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Otology and Ophthalmology Flashcards

1
Q

Tonotropy

A

different frequencies lead to vibration at specific location on basilar membrane

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2
Q

low frequency sounds are heard at ?

A

apex near helicotrema (Wide and flexible)

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3
Q

high freq sounds are heard at ?

A

base of cochlea which is thin and rigid

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4
Q

Weber test: localized to affected ear

Rinne test: abnormal because bone conduction >air

A

conductive hearing loss

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5
Q

Weber test: localized to unaffected ear

Rinne test: normal, air >bone

A

sensorineural hearing loss

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6
Q

Noise induced hearing loss: damage to? loss of what freq first?

A

damage to the sterociliated cells in organ of corti

loss of high frequency first

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7
Q

Age related progressive hearing loss

A

presbycusis

destruction of hair cells at cochlear base (loss of high freq)

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8
Q

OVergrowth of desquamated keratin debris within the middle ear space

A

cholesteatoma

may erode ossicles, mastoid air cells resulting in conductive hearing loss

painless otorrhea

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9
Q

Meniere disease triad

A

sensorineural hearing loss vertigo
tinnitus

type of peripheral vertigo that involves inner ear etiology vs central that is a brainstem or cerebellar lesion

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10
Q

Layers of eye (inside to out)

A

Retina (inner)
Choroid (middle)
Sclera (outer)

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11
Q

Most common cause of conjunctivitis (inflammation of the conjunctiva –> red eye)

A

viral due to adenovirus

sparse mucous discharge, swollen preauricular node, self resolving

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12
Q

Hyperopia

A

farsighted

eye too short for refractive power of cornea and lens –> light focused behing retina

convex lens needed

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13
Q

Myopia

A

nearsighted

eye too long for refractive power of cornea and lens –> light focused in front of retina

concave (diverging) lens

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14
Q

Presbyopia

A

aging related impaired accomodation (focusing on near objects)

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15
Q

aqueous humor pathway

A

90% via the trabecular outflow

10% via the uveoscleral outfloq

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16
Q

trabecular outflow

A

drainage through trabecular meshwork –> canal of schlemm –> episcleral vasculature

increases with M3 agonist

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17
Q

Uveoscleral outflow

A

drainage into uvea and sclera

increases with prostaglandin agonist

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18
Q

Aq humour

A

produced by nonpigmented epithelium on ciliary body

decrease by beta blockers, alpha 2 agonists, and carbonic anhydrase inhibitors

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19
Q

Iris dilator muscle

A

alpha1

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20
Q

Iris sphincter muscle

A

M3

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21
Q

Patient presents with increased intraocular pressure and progressive peripheral visual field loss

A

Glaucoma

optic disc atrophy with characteristic cupping(thinning of outer rim of optic nerve head)

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22
Q

Open angle glaucoma

A

the angle in your eye where the iris meets the cornea is as wide and open as it should be, but the eye’s drainage canals/trabecular meshwork become clogged over time with WBC,RBC, retinal elements, causing an increase in internal eye pressure and subsequent damage to the optic nerve.

associated with increased age

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23
Q

Closed angle/narrow glaucoma

A

primary cause - enlargement or anterior movement of lens against central iris (pupil margin) causing obstruction of aq flow through pupil. Fluid builds up behind iris and pushes peripheral iris against cornea and impedes flow through trabecular meshwork

secondary cause-hypoxia from retinal disease induces vasoproliferation in iris that contracts angle

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24
Q

Chronic vs acute closed angle glaucoma

A

chronic -damage to optic nerve and peripheral vision
acute- true emergency. increased IOP pushes iris forward and closes the angle abruptly.

sudden vision loss, halos around lights, frontal headache, fixed and mid dilated pupil

mydriatic agents contraindicated

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25
anterior uveitis? posterior uveitis?
anterior is iritis posterior is choroiditis and or retinitis may have hypopyon (accumulation of pus in anterior chamber) or conjunctival redness associated with systemic inflammatory disorders like RA or HLA-B27 associated conditions
26
Age related macular degeneration
degeneration of macula (central area of retina) causes distortion (metamorphopsia) and eventual loss of central vision (Scotomas) dry-nonexudative wet-exudative
27
Deposition of yellowish extracellular material in between Bruch membrane and retinal pigment epithelium with gradual decrease in vision
dry age related macular degeneration
28
Rapid loss of vision due to bleeding secondar to choroidal neovascularization
wet age related macular degeneration treat with anti-VEGF (vascular endothelial growth factor) injections
29
Type of diabetic retinopathy
nonproliferative- damaged capillaries leak blood and lipids and fluid seep into retina causing hemorrhages and macular edema proliferative - chronic hypoxia results in new blood vessel formation with resultant traction on retina
30
Flame shaped retinal hemorrhages, AV nicking, microaneurysms, macular star, cotton wool spots
hypertensive retinopathy increased risk of stroke, CAD, kidney dz presence of papilledema requires immediate lowering of BP
31
Papilledema
is a condition in which increased pressure in or around the brain causes the part of the optic nerve inside the eye to swell optic disc swelling that b/l due to increased ICP enlarged blind spot and elevated optic disc with blurred margins
32
Retinal vein occlusion
blockage of central of branch retinal vein due to compression from nearby arterial atherosclerosis retinal hemorrhage and venous engorgement "blood thunder appearance"
33
Retinal detachment
separation of neurosensory layer of retina (photoreceptor layer with rods and cones) from outermost pigmented epithelium (important for protecting the retina from light) --> degeneration of photoreceptors -->vision loss could be secondary to diabetic traction etc crinkling of retinal tissue and changes in vessel direction
34
Patient complains of flashes and floaters and then loss of vision in one eye as if a curtain was drawn down
SURGICAL EMERGENCY! | retinal detachment
35
Central retinal artery occlusion
acute painless monocular vision loss retina cloudy with attenuated vessels and cherry red spot at fovea (center of macula)
36
Retinitis pigmentosa
inherited retinal degeneration starts with night blindness (rods affected first) bone spicule shaped deposits around macula
37
Retinitis
retinal edema and necrosis leading to scar
38
Pupillary control pathway for miosis
(constriction, parasympathetic) first neuron: edinger-westphal nucleus to ciliary ganglion via CN III 2nd neuron: short ciliary nerves to spincter pupillae mm "short ciliary nerves shorten the pupil diameter"
39
Pupillary light reflex
light in either retina sends a signal via CN II to pretectal nuclei in midbrain to activate bilateral edinger-westphal nuclei--> pupil constrict bilaterally illumination in one eye- causes bilateral pupillary constriction
40
Mydriasis control pathway
(Dilation, sympathetic) 1st neuron: hypothalamus to ciliospinal center of budge (C8-T2) 2nd neuron: exit at T1 to superior cervical ganglion while traveling along cervical sympathetic chain 3rd neuron: plexus along internal carotid through cavernous sinus --> enters orbit as long ciliary nerve to pupillary dilatory muscles long ciliary nerves make the pupil diameter longer
41
Marcus gunn pupil
when the light shines into a normal eye, constriction of the ipsilateral (direct reflex) and contralateral eye (consensual reflex) is observed when swung to affected eye, both pupils dilate instead of constrict due to impaired conduction of light signal along the injured optic nerve
42
Horners syndrome
sympathetic denervation of face Ptosis - slight drooping of eyelid due to superior tarsal mm Anhidrosis - absence of sweating and flushing of affected side Miosis- pupil constriction
43
Horners syndrome lesion
sympathetic chain 1st neuron: pontine hemorrhage, lateral medullary syndrome, spinal cord lesion above T1 2nd neuron (stellate ganglion): pancoast tumor 3rd neuron: carotid dissection (painful)
44
Lateral rectus innervation
CN 6
45
Superior oblique innervation
CN 4
46
Innervation of all eye mm except superior oblique and lateral rectus
CN 3 "LR6SO4R3 chemical formula"
47
strongest action of superior oblique
depression when eye is adducted when abducted it acts to intort the eye towards the nose
48
ptosis and "down and out"
CN III damage on motor (Central)
49
Diminished or absent pupillary reflex "blown pupil" often with down and out gaze
CN III damage on parasympathetic output
50
Cavernous sinus thrombosis would affect what CNs
4,6,V1,V2
51
Eyes move upward particularly on contralateral eye. When going down stairs the patient may tilt head in opposite direction to compensate
CN 4 cant see the floor with CN 4 damage
52
Affected eye unable to abduct and is displaced medially in primary position of gaze
CN 6 damage lateral rectus can function and therefore medial gaze dominates
53
Right anopia
optic nerve lesion complete loss in right eye
54
Bitemporal hemianopia
pit lesion, chiasm loss of left field in left eye loss of right field in right eye
55
Left homonymous hemianopia
optic tract lesion loss of Left eye field in both eyes if lesion on R optic tract
56
Left upper quadrantanopia
right temporal lesion, MCA @ meyer loop
57
Left lower quadrantanopia
right parietal lesion, MCA @ dorsal optic radiation
58
Left hemianopia with macular sparing
PCA infarct affecting the meyer loop and dorsal optic radiation on right side
59
Central scotoma in left eye
macular degeneration in left eye
60
Meyer loop
lower retina, loops around inferior horn of lateral ventricle
61
Dorsal optic radiation
superior retina takes shortest path via internal capsule
62
Cavernous sinus
collection of venous sinuses on either side of pituitary drains into internal jugular vein CN 3,4,V1,6,V2, pupillary fibers en route to orbit all pass through cavernois sinus cavernous portion of internal carotid
63
Patient presents with variable ophthalmoplegia, decreased corneal sensation, horner syndrome, occasional decreased maxillary sensation
Cavernous sinus syndrome CN 6 most susceptible to injury
64
Medial longitudinal fasciculus (MLF)
pair of tracts that allows for crosstalk between CN 6 and CN 3 nuclei coordinates both eyes to move in same horizontal direction highly myelinated for fast communication between eyes
65
MLF lesion seen classically in MS
lateral
66
lesion in MLF
internuclear opthalmoplegia a conjugate horizontal gaze palsy lack of communication between two eyes - when CN 6 nucleus activates ipsilateral lateral rectus, contralateral CN 3 nucleus does not stimualte medial rectus to contract abductng eyes gets nystagmus because CN 6 overfires to stimulate CN 3 right vs left INO refers to eye with nystagmus
67
internuclear opthalmoplegia (INO)
ipsilateral adduction failure | Nystagmus in opposite eye

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