

123
Q

change in speed of light from air to water (increasing refractive index)

A

slows down

124
Q

direction of light deviation in a prism

A

towards base

125
Q

structure of diverging lens

A

> < (-)

126
Q

structure of converging lens

A

<> (+)

127
Q

unit of measurement of lens power

A

diopter (D), 1/focal length

128
Q

factors affecting lens power

A

lens curvature, difference in refractive indices

129
Q

total converging power of human eye

A

60D - 40D cornea, 20D lens

130
Q

parallel light rays dall into pinpoint focus on retina

A

emmetropia

131
Q

types of ammetropia

A

myopia, hyperopia, astigmatism

132
Q

focus point in myopia

A

in front of retina

133
Q

focus point in hyperopia

A

behind retina

134
Q

causes of myopia/hyperopia

A

axial (eyeball length), refractive (corneal curvature)

135
Q

correction of myopia

A

divergent lenses (negative)

136
Q

correction of hyperopia

A

convergent lenses (positive)

137
Q

astigmatism

A

uneven curvature of cornea/lens at different meridians

138
Q

correction of astigmatism

A

cylindrical lenses

139
Q

types of astigmatism

A

simple (myopic/hyperopic), compound (myopic/hyperopic), mixed

140
Q

physiologic changes in accommodation

A

pupils constrict, eyes converge, lenses thicken

141
Q

presbyopia

A

loss of focusing/accommodating power in old age (>40 yo)

142
Q

correction of presbyopia

A

convergent lenses (positive)

143
Q

number of photoreceptors in mature retina

A

120M rods, 6M cones

144
Q

senses perceived by retina

A

light, form, color

145
Q

components of visual pigments

A

Vit A + opsin

146
Q

components of rhodopsin

A

cis-retinal Vit A + opsin

147
Q

mechanism of conversion of light to impulses

A

light -> rhodopsin cleavage -> hyperpolarzation (Ca permeability); energy released through cis->trans conversion of retinene

148
Q

minimum visual angle of Snellen big “E”

A

5 minutes

149
Q

minimum visual angle of arms of Snellen big “E”

A

1 minute

150
Q

determinant of visual acuity

A

form sense

151
Q

color blindness: ‘prot(o)-‘

A

red

152
Q

color blindness: ‘deuter(o)-‘

A

green

153
Q

color blindness: ‘tri-‘

A

blue

154
Q

color blindness: ‘-anomaly’

A

deficiency in color

155
Q

color blindness: ‘-anopia’

A

loss of color

156
Q

cone monochromats

A

only one color

157
Q

rod monochromats

A

achromats, totally color blind

158
Q

pattern of inheritance of color blindness

A

sex-linked, recessive

159
Q

monocular vs. binocular vision

A

monocular - complete decussation; binocular - partial decussation

160
Q

visual relay pathway

A

retina -> CN II -> optic chiasm (partial decussation) -> optic tracts -> LGN -> optic radiations (temporal/parietal) -> strial cortex (occipital)

161
Q

images received by occipital lobe

A

C/L images; (e.g. left lobe receives right hemi-field images)

162
Q

decussating images at optic chiasm

A

images from temporal hemi-fields (images from nasal half of retina)

163
Q

images relayed by optic tract

A

C/L images; (e.g. left tract relays right hemi-field images)

164
Q

visual field defect: optic nerve

A

I/L anopia

165
Q

visual field defect: optic chiasm

A

bitemporal hemianopia

166
Q

visual field defect: optic tract

A

C/L homonymous hemianopia

167
Q

visual field defect: temporal optic radiation

A

C/L superior homonymous hemianopia (pie in the sky)

168
Q

visual field defect: parietal optic radiation

A

C/L inferior homonymous hemianopia (pie on the floor)

169
Q

visual field defect: occipital lobe

A

C/L homonymous hemianopia

170
Q

types of eye symptoms

A

abnormalities of vision, abnormalities of ocular appearance, abnormalities of ocular sensation

171
Q

abnormalities of vision

A

vision loss, visual distortion, flashing/flickering lights, floaters, oscillopsia, diplopia

172
Q

abnormalities of ocular appearance

A

red eye, color abnormalities, miosis, focal mass, proptosis, strabismus, abnormal size

173
Q

abnormalities of ocular sensation

A

pain, irritation, headache

174
Q

BOV algorithm

A

sudden/gradual? mild/severe?; sudden mild - suspect dry eye; sudden severe - suspect CRAO; gradual mild - suspect error of refraction; gradual severe - suspect cataract or glaucoma

175
Q

DDx: BOV

A

refractive error, ptosis, ocular media disturbance, retinal dx, CN II dx, visual pathway abnormalities

176
Q

DDx: glare/photophobia

A

corneal edema, cataracts; irritation, foreign bodies, acute inflammation, error of refraction, mydriasis, scratches on glasses, hazy ocular media

177
Q

DDx: visual distortion

A

CSCR, ARMD; migraine, strong correction, macular and CN II lesions

178
Q

DDx: flashing/flickering

A

retinal detachment, posterior vitreous detachment; retinal traction, posterior vitreous detachment, migrainous scintillations/aura

179
Q

DDx: floaters

A

vitreous condensations; normal vitreous strands, pathologic pigments, blood, inflammatory cells

180
Q

DDx: oscillopsia (shaking vision)

A

nystagmus; lid twitching (myokymia), nystagmus

181
Q

DDx: diplopia

A

monocular (error of refraction, media abnormalities, corneal irregularities, lens dislocation)

182
Q

DDx: red eye with swelling

A

preseptal cellulitis, orbital cellulitis, external hordeolum

183
Q

DDx: red eye without swelling

A

conjunctivitis, iritis, acute glaucoma, scleritis, pterygium, subconjunctival hemorrhage

184
Q

DDx: periocular pain

A

lid, tear sac, sinuses, temporal artery tenderness

185
Q

DDx: retrobulbar pain

A

orbital inflammation, orbital myositis, optic neuritis

186
Q

DDx: ocular pain

A

corneal abrasion, corneal foreign body, glaucoma, corneal ulcer, endophthalmitis

187
Q

DDx: nonspecific pain

A

accommodation fatigue, binocular fusion, tension/fatigue referred discomfort

188
Q

DDx: itching

A

allergic sensitivity

189
Q

DDx: dryness

A

dry eye, mild corneal irritation

190
Q

DDx: tearing

A

ocular surface irritation, (with edema) abnormal lacrimal drainage

191
Q

DDx: watery secretion

A

allergy

192
Q

DDx: mucoid discharge

A

allergy, viral conjunctivitis

193
Q

DDx: ropy/stringy discharge

A

allergy

194
Q

DDx: mucopurulent secretion

A

bacterial/viral conjunctivitis

195
Q

DDx: copious purulent secretion

A

gonococcal conjunctivitis

196
Q

DDx: bloody discharge

A

viral conjunctivitis, SJS

197
Q

DDx: dried crusts on lashes

A

blepharitis

198
Q

DDx: headache

A

errors of refraction, presbyopia, migraine, sinusitis, high and low BPs, intracranial pressure, closure glaucoma

199
Q

DDx: headache + nausea + vomiting

A

increased intracranial pressure

200
Q

DDx: U/L headache from I/L eye + nausea + vomiting

A

closure glaucoma

201
Q

parts of basic eye exam

A

VA, gross (eye and adnexae, pupil), EOM, IOP, fundoscopy

202
Q

methods of measuring decreased vision

A

move closer to 1 m -> finger counting -> hand movement -> light projection -> light perception -> NLP

203
Q

parts of gross examination

A

eye position, eyelids and eyelashes, conjunctiva and sclera, cornea and iris, pupil

204
Q

parts of pupul examination

A

size and shape, light reflex, swinging flashlight

205
Q

normal pupil size

A

2-4mm

206
Q

affected part if (-) consensual and direct pupillary responses

A

efferent arm of involved eye (given vision is normal)

207
Q

affected part if (+) RAPD

A

optic nerve of dilating eye (consensual > direct response); I/L lesion

208
Q

purpose of swinging flashlight test

A

r/o U/L CN II lesion or asymmetry

209
Q

normal IOP

A

10-21 mmHg (with both eyes at least within 2 mmHg of each other)

210
Q

c/i of tension tonometry

A

suspected globe perforation

211
Q

used for indentation tonometry

A

Schiotz tonometer

212
Q

cons of Schiotz tonometer

A

affected by scleral rigidity, patients must be supine

213
Q

findings in tension tonometry

A

soft, hypotonic, firm

214
Q

gold standard for IOP measurement

A

applanation tonometry

215
Q

used for applanation tonometry

A

Goldman Applanation tonometer

216
Q

c/i of applanation tonometry

A

patients with corneal abnormalities (e.g. scars)

217
Q

cons of applanation tonometry

A

needs special equipment, needs ophthalmologist, affected by corneal thickness and irregular corneal curvatures

218
Q

used for mass measurement of IOP

A

air puff noncontact tonometer

219
Q

structures to observe in fundoscopy

A

ocular media (ROR), optic disc (ddb, CDR), retinal vasculature (AVR), retinal background (h/e, color) , macular area (foveal reflex, h/e)

220
Q

normal CDR

A

< 0.5

221
Q

cause of increased CDR

A

glaucoma -> death of ganglion cells

222
Q

forms optic cup

A

aggregation of ganglion cells from retina

223
Q

course of retinal BV temporally

A

arching

224
Q

course of retinal BV nasally

A

radial

225
Q

retinal structure with light reflex stripe

A

retinal arteries

226
Q

normal AVR

A

2:3-4:5

227
Q

DDx: Drusen lesions

A

ARMD

228
Q

DDx: dot hemorrhages

A

diabetes

229
Q

DDx: submacular hemorrhage

A

ARMD

230
Q

DDx: hard exudates

A

HTN, DM, vHLD, radiation

231
Q

DDx: soft exudates

A

HTN, DM, CTdx, HIV

232
Q

DDx: boat hemorrhage

A

trauma, blood dyscrasia, sudden increase in IOP

233
Q

DDx: flame hemorrhage

A

HTN, RVO, blood dyscrasia, trauma

234
Q

DDx: vitreous hemorrhage

A

HTN, DM, trauma

Ophthalmology SIM (1 decks)

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