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Green Book > Paper 1 > Flashcards

Paper 1 Flashcards

1
Q

In the superior orbital fissure which nerves pass outside the common tendinuous ring

A

Lacrimal
Frontal
Trochlear

NERVES!

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2
Q

Horizontal and vertical diameter of the cornea

A

H- 11.7
V- 10.6

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3
Q

What is diploe in bones

A

Layers of compact bone are separated by a layer of spongy bone called diploe

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4
Q

Where does the frontal sinus drain into

A

Middle Meatus

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5
Q

Where does the Maxillary sinus drain into

A

Middle meatus

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6
Q

Where does the Anterior and middle ethmoidal sinus drain into

A

Middle meatus

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7
Q

Where does the Posterior ethmoidal sinus drain into

A

Superior meatus

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8
Q

Where does the Sphenoidal sinus drain into

A

Sphenoethmoidal recess/superior meatus

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9
Q

Where does the Nasolacrimal duct open into

A

Inferior meatus

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10
Q

Where does anterior blepharitis occur

A

Anterior to the gray line. Around the lash margins, crusting and dryness

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11
Q

Where do the meibomian glands lie in relation to the gray line

A

Posterior to the gray line

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12
Q

What portions does the lacrimal gland consist of

A

orbital
palpebral

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13
Q

What is the innervation of the lacrimal gland

A

1) Parasympathetic- lacrimatory nucleus of CN VII. Fibres travel via the nervus intermedius to the pterygopalatine ganglion then via maxillary nerve to zygomatic and zygomaticotemporal branches and finally via the lacrimal nerve to the gland

2) Sympathetic- from the superior cervical ganglion. Fibres travel in the nerve plexus surrounding the ICA then via the deep petrosal nerve to maxillary nerve. Then via zygomatic and zygomaticotemporal nerve branches and finally via the lacrimal nerve to the gland as the PNS

3) Sensory- From the lacrimal nerve which is a branch of trigeminal nerve V1

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14
Q

EOM vs Skeletal muscle fibres

A

EOM:
Thin connective tissue including epimysium
Loosely packed muscle fibres
Large diameter fibres (10-40 microns) occupying centre and smaller fibres (5-15 microns) peripherally
Long muscle spindles providing feedback about muscle activity to CNS
EOM more vascular than skeletal muscle

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15
Q

Structures passing through foramen spinosum

A

1) MMA
2) MMV
3) Meningeal branch of the mandibular nerve

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16
Q

What does the foramen spinosum connect

A

connects the middle cranial fossa to the inferotemporal fossa

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17
Q

Nerve branches of the facial nerve

A

Temporal
Zygomatic
Buccal
Mandibular
Cervical

TO ZANZIBAR BY MOTOR CAR

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18
Q

Bleeding from meningeal arteries causes what kind of haematoma?

A

Extradural

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19
Q

Which line represents termination of Descemet layer

A

Schwalbe line

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20
Q

Which location is posterior lens capsule thinnest

A

Posterior pole

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21
Q

Site of attachment of vitreous base

A

Peripheral retina and pars plana

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22
Q

From innermost to outermost layers of RPE Bruch membrane

A

Basal lamina of RPE
Inner collagenous layer
elastin layer
outer collagenous layer
Basal lamina of choriocapillaris

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23
Q

Point of insertion of lateral canthal tendon

A

Whitnall tubercle

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24
Q

What is the sensory innervation of the iris

A

Long and short ciliary nerves derived from the nasociliary nerves

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25
Q

Posterior to anterior orientation of the optic canal

A

Inferolateral

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26
Q

What does the optic canal connect

A

Middle cranial fossa and orbital apex

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27
Q

Is the ciliary body AP length greater nasally or temporally

A

Temporally

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28
Q

Muscular layers of ciliary body from outer to inner

A

Outer longitudinal
Middle radial
Inner circular

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29
Q

What iris structure contributes to blood aqueous barrier

A

Non fenestrated iris capillaries with tight junctions and pericytes

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30
Q

Where is the minor arterial circle of the iris found

A

At the level of the collarette

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31
Q

Where do the lymphatics from the right side of the head and neck and the right arm drain into

A

common lymphatic duct–>right lymphatic duct–> Right subclavian vein

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32
Q

What lymphatic duct drains the rest of the body

A

Thoracic duct–>left subclavian vein

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33
Q

Where do the right and left subclavian veins drain into?

A

Brachiocephalic veins and SVC

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34
Q

Which blood vessel layer is fragmented in GCA

A

Internal elastic lamina

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35
Q

What does aqueous contain high levels of compared to plasma

A

Ascorbate
Lactate

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36
Q

What does aqueous contain lower levels of compared to plasma

A

Slightly lower level of bicarbonate
Lower levels of glucose and calcium
Much lower levels of albumin

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37
Q

In collagen synthesis what is transcription

A

DNA–>RNA

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38
Q

In collagen synthesis what is translation

A

RNA–> peptide formation

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39
Q

What is the basic repeating sequence of amino acid sequence in collagen

A

Glycine-X-Y
X is often proline
Y is often hydroxyproline

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40
Q

What is involved in post translational modification of collagen synthesis

A

Vitamin c dependent hydroxylation of the Y position amino acid
Glycosylation
Triple helix formation linked by covalent S–S bonds

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41
Q

What happens to collagen on excretion from the cell

A

Cleavage of terminal peptide chains making it insoluble

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42
Q

How is collagen modified extracellularly

A

Lysine oxidation
Formation of crosslinks

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43
Q

What are Matrix metalloproteinases

A

Zinc and calcium dependent endopeptidases which act as an enzyme cascade to degrade ECM
Examples: collagenases and gelatinases

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44
Q

Where are MMP’s found

A

released by neutrophils in acute inflammation
found in normal tissues for growth, maintenance, repair and remodelling

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45
Q

How are MMP’s kept in check

A

Endogenous inhibitors called TIMP

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46
Q

What is 90% of the lens protein called

A

Crystallins

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47
Q

Which growth factor stimulates differentiation of anterior lens epithelial cells into lens fibres

A

Fibroblast growth factor

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48
Q

What is the charge on glycosaminoglycans

A

Highly negatively charged. Polysaccharides consisting of long chains of repeating dissacharides. They are inflexible

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49
Q

How does the endothelial cell pump work

A

Na/K ATPase pumps sodium actively into AC.
Passive diffusion of potassium and chloride

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50
Q

Where is pericyte coverage the highest in the eye

A

In the retinal vessels with a frequency of 1:1 pericytes to endothelial cells due to maintaining high metabolic demands of the retina and requirement to maintain the blood retinal barrier

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51
Q

What do pericytes do?

A

Maintain the blood brain barrier regulating permeability.
Communicate with endothelial cells by paracrine signalling and direct contact

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52
Q

How does Aflibercept work?

A

Decoy receptor molecule for VEGF

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53
Q

How does Bevacizumab/Ranibizumab work?

A

Monoclonal antibody to VEGF

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54
Q

How do VEGF receptors work

A

Via intracellular tyrosine kinase activity

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55
Q

How long do rod photoreceptors take for the renewal cycle to be complete

A

9-10 days

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56
Q

Which embryological layer does the lens come from?

A

surface ectoderm

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57
Q

In which quadrant are colobomas typically located

A

Inferonasally

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58
Q

Are glycosaminoglycans hydrophilic or hydrophobic

A

Hydrophilic

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59
Q

Which muscles come from the first pharyngeal arch

A

Muscles of mastication (masseter, temporalis, lateral and medial pterygoid)
Mylohyoid
Tensor tympani, tensor veli palatini, anterior belly of digastric

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60
Q

Which muscles come from the second pharyngeal arch

A

Muscles of facial expression, stylohyoid, stapedius, posterior belly of digastric

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61
Q

Which muscles come from the third pharyngeal arch

A

Stylopharyngeus

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62
Q

Which muscles come from the fourth pharyngeal arch

A

Pharyngeal constrictors, levator palatini, cricothyroid

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63
Q

Which muscles come from the sixth pharyngeal arch

A

Intrinisc muscles of the larynx except cricothyroid

64
Q

Which week are optic nerve fibres present from

A

Week 6-7

65
Q

When does myelination of the optic nerve first start

A

Month 7- from the optic chiasm

66
Q

When is myelination of the optic nerve complete

A

1 to 3 months of age in full term baby

67
Q

Vitreous collagen type predominance

A

Type 2

68
Q

Edwards syndrome trisomy

A

Trisomy 18

69
Q

Patau Syndrome trisomy

A

Trisomy 13

70
Q

Klinefelter syndrome trisomy

A

47 XXY

71
Q

When are the introns removed from the mRNA sequence

A

Before leaving the nucleus

72
Q

What is the aim of genetic linkage analysis

A

To discover how often 2 loci are separated by meiotic recombination. The probability of crossing over between 2 genetic loci on the same chromosome is proportional to the distance between them

73
Q

What is the charge on histones

A

Histones have a HIGH POSITIVE CHARGE

74
Q

Which amino acid are found in histones giving it the positive charge

A

Lysine
Arginine

75
Q

Which type of DNA polymerase is the principal enzyme in mitochondrial DNA replication

A

DNA Polymerase gamma

76
Q

Which corneal dystrophy is autosomal recessive

A

Macula corneal dystrophy- safe to assume all others are autosomal dominant

77
Q

What layer of the cornea is affected in Reis- Buckler corneal dystrophy

A

Epithelial basement membrane.
Stains with Masson Trichrome

78
Q

What can Reis Buckler corneal dystrophy manifest as

A

Recurrent corneal erosion syndrome and corneal opacification

79
Q

Examples of gene therapy vectors

A

Viral vectors- Adenoviruses, Retroviruses, Adeno associated viruses, HSV
Non viral vectors- Liposomes and naked DNA in the form of plasmids

80
Q

Which antibody is a potent activator of the complement system

A

IgM

81
Q

Examples of antigen presenting cells

A

Macrophages
Monocytes
Dendritic cells
Some B cells
Activated endothelial cells

82
Q

Which MHC class molecule is HLAB27 an example of

A

MHC class I

83
Q

What electric potential does the EOG measure

A

Resting electric potential between the RPE (electrically negative) and cornea (positive).
A test of the function of the outer retina and RPE hence abnormal in conditions affecting RPE photoreceptor interface or conditions with generalised RPE disease

84
Q

Does the patient need to be awake for EOG

A

Yes, needs a cooperative patient to move eyes horizontally

85
Q

Which major conditions is the EOG affected in

A

Best vitelliform macula dystrophy
Acute Zonal Occult outer retinopathy (Azoor)

86
Q

Commonest cause of endogenous exophthalmitis

A

Coagulase negative staph- Staph epidermidis

87
Q

Culture for Mycobacterium TB

A

Lowenstein Jensen medium

88
Q

How does Rifampicin work

A

Inhibits bacterial DNA dependent RNA polymerase

89
Q

How does Chloramphenicol and Erythromycin work

A

Inhibit 50s subunit of bacterial ribosome inhibiting bacterial protein synthesis

90
Q

How does Vancomycin and Cefuroxime work

A

Inhibit bacterial cell wall synthesis

91
Q

Difference between Acanthamoeba trophozoites and cysts

A

Trophozoitesa are relatively sensitive to treatment
Cysts can take many weeks to eradicate

92
Q

How does Botox work

A

Botulinum toxin A- Inhibits exocytosis of Acetylcholine from presynaptic receptor endplate

93
Q

Example of nematodal infection

A

Toxoplasmosis
Toxocara

94
Q

Which Toxocara are shed in dog faeces

A

Toxocara canis ova

95
Q

Which Toxocara and Toxoplasma are shed in cat faeces

A

Toxocara cati ova
Toxoplasma gondii

96
Q

What ocular features can Toxocara and Toxoplasma cause

A

White chorioretinal lesions
vitritis
Infection may be asymptomatic

97
Q

What are the photometric units of illuminance

A

Lux measured in lumen/m squared

98
Q

What are the radiometric units of irradiance

A

Watt/m squared

99
Q

How to check the axis of a refractive correction using JCC

A

Handle of cross cylinder held in line with axis of trial cylinder

100
Q

How to check the power of a refractive correction using JCC

A

The positive or negative cylinder marking on the cross cylinder is held in line with the axis of the trial cylinder

101
Q

In what position are glass prisms meant to be held

A

Prentice position

102
Q

In what position are plastic prisms meant to be used

A

Position of minimum deviation

103
Q

What are the properties of the image formed by the plane mirror

A

Virtual erect laterally inverted

104
Q

How to adjust the IOL power in ciliary sulcus lens

A

If normal AL- reduce power by 1 dioptre
If original bag dioptric power lens >28 reduce by 1.5 dioptre
If original bag dioptric power <17 reduce by 0.5 dioptre

105
Q

Which stereoacuity tests requires glasses wear

A

Worth 4 Dot test
Titmus test- polarised glasses

106
Q

Which stereoacuity test does not require glasses wear

A

Frisby testing

107
Q

Does a patient’s refractive error have a greater effect on direct or indirect ophthalmoscopy

A

Direct ophthalmoscopy
Myopia- smaller view
Presbyopia- Larger view

108
Q

Magnification of direct ophthalmoscope

A

15x

109
Q

Image formed by indirect ophthalmoscope

A

Real, Inverted vertically and horizontally

110
Q

Image formed by direct ophthalmoscope

A

Erect image no lateral inversion

111
Q

Galilean telescope image properties

A

Virtual erect magnified and at infinity

112
Q

Type of lenses within the Galilean telescope

A

Convex objective lens
Concave eyepiece lens
separated by the difference of their focal lengths

113
Q

Fluorescein light absorption and emission wavelength ranges

A

Absorption 495m
Emission 530nm

114
Q

How does corneal stroma mainatain corneal clarity

A

Destructive interference

115
Q

Features of NF1

A

Iris lisch nodules
Optic nerve glioma
Neurofibroma/plexiform neurofibroma
Phaeochromocytoma

116
Q

Features of NF2

A

Acoustic Neuroma
Meningioma
Glioma
Ependymoma

117
Q

Is NF autosomal dominant

A

YES!!

118
Q

Which chromosome is the NF1 and NF2 gene on

A

NF1- 17
NF2- 22

119
Q

Which condition are Dalen Fuch’s nodules found in

A

Epitheloid cells (Activated macrophages) and lymphocytes between bruch membrane and RPE from granulomatous inflammation in SO and VKH

120
Q

Which part of the eye do uveal melanomas occur in

A

Iris 8%
Ciliary body 12%
Choroid 80%

121
Q

Does Haematoxylin bind to acidic or basic substances

A

Acidic structures- blue stain
eg nucleic acids

122
Q

Does Eosin bind to acidic or basic substances

A

Basic substances- pink stain
eg Amyloid

123
Q

Where are hard exudates found in the retinal layers

A

localised hypoperfusion leading to damage of the endothelial capillaries and breakdown of inner blood retinal barrier causing leakage of plasma into the OPL appearing as pale deposits

124
Q

Where does corneal arcus lipid deposition occur

A

corneal Stroma

125
Q

When can proliferative vitreoretinopathy occur

A

PVR common cause of failure post RD surgery.
Can occur in untreated RD
Contraction and phthisis bulbi can occur

126
Q

What are first order kinetics of drug metabolism

A

Linear- rate is proportional to concentration of drug

127
Q

What are zero order kinetics of drug metabolism

A

Non linear- metabolism rate of drug independent of concentration ( non linear)

128
Q

What is the impact of lipid solubility on distribution of drug

A

Increases drug absorption and distribution eg by allowing diffusion across cell membranes and blood-retinal barrier

129
Q

Side effects of ciclosporin

A

Nephrotoxicity
Tremor
Hirsuitism
Gingival hypertrophy

130
Q

How does brimonidine work

A

Alpha 2 receptor agonist

131
Q

Horner syndrome which fails to dilate with 4% cocaine

A

All horner lesion

132
Q

Horner syndrome which fails to dilate with 1% hydroxyamphetamine

A

3rd order lesion

133
Q

Horner syndrome which dilates with Apraclonidine 0.5% or 1%

A

All horner lesion

134
Q

Horner syndrome which dilates with phenylephrine

A

3rd order lesion

135
Q

Examples of Eicosanoids

A

Prostaglandins, Thromboxanes (Together termed prostanoids)
Leukotrienes

136
Q

How do NSAIDs inhibit inflammation

A

inhibit cyclooxygenease and therefore synthesis of prostaglandins

137
Q

On which receptors do prostaglandins exert their effect

A

GPCR

138
Q

What impact does Thromboxane have on vessels

A

Eicosanoid which cause vasoconstriction and platelet aggregation

139
Q

What do Eicosanoids do

A

Signalling molecules and inflammatory mediators .
Inflammatory response always involves prostanoid generation

140
Q

Half life of Midazolam

A

1-3 hours. GABAa receptor agonists in CNS

141
Q

Are histamine receptors GPCR’s

A

YES!

142
Q

Histamine H1 receptor activation effects

A

Activation of phospholipase C
Increased intracellular calcium concentration

Cause:
Increased vascular permeability
Vasodilation
CNS depressant

143
Q

Histamine H2 receptor activation effects

A

Activation of adenylate cyclase and increase in cAMP

Cause:
Increased gastric acid production
Increased cardiac stroke volume

144
Q

What does Chromaticity depend on

A

Hue
Saturation
Luminance

145
Q

What is the Bezole Brucke effect

A

With increasing brightness eventually all hues appear yellow white whilst very low lumuinous hues appear achromatic

146
Q

What is the maximal spectral sensitivity of green cones

A

535-550 nm

147
Q

What happens in dark adaptation

A

Bipartite.
Initial rapid 5-10 mins increase in cone sensitivity and a slower period 15-30 mins where rods reach max sensitivity

148
Q

How long does dark adaptation take

A

30 mins

149
Q

What does Somatostatin do

A

Inhibits the release of growth hormone

150
Q

Which process is thought to account in 80-90% aqueous production

A

Active secretion
Remainder by ultrafiltration

151
Q

Which glycosaminoglycan is responsible for maintaining corneal clarity

A

Keratan sulphate

152
Q

What are saccades

A

Rapid eye movements to change points of fixation
Voluntary or reflexive
Max velocity 900 degrees per second

153
Q

What are smooth pursuits

A

Slow tracking movement to keep target on fovea
Voluntary movement
Max velocity 100 degrees per second

154
Q

What is a type 2 error

A

Failure to reject the null hypothesis even though it is false i.e failing to detect a real difference

155
Q

What is a type 1 error

A

null hypothesis is rejected when it is true i.e finding a difference when there is none

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