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Ophthamology > Physiology > Flashcards

Physiology Flashcards

1
Q

CSF

A

Cerebrospinal Fluid

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2
Q

CSF: Composed mainly of what?

A

Water

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3
Q

CSF: Produced from where?

A

Secretory epithelium of the chorioid plexus

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4
Q

CSF: In the CNS what is the volume of CSF present?

A

150ml

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5
Q

CSF: Function

A

Supplies water, amino acids and ions whilst removing metabolites

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6
Q

CSF: 3 functions

A

Mechanical Protection - shock-absorbing medium that protects brain tissue so that the brain floats within the cranial cavity

Homeostatic Function - pH of the CSF affects pulmonary ventilation and cerebral blood flow to transport hormones

Circulation - medium for minor exchange of nutrients and waste products between the blood and brain tissue

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7
Q

Embryology of the Brain and Ventricular System: At 3 weeks what has developed?

A

The neural canal gives rise to the adult brain and ventricles and the spinal cord central canal

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8
Q

Embryology of the Brain and Ventricular System: The chorioid plexus develops from what?

A

Cells in the walls of the ventricles

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9
Q

Embryology of the Brain and Ventricular System: How is the chorioid fissure formed?

A

Developing arteries invaginate the roof of the ventricle

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10
Q

Embryology of the Brain and Ventricular System: How is the chorioid plexus formed?

A

Involuted ependymal cells along the vessels enlarge into the villi

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11
Q

Embryology of the Brain and Ventricular System: Chorioid plexus in the adult brain is found within what?

A

3rd, 4th and lateral ventricles

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12
Q

Chorioid Plexus

A

Network of capillaries in the walls of the ventricles

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13
Q

CSF Production: Secretion involves the transport of what to where?

A

Ions - Sodium, Chloride and Bicarbonate
Across the epithelium from the blood to the CSF

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14
Q

CSF Production: Secretion is dependent on what?

A

Sodium transport across the cells into the CSF

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15
Q

CSF Production: Electrical gradient with Sodium allows the synchronised transport of what?

A

Cl-

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16
Q

CSF Production: CSF has a lower what (3) than blood plasma?

A

K+
Glucose
Protein

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17
Q

CSF Production: CSF has a higher what (2) than blood plasma?

A

Sodium
Chloride

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18
Q

The Ventricular System: What are the ventricles names?

A

Lateral ventricles
Third Ventricle
Fourth Ventricle

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19
Q

The Ventricular System: CSF Flow - Intraventricular Foramen of Monroe

A

Allows flow from the lateral ventricles to the third ventricle

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20
Q

The Ventricular System: CSF Flow - Cerebral Aqueduct of Sylvius

A

Allows flow from the Third Ventricle to the Fourth Ventricle

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21
Q

The Ventricular System: CSF Flow - Foramen of Magendie

A

Median aperture that allows flow from the Fourth Ventricle to the Subarachnoid Space

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22
Q

The Ventricular System: CSF Flow - Foramina of Luschka

A

Lateral aperture that allows flow from the Fourth Ventricle to the Subarachnoid Space

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23
Q

CSF Circulation: The CSF is originally formed where?

A

Chorioid Plexus of each lateral ventricle

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24
Q

CSF Circulation: Flows from the lateral ventricles to the third ventricle how?

A

Through two narrow openings in the interventricular foramina

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25
Q

CSF Circulation: Where is CSF added in third ventricle?

A

Roof

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26
Q

CSF Circulation: CSF flows from the third ventricle to where and how?

A

Into the fourth ventricle through the cerebral aqueduct of the midbrain

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27
Q

CSF Circulation: CSF enters the subarachnoid space how?

A

Through 3 openings in the roof of the fourth ventricle - single median aperture and paired lateral apertures

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28
Q

CSF Circulation: After the subarachnoid space the CSF circulates into what?

A

Central canal of the spinal cord

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29
Q

CSF Circulation: Where does CSF flow through the subarachnoid space and ventricular system?

A

Between the Pia and Dura Mater

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30
Q

CSF Circulation: CSF returns to venous blood via what?

A

Arachnoid granulations into the superior sagittal sinus

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31
Q

CSF Circulation: Interstitial fluid of the brain is composed mostly of what?

A

Circulating CSF

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32
Q

CSF Circulation: Interstitial fluid of the brain drains to the CSF via what?

A

Perivascular space

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33
Q

Blood Brain Barrier: Structure

A

Highly selective barrier between the systemic circulation and the brains extracellular fluid formed by endothelial cells

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34
Q

Blood Brain Barrier: BBB consists of what three structures?

A

Capillary endothelium
Basal membrane
Perivascular astrocytes

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35
Q

Blood Brain Barrier: Tight junctions between the brain endothelial cells function

A

Prevent paracellular movement of undesirable molecules

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36
Q

Blood Brain Barrier: What cells prevent the crossing of CSF into the blood?

A

End foot of the astrocytes

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37
Q

Blood Brain Barrier: What parts of the brain do not have a BBB?

A

Circumventricular organs
Pineal gland

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38
Q

Blood Brain Barrier: Main function

A

Protect the brain from harmful neurotoxins and helps prevent infection from spreading to the brain

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39
Q

Pathologies of the Ventricles, Chorioid Plexus and CSF: Examples of Tumours (3)

A

Colloid Cyst
Ependymomas
Choroid Plexus Tumours

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40
Q

Pathologies of the Ventricles, Chorioid Plexus and CSF: Colloid Cysts are often found where?

A

At the interventricular foramen

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41
Q

Pathologies of the Ventricles, Chorioid Plexus and CSF: Ependymomas arise from where?

A

Ependymal cells lining the ventricles

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42
Q

Ventricular Haemorrhage

A

Accumulation of blood within the ventricles

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43
Q

Ventricular Haemorrhage: Epidural Haematoma

A

Arterial bleed between the skull and dura mater

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44
Q

Ventricular Haemorrhage: Subdural Haematoma

A

Venous bleed between the dura mater and arachnoid

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45
Q

Hydrocephalus

A

Accumulation of the CSF in the ventricular system or around the brain causing ventricular enlargement and increased CSF pressure

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46
Q

Hydrocephalus: Aetiologies (2)

A

Obstruction of drainage
Overproduction of CSF

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47
Q

Idiopathic Intracranial Hypertension and Pseudotumour Cerebri: What type of condition is this?

A

Enigmatic

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48
Q

Idiopathic Intracranial Hypertension and Pseudotumour Cerebri: Clinical Presentation (2)

A

Headache
Visual disturbances

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49
Q

Idiopathic Intracranial Hypertension and Pseudotumour Cerebri: Why do visual disturbances develop?

A

Papilloedema

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50
Q

Papilloedema

A

Optic disc swelling due to increased intracranial pressure transmitted to the subarachnoid space surrounding the optic nerve

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51
Q

Papilloedema: Clinical Presentation (4)

A

Enlarged blind spot
Blurring of vision
Visual obscurations
Loss of vision

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52
Q

Aqueous Humor

A

Specialised fluid that bathes the structures within the eye

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53
Q

Aqueous Humor: Function

A

Provides oxygen and metabolites

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54
Q

Aqueous Humor: Ascorbate has what function?

A

Powerful antioxidant

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55
Q

Aqueous Humor: What is the function of bicarbonate in this?

A

Buffers the H+ produced in the cornea and lens by anaerobic glycolysis

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56
Q

Aqueous Humor: Produced in an … dependent process?

A

Energy

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57
Q

Aqueous Humor: Produced from what?

A

Epithelial layer of the ciliary body

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58
Q

Aqueous Humor: Secreted into where from the ciliary body?

A

Posterior chamber of the eye then flows to the anterior chamber

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59
Q

Aqueous Humor: Drained into what and how?

A

Into the scleral venous sinus via a trabecular meshwork and the canal of Schlemm

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60
Q

Aqueous Humor: Where is the canal of Schlemm located?

A

In the angle between the iris and cornea iridocorneal angle

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61
Q

Aqueous Humor: Small amount diffuses through what to where?

A

Vitreous to be absorbed across the retinal pigment epithelium

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62
Q

Aqueous Humor: Ionic Composition - Function of Carbonic Anhydrase

A

Hydration of Carbon Dioxide to form Bicarbonate and H+

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63
Q

Aqueous Humor: Ionic Composition - What happens to Bicarbonate and H+?

A

Transported across the basolateral membranes of pigmented epithelial cells into the interstitial fluid in exchange for Chloride and Sodium

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64
Q

Aqueous Humor: Ionic Composition - Cl- and Na+ Ions that enter cells undergo what?

A

Diffusion via gap junctions between pigmented and non-pigmented cells

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65
Q

Aqueous Humor: Ionic Composition - Cl- and Na+ are transported out of non-pigmented cells into aqueous humor how?

A

Na+/K+/2Cl- Transporters

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66
Q

Aqueous Humor: Ionic Composition - K+ ions leaving the cell are recycled how?

A

Na+/K+ pump and Cl- channels

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67
Q

Aqueous Humor: How does water move?

A

AQP1 aquaporins of non-pigmented cells and via the paracellular cell pathway

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68
Q

Glaucoma: Occurs due to what?

A

Increased intra-ocular pressure due to imbalance between the rates of secretion and removal of aqueous humor

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69
Q

Glaucoma: How can we treat this?

A

Carbonic Anhydrase Inhibitors

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70
Q

Glaucoma: How do Carbonic Anhydrase Inhibitors work?

A

Reduce the production of aqueous humor to reduce ocular pressure

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71
Q

Glaucoma: Examples of Carbonic Anhydrase Inhibitors (2)

A

Dorzolamide
Acetazolomide

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72
Q

Ciliary Epithelium: The ciliary body and posterior surface of the iris is covered by what?

A

Two juxtaposed layers of epithelial cells:
1. Forward continuation of the pigment epithelium of the retina
2. Inner non-pigmented epithelial layer

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73
Q

Microbiology: Bacterial Conjunctivitis - Causative organisms in neonates (3)

A

Staphylococcus aureus
Neisseria gonorrhoea
Chlamydia trachomatis

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74
Q

Microbiology: Bacterial Conjunctivitis - Causative Organisms in patients that are not neonates (3)

A

Staphylococcus aureus
Streptococcus pneumoniae
Haemophilus influenzae

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75
Q

Microbiology: Bacterial Conjunctivitis - Management options (3)

A

Topical Antibiotics - Chloramphenicol, Fusidic Acid and Gentamicin

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76
Q

Microbiology: Bacterial Conjunctivitis - Chloramphenicol does not manage what bacteria?

A

Pseudomonas aeruginosa

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77
Q

Microbiology: Bacterial Conjunctivitis - Chloramphenicol is avoided in what cases? (2)

A

Allergy
Aplastic anaemia

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78
Q

Microbiology: Bacterial Conjunctivitis - Chloramphenicol Effective against what bacteria? (3)

A

Streptococcus
Staphylococcus
Haemophilus influenza

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79
Q

Microbiology: Bacterial Conjunctivitis - Chloramphenicol has a risk of what side effect?

A

Gray Baby if the dose is too high

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80
Q

Microbiology: Bacterial Conjunctivitis - Chloramphenicol why does this present with Gray Baby?

A

Neonata cannot process the drug as the liver is immature and can cause hypotension

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81
Q

Microbiology: Bacterial Conjunctivitis - Fusidic Acid treats what bacteria?

A

Staphylococcus aureus

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82
Q

Microbiology: Bacterial Conjunctivitis - Gentamicin treats what bacteria?

A

Coliforms
Pseudomonas aeruginosa

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83
Q

Microbiology: Viral Conjunctivitis - Causative organisms (3)

A

Adenovirus
Herpes simplex
Herpes zoster

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84
Q

Microbiology: Viral Conjunctivitis - Management

A

Ganciclovir

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85
Q

Microbiology: Viral Conjunctivitis - Ganciclovir Mechanism of Action

A

Inhibits viral DNA synthesis as base analogue mimics Guanine

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86
Q

Microbiology: Viral Conjunctivitis - Ganciclovir application

A

Used for dendritic ulcers of the cornea

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87
Q

Microbiology: Chlamydial Conjunctivitis - Management

A

Topical Oxytetracycline

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88
Q

Microbiology: Chlamydial Conjunctivitis - Suspect in what cases?

A

Bilateral conjunctivitis in young children

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89
Q

Microbiology: Chlamydial Conjunctivitis - May have what complication?

A

Subtarsal scarring

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90
Q

Microbial Keratitis: Bacterial Keratitis - Why is admission required?

A

For hourly drops

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91
Q

Microbial Keratitis: Bacterial Keratitis - Usually associated with what? (2)

A

Corneal pathology
Contact lens wearing

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92
Q

Microbial Keratitis: Bacterial Keratitis - Management options (2)

A

4-Quinolone e.g Ofloxacin
Gentamicin + Cefuroxime

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93
Q

Microbial Keratitis: Bacterial Keratitis - 4-Quinolones does not treat what bacteria?

A

Streptococcus pneumoniae

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94
Q

Microbial Keratitis: Herpetic Keratitis - If recurrent can result in what?

A

Reduced corneal sensation

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95
Q

Microbial Keratitis: Herpetic Keratitis - Management

A

Topical Antiviral Ganciclovir

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96
Q

Microbial Keratitis: Herpetic Keratitis - Risk of Ganciclovir management

A

Can cause corneal melt and perforation of the cornea

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97
Q

Microbial Keratitis: Adenoviral Keratitis - Usually follows what? (2)

A

URTI
Conjunctivitis

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98
Q

Microbial Keratitis: Adenoviral Keratitis - Management

A

May require steroids to speed up recovery if chronic

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99
Q

Microbial Keratitis: Fungal Keratitis - Seen in what patients? (2)

A

Those who work outside
Ocular surface disease

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100
Q

Microbial Keratitis: Fungal Keratitis - Management

A

Topical Anti-fungals - Natamycin or Amphotericin

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101
Q

Keratitis: Causative amoebic organism

A

Acanthomoeba

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102
Q

Keratitis: Management if Acanthomoeba causative organism (3)

A

Polyhexamethylene Biguanide
Propamide Brolene
Chlorhexadine

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103
Q

Pre-Septal Cellulitis: Often associated with what structures?

A

Paranasal snuses

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104
Q

Pre-Septal Cellulitis: Diagnostic test

A

CT scan to identify orbital abscesses

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105
Q

Pre-Septal Cellulitis: Clinical Presentation (4)

A

Painful
Proptosis - bulging of one or both eyes
Pyrexial
Sight Threatening

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106
Q

Orbital Cellulitis: Direct extension from what?

A

The sinus or focal orbital infection

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107
Q

Orbital Cellulitis: When is a scan required?

A

Any suggestion of restriction of the muscles or optic nerve dysfunction

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108
Q

Orbital Cellulitis: Management

A

Broad spectrum antibiotics - if an abscess is present this requires drainage

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109
Q

Endophthalmitis

A

Infection of the inside of the eye

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110
Q

Endophthalmitis: Clinical Presentation (3)

A

Painful
Decreasing vision
Incredibly red eye

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111
Q

Endophthalmitis: Management

A

Intraviteal - Amikacin or Ceftazidime or Vancomycin
Topical antibiotics

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112
Q

Endophthalmitis: Most common Causative Organism

A

Staphylococcus epidermidis

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113
Q

Chorioretinitis: When does Cytomegalovirus Retinitis present?

A

During AIDS

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114
Q

Chorioretinitis: Viral aetiologies (2)

A

Herpes Simplex Virus
Herpes Zoster Virus

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115
Q

Chorioretinitis: Fungal aetiologies

A

Candida

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116
Q

Chorioretinitis: Parasitic aetiologies (2)

A

Toxoplasma gondii
Toxocara canis

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117
Q

HSK-HSV Chorioetinitis: Alternate Name

A

Acute Retinal Necrosis

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118
Q

Chorioetinitis: Endogenous Type is caused by what?

A

Candida and Aspergillus

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119
Q

Chorioetinitis: Endogenous Type - Associated with what? (2)

A

Bacterial endocarditis
Indwelling catheters

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120
Q

Chorioetinitis: Endogenous Type - How is this diagnosed?

A

Imaging shows Roth spots with disseminated embolic bacterial abscesses

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121
Q

Chorioetinitis: Toxoplasmosis - Causative organism

A

Toxoplasmosis gondii

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122
Q

Chorioetinitis: Toxoplasmosis - Aetiologies (2)

A

Contaminated soil
Undercooked meat

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123
Q

Chorioetinitis: Toxoplasmosis - Clinical presentation

A

Mild Flu-like illness followed by cyst formation in the latent phase

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124
Q

Chorioetinitis: Toxoplasmosis - Management when sight threatening (2)

A

Clindamycin
Azithromycin

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125
Q

Chorioetinitis: Toxocara Canis - Description of the organism

A

Parasitic nemotode that affects cats and dogs

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126
Q

Chorioetinitis: Toxocara Canis - Unable to do what in humans?

A

Replicate

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127
Q

Chorioetinitis: Toxocara Canis - How does this cause irreversible vision loss?

A

Forms granulomas

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128
Q

Chorioetinitis: Toxocara Canis - Diagnostic test

A

ELISA test on the serum

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129
Q

Antibiotics: Chloramphenicol - Mechanism of action

A

Inhibits Peptidyl Transferase Enzyme

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130
Q

Antibiotics: Chloramphenicol - Bacteriocidal action on what bacteria? (2)

A

Streptococcus
Haemophilus influenzae

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131
Q

Antibiotics: Chloramphenicol - Bacteriostatic action on what bacteria?

A

Staphylococcus

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132
Q

Antibiotics: Chloramphenicol - Side effects (3)

A

Allergy
Irreversible Aplastic Anaemia
Gray baby syndrome

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133
Q

Antibiotics: Inhibition of Cell Wall Synthesis - Two Types

A

Penicillins
Cephalosporins

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134
Q

Antibiotics: Inhibition of Cell Wall Synthesis - Used for what bacteria in Dacrocystitis? (2)

A

Streptococcus pyogenes
Staphylococcus aureus

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135
Q

Antibiotics: Inhibition of Nucleic Acid Synthesis - Example of type of drug

A

Quinolones - Ofloxacin

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136
Q

Vision: The pattern of the object must fall onto what?

A

The vision receptors - rods and cones

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137
Q

Vision: The pattern of the object must fall onto the vision receptors to enable what?

A

Accomodation

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138
Q

The Visual Field: How is binocular visual field generated?

A

Monocular visual fields (+/- 45 degrees) are overlapped

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139
Q

The Visual Field: The retina is divided in half relative to what?

A

The fovea

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140
Q

The Visual Field: Two halves of the visual field retina

A

Nasal hemiretina
Temporal hemiretina

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141
Q

The Visual Field: What happens to the nerve fibres of the nasal hemiretina?

A

Crosses at the optic chiasma

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142
Q

Visual Field: Visual Field Mapping involves what structures? (4)

A

Retina
Lateral Geniculate Nucleus
Superior Colliculus
Cortex

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143
Q

Visual Field: Why is the central field over-represented?

A

As the magnification factor is not constant

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144
Q

Visual Field: Primary Visual Cortex - In this the eye-specific inputs are segregated where?

A

Layer 4

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145
Q

Visual Field: Primary Visual Cortex - At the primary visual area vision is largely segregated into what?

A

Ocular dominance columns

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146
Q

Visual Field: Primary Visual Cortex - Each column in the primary visual area is dominated by what?

A

Input from one of the two eyes

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147
Q

Visual Field: Primary Visual Cortex - Cells outside of layer 4 receive input from where?

A

Both eyes

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148
Q

Visual Perception: Ambylopia can be caused by what from infancy?

A

Strabismus - wandering eye

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149
Q

Hebb’s Postulate

A

When the axon of cell A is near enough to excite cell B and is repeatedly fired, growth and metabolic changes cause increased efficiency in cell A

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150
Q

Retina: Direct Pathway Stages (3)

A
  1. Photoreceptors
  2. Bipolar Cells
  3. Ganglion Cells
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151
Q

Retina: Function of horizontal cells

A

Receive input from photoreceptors and project to other photoreceptors and bipolar cells

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152
Q

Retina: Function of amacrine cells

A

Receive input from bipolar cells and project to ganglion cells, bipolar cells and other amacrine cells

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153
Q

Photoreceptors: Two types

A

Rods
Cones

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154
Q

Photoreceptors: Function

A

Converts electromagnetic radiation to neural signals via transduction

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155
Q

Photoreceptors: Four regions

A

Outer segment
Inner segment
Cell body
Synaptic terminal

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156
Q

Photoreceptors: Phototransduction - The resting membrane potential is …

A

Depolarised

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157
Q

Photoreceptors: Phototransduction - Resting Membrane Potential (mV)

A

-20 mV

158
Q

Photoreceptors: Phototransduction - On light exposure what happens to Vm?

A

Hyperpolarises

159
Q

Photoreceptors: Phototransduction - In the dark what happens to Vm?

A

It is positive

160
Q

Photoreceptors: Phototransduction - Why is Vm positive when its dark?

A

cGMP-gated Na+ channel is open

161
Q

Photoreceptors: Modulation of the Dark Current - In the Dark the Outer segment Sodium Potential is what?

A

Equal to the potassium potential - therefore Vm is between ENa and EK

162
Q

Photoreceptors: Modulation of the Dark Current - In the Light the Outer Segment Sodium Potential is what?

A

Reduced - as the channels close on the outer segment so ENa<EK

163
Q

Photoreceptors: Modulation of the Dark Current - In the light the Outer Segment is …

A

Hyperpolarised

164
Q

Photoreceptors: Visual Pigment Molecules - What is present on Rods?

A

Rhodopsin

165
Q

Photoreceptors: Visual Pigment Molecules - Rhodopsin is composed of what?

A

Retinal - Vitamin A derivative
Opsin - G-protein coupled receptor

166
Q

Photoreceptors: Visual Pigment Molecules - Rhodopsin is present where?

A

In the membrane folds of the discs of the outer segment

167
Q

Photoreceptors: Visual Pigment Molecules - Light enables what reaction in Rhodopsin?

A

11-cis-Retinal to All-Trans-Retinal (active form)

168
Q

Phototransduction: Molecular mechanism (4 stages)

A
  1. All-trans-Retinal activates Transducin
  2. Molecular cascades causes reduced cGMP
  3. Closure of cGMP-gated Na+ Channels
  4. Lowered Na entry results in hyperpolarisation
169
Q

Phototransduction: Dark Current Channel - What state is it in in the dark?

A

Open

170
Q

Phototransduction: Dark Current Channel - What state is it in in the light?

A

Opened by cGMP

171
Q

Phototransduction: Dark Current Channel - Permeable to what?

A

Sodium

172
Q

Phototransduction: Dark Current Channel - Enables steady release of what?

A

Glutamate

173
Q

Phototransduction: Dark Current Channel - Relationship between Glutamate and Light

A

Glutamate decreases with light

174
Q

Visual Acuity

A

Ability to distinguish two nearby points

175
Q

Visual Acuity: Determined by what two factors?

A

Photoreceptor spacing
Refractive power

176
Q

Visual Acuity: Rod function

A

Enable vision in dim light

177
Q

Visual Acuity: Cone function

A

Enable vision in day light

178
Q

Visual Acuity: Why does the rod system decrease acuity?

A

More convergence

179
Q

Colour Vision: Cannot see what light ranges?

A

Infrared
UV range

180
Q

Rods: Does it detect colour?

A

No its achromatic

181
Q

Rods: Convergence is (high/low)

A

High

182
Q

Rods: Level of light sensitivity

A

High

183
Q

Rods: Level of visual acuity

A

Low

184
Q

Cones: Does it detect colour?

A

Yes - chromatic

185
Q

Cones: High density where?

A

Fovea

186
Q

Cones: Level of convergence

A

Low

187
Q

Cones: Level of light sensitivity

A

Low

188
Q

Cones: Level of visual acuity

A

High

189
Q

Immunology: Basic Immune responses for the eye (3)

A

Blink reflex
Physical and chemical properties of the eye surface
Limit exposure and size of the eye

190
Q

Immunology: Blink Reflex - Function

A

Tears enable flushing of the eye

191
Q

Immunology: Blink Reflex - Mucous layer acts as a what?

A

Anti-adhesive

192
Q

Immunology: Chemical Protection - 7 components of the tears

A

Lysozyme
Lactoferrin and Transferrin
Lipids
Angiogenin
Secretory IgA
Complement system
IL-6 -8 and MIP

193
Q

Immunology: Chemical Protection - Function of Lysozyme

A

Protective against Gram Negative bacteria and Fungi

194
Q

Immunology: Chemical Protection - Function of Lactoferrin and Transferrin

A

Protective against Gram positive bacteria

195
Q

Immunology: Chemical Protection - Function of tear lipids

A

Anti-bacterial to cell membranes

196
Q

Immunology: Chemical Protection - Function of Angiogenin

A

Anti-microbial effect within the tear film

197
Q

Immunology: Chemical Protection - Function of IL-6 -8 and MIP

A

Anti-microbial products that recruit leukocytes

198
Q

Immunology: Immune Cells - Function of Neutrophils

A

Attracted by chemotaxis to the site to release Free radicals and enzymes

199
Q

Immunology: Immune Cells - Function of Macrophages

A

Phagocytosis of damaged cells to aid the activation of adaptive immune system

200
Q

Immunology: Immune Cells - Function of Conjunctival Mast Cells

A

Vasoactive mediators

201
Q

Immunology: What is the main Antigen Presenting Cell of the External Eye?

A

Langerhans Cells

202
Q

Immunology: Langerhans Cells are rich in what molecules?

A

Class II MHC

203
Q

Immunology: Langerhans Cells - Abundant in what location?

A

Corneo-scleral limbus

204
Q

Immunology: Langerhans Cells - Absent from what location?

A

Central third of the cornea

205
Q

Immunology: Conjunctiva - The only part of the eye with what?

A

Lymphatic drainage

206
Q

Immunology: Conjunctiva - What is present within this area in conjunctival zones?

A

Diffuse lymphoid populations

207
Q

Immunology: Conjunctiva - What Lymphocytes are present?

A

CD4+ T cells
CD8+ T cells
IgA-secreting plasma cells

208
Q

Immunology: Conjunctiva - What cells acts as APCs here?

A

Dendritic cells

209
Q

Immunology: Conjunctiva - What is present in the MALT?

A

Macrophages
Langerhans Cells
Mast cells
Neutrophils and Eosinophils - if recruited

210
Q

Immunology: Cornea and Sclera - What is the structure here?

A

Tough collagen coat

211
Q

Immunology: Cornea and Sclera - Is there a blood supply?

A

No

212
Q

Immunology: Cornea and Sclera - Langerhans cells are only present where?

A

Peripheral cornea

213
Q

Immunology: Lacrimal Gland - Has more of what compared to the conjunctiva?

A

Plasma cells and CD8+ T cells

214
Q

Immunology: Lacrimal Drainage System - What is present here?

A

Diffuse lymphoid tissue and follicles in MALT

215
Q

Immune Privilege: Advantage

A

Tolerate the introduction of antigens without eliciting an inflammatory immune response

216
Q

Immune Privilege: Examples of sites with Immune Privilege (4)

A

Brain or CNS
Testes
Placenta and Foetus
Eyes

217
Q

Immune Privilege: Sites in the Eye that are Immune Privileged (5)

A

Cornea
Anterior chamber
Lens
Vitreous chamber
Sub-retinal space

218
Q

Immune Privilege: ACAID

A

Anterior Chamber Associated Immune Deviation

219
Q

Hypersensitivity Reactions: Occular Example of Type I

A

Acute Allergic Conjunctivitis

220
Q

Hypersensitivity Reactions: Occular Example of Type II

A

Ocular Cicatricial Pemphigoid

221
Q

Hypersensitivity Reactions: Occular example of Type III

A

Autoimmune corneal melting

222
Q

Hypersensitivity Reactions: Occular example of Type IV

A

Corneal Graft Rejection - vascularisation of the host cornea reaching the donor tissue results in graft rejection

223
Q

Corneal Transplants: Factors that help maintain immune privilege - Why is the net antigenic load is reduced?

A

Reduced and impaired expression of MHC Class I and II

224
Q

Corneal Transplants: Factors that help maintain immune privilege - The cornea lacks what two structures?

A

Blood
Lymph vessels

225
Q

Corneal Transplants: Factors that help maintain immune privilege - Central cornea is deficient of what?

A

Langerhans Cells

226
Q

Corneal Transplants: Factors that help maintain immune privilege - Secretion of what?

A

Immunosuppressive properties

227
Q

Meninges

A

Protective coverings of the brain and spinal cord

228
Q

Meninges: Dura Mater - Sensory supply

A

CN V

229
Q

Meninges: Dura Mater - Function

A

Encloses the dural venous sinuses

230
Q

Meninges: Sub-Arachnoid Space - What is present here? (2)

A

Circulating CSF
Blood vessels

231
Q

Meninges: Pia Mater - Function

A

Adheres to the brain, nerves and vessels

232
Q

Sub-Arachnoid Space: Location

A

Between the arachnoid and pia mater

233
Q

Sub-Arachnoid Space: Contains what?

A

CSF

234
Q

Sub-Arachnoid Space: CSF can be accessed where?

A

Lumbar puncture at L3/4 or L4/5 intervertebral disc

235
Q

Sub-Arachnoid Space: Ends where?

A

S2

236
Q

Raised Intra-Ocular Pressure: Increase in pressure within the cranial cavity due to what? (2)

A

Increased pressure in fluid surrounding the brain
Increase in pressure within the pressure

237
Q

Raised Intra-Ocular Pressure: 3 components of the cranial cavity

A

Brain
Blood Volume
CSF

238
Q

Raised Intra-Ocular Pressure: Monro-Kellie Hypothesis

A

Increasing the volume of one of the three components increases the volume of the other two must increase to maintain the equilibrium

239
Q

The Optic Nerve: Raised Intra-cranial pressure is transmitted along what?

A

The sub-arachnoid space in the optic nerve sheath

240
Q

The Optic Nerve: Compression of the optic nerve may also compress what? (2)

A

Central artery
Vein of the retina

241
Q

The Optic Nerve: Compression of the optic nerve can lead to?

A

Papilloedema - leads to bulging or swollen optic discs when caused by raised ICP

242
Q

The Optic Nerve: Symptoms of the Optic Nerve Compression (5)

A

Transient visual obscurations
Transient flickering
Blurring of vision
Constriction of the visual field
Decreased colour perceptio

243
Q

The Oculomotor Nerve: Raised ICP can compress the oculomotor nerve when?

A

If the medial temporal lobe herniates through the tentorial notch

244
Q

The Oculomotor Nerve: Compression causes what? (2)

A

Paralysis of somatic motor innervation to the 4 extra-ocular muscles and eye lid

Paralysis of parasympathetic innervation of the sphincter of the pupil

245
Q

The Oculomotor Nerve: Clinical Presentation of compression (4)

A

Loss or slowing of pupillary light reflex
Dilated pupil
Ptosis
Eye turned inferolaterally - due to unopposed actions of lateral rectus and superior oblique

246
Q

The Trochlear Nerve: Emerges from where?

A

Midbrain

247
Q

The Trochlear Nerve: Supplies what meninges?

A

Dura mater

248
Q

The Trochlear Nerve: Compression can result in what?

A

Paralysis of the superior oblique muscle

249
Q

The Trochlear Nerve: Clinical Presentation

A

Diplopia when looking down - inferior oblique is unopposed so cannot move inferomedially

250
Q

The Abducens Nerve: Susceptible to what type of damage?

A

Stretching

251
Q

The Abducens Nerve: Complication of stretching

A

Paralysis of lateral rectus muscle

252
Q

The Abducens Nerve: Clinical presentation of stretching

A

Eye cannot move laterally in the horizontal plane - medial deviation of the eye

253
Q

Dural Septae

A

Folds of the dura mater that creates a septa in the cranial cavity

254
Q

Dural Septae: Divides the cranial cavity into what four sections?

A

Falx Cerebri
Tentorium Cerebelli
Falx Cerebelli
Diaphragma Sellae

255
Q

Mechanisms of Ocular Trauma (3)

A

Blunt trauma
Penetrating trauma
Burns - chemical, physical or thermal

256
Q

Blunt Trauma: Blow Out Fractures - Mechanism

A

Fracture to one of the walls of the orbit but the orbital rim remains intact

257
Q

Blunt Trauma: Blow Out Fractures - What type are most common?

A

Inferior blowout fractures

258
Q

Blunt Trauma: Blow Out Fractures - In an inferior blowout fracture what happens?

A

Orbital fat prolapses into the maxillary sinus that may be joined by prolapse of the inferior rectus muscle

259
Q

Blunt Trauma: Blow Out Fractures - How may inferior blow out affect vision?

A

Diplopia

260
Q

Hyphaemia

A

Blood in the anterior chamber

261
Q

Hyphaemia is a sign of what?

A

Intra-ocular trauma

262
Q

Sub-conjunctival Haemorrhage: Mechanism

A

One of the small blood vessels within the conjunctiva ruptures to release blood into the space between the sclera and conjunctiva

263
Q

Sub-conjunctival Haemorrhage: Management

A

Self resolving within 2 weeks

264
Q

Penetrating Trauma

A

Injury that penetrates the cornea or the sclera

265
Q

Penetrating Trauma: Types of injury caused by small objects? (5)

A

Sub-tarsal
Conjunctival
Corneal
Intra-ocular
Intra-orbital

266
Q

Penetrating Trauma: What do intra-ocular injuries require?

A

X-ray for potential intra-ocular foreign bodies

267
Q

Penetrating Trauma: Signs of a Penetrating Foreign Body (4)

A

Irregular pupil
Shallow anterior chamber
Localised cataract
Gross inflammation

268
Q

Sympathetic Opthalmia

A

Penetrating injury to one eye that results in the exposure of intra-ocular antigens for auto-immune reactions in both eyes

269
Q

Sympathetic Opthalmia: Complication

A

Bilateral blindness

270
Q

Burns: Alkali - Pathological changes (2)

A

Cicatrising changes to the conjunctiva and cornea
Can change the pH of the entire eye

271
Q

Burns: Alkali - Is penetration easy?

A

Yes

272
Q

Burns: Acid - Is penetration easy?

A

No

273
Q

Burns: Acid - Impact on proteins

A

Causes coagulation

274
Q

Burns: Complications (4)

A

Limbal ischaemia
Corneal scarring
Corneal vascularisation
End stage scarring

275
Q

Average diameter of the optic nerve

A

1.5 mm

276
Q

The Optic Nerve: What are the 3 C’s?

A

Contour
Colour
Cup

277
Q

The Optic Nerve: What happens to the disc in Disc Drusen?

A

Disc margin appears blurred

278
Q

The Optic Nerve: Colour

A

Orange with a pale centre

279
Q

The Optic Nerve: Aetiologies of changes in colour (5)

A

Glaucoma
Optic neuritis
Arteric ischaemic optic neuropathy
Non-arteritic ischaemic optic neuropathy
Compressive lesion

280
Q

The Optic Nerve: Disc - why is it pale?

A

Devoid of neuroretinal tissue

281
Q

The Optic Nerve: Normal Cup:Disc ration?

A

0.3

282
Q

The Optic Nerve: What does an increase in cup:disc ratio suggest?

A

Decrease in the quantity of healthy neuroretinal tissue

283
Q

Visual Pathologies: Homonymous

A

Same part of the field in each eye

284
Q

Visual Pathologies: Hemianopic

A

Half of the field is affected

285
Q

Visual Pathologies: Quadrantanopic

A

Quarter of the field is affected

286
Q

Visual Pathologies: Most common cause of Quadrantanopic pathology

A

Occipital lobe stroke

287
Q

Visual Pathologies: Inferior quadrantic defect due to what?

A

Parietal lobe defect

288
Q

Visual Pathologies: Superior quadrantic defect due to what?

A

Temporal lobe defect

289
Q

What is given after a foreign body is removed from the eye?

A

Chloramphenicol ointment

290
Q

Systemic Disease: Myotonic Dystrophy

A

Difficulty in releasing grip

291
Q

Systemic Disease: Myotonic Dystrophy - Genetics

A

Autosomal dominant mutation of the dystrophica myotonica protein kinase gene

292
Q

Systemic Disease: Myotonic Dystrophy - Common ocular presentations (3)

A

Early onset cataracts
Ptosis
Hypermetropia

293
Q

Systemic Disease: Myotonic Dystrophy - Uncommon Ocular Presentations (4)

A

Mild ophthalmoplegia
Pupillary light-near dissociation
Pigmentary retinopathy
Optic atrophy

294
Q

Systemic Disease: Neurofibromatosis Type I - Ocular presentation (2)

A

Optic glioma - causes an afferent pupillary defect with globe proptosis
Two or more Lisch Nodules - bilateral yellow or brown shaped nodules

295
Q

Systemic Disease: Thyroid Eye Disease - Pathophysiology

A

Inflammation. ofthe eye muscles and orbital fat causes fluid retention and swelling of the eye

296
Q

Systemic Disease: Thyroid Eye Disease - Appearance (4)

A

Peri-orbital swelling
Prominent eyes - lid retraction with proptosis
Kocher Sign - frightened appearance of eyes
Conjunctival injection

297
Q

Systemic Disease: Thyroid Eye Disease - Symptoms of soft tissue involvement (3)

A

Grittiness
Photophobia
Lacrimation

298
Q

Systemic Disease: Thyroid Eye Disease - Signs of soft tissue involvement (3)

A

Hyperaemia
Chemosis
Periorbital swelling

299
Q

Systemic Disease: Thyroid Eye Disease - Proptosis complications

A

Keratopathy causing corneal ulceration

300
Q

Systemic Disease: Thyroid Eye Disease - Optic Neuropathy complications (2)

A

Reduced colour vision
Vision with RAPD

301
Q

Systemic Disease: Dermatomyositis - Ocular presentation (3)

A

Bilateral lilac eyelid discolouration - heliotropic rash
Swelling of the eyelids and periorbital skin
Dry eyes and scleritis

302
Q

Systemic Disease: Marfan Syndrome - Genetics

A

Autosomal dominant mutation of the fibrillin-1 gene

303
Q

Systemic Disease: Marfan Syndrome - Ocular presentation

A

Dislocated Lens - ectopia lentis

304
Q

Systemic Disease: Rheumatoid Arthritis - Corneal findings (2)

A

Scleromalacia perforans
Peripheral ulcerative keratitis

305
Q

Systemic Disease: What diseases present with Mutton-Fat Keratic Precipitates (Granulomatous Anterior Uveitis) (3)

A

Sarcoidosis
TB
Syphillis

306
Q

Systemic Disease: Infective Causes of Uveitis (6)

A

TB
Herpes Zoster
Toxoplasmosis
Candidiasis
Syphillis
Lyme Disease

307
Q

Systemic Disease: Non-infective causes of Uveitis (4)

A

HLA-B27
Juvenile Arthritis
Sarcoidosis
Behcet’s Disease

308
Q

Systemic Disease: Causes of Vortex Keratopathy (4)

A

Amiodarone
Hydroxychloroquine
Chloropromazine
Fabry Disease

309
Q

Systemic Disease: Causes of Bulls Eye Maculopathy (2)

A

Hydroxychloroquine
Chloroquine

310
Q

Systemic Disease: Causes of Symbelpharon (3)

A

SJS - Sulfa drugs and penicillin
Ocular cicatricial pemphigoid
Chemical injury

311
Q

Systemic Disease: Impact on the eye with Steroid use

A

Raised intraocular pressure

312
Q

The Retina: How many layers?

A

9

313
Q

The Retina: Diabetic Retinopathy - 3 Types

A

Non-proliferative Diabetic Retinopathy
Proliferative Diabetic Retinopathy
Diabetic Macular Oedema

314
Q

The Retina: Non-Proliferative Diabetic Retinopathy - 5 signs on examination

A

Micro-aneurysms
Hard exudates
Intra-retinal haemorrhages
Cotton wool spot
Venous beading

315
Q

The Retina: Proliferative Diabetic Retinopathy - 2 signs on examination

A

Neovascularisation
Vitreous haemorrhage and traction

316
Q

The Retina: Proliferative Diabetic Retinopathy - Clinical Presentation (2)

A

Floaters
Severe visual loss

317
Q

The Retina: Proliferative Diabetic Retinopathy - Management

A

Immediate ophthalmologic consultation

318
Q

The Retina: Diabetic Retinopathy - Management for CSME (Clinically-significant Macular Oedema)

A

Focal macular laser

319
Q

The Retina: Diabetic Retinopathy - Management for Proliferative Diabetic Retinopathy

A

Panretinal Photocoagulation

320
Q

The Retina: Diabetic Retinopathy - Management for Vitreous Haemorrhage or Retinal Detachment

A

Vitrectomy

321
Q

The Retina: Diabetic Retinopathy - Management for Diabetic Macular Oedema

A

Anti-VEGF

322
Q

who do i love

A

kirsten <3

323
Q

Normal Axial Length

A

> 26 mm

324
Q

Normal Spherical Equivalent

A

<8.00 D

325
Q

Posterior Vitreous Detachment: 3 classifications

A

Break
Hole
Tear

326
Q

Posterior Vitreous Detachment: Break

A

Full-thickness defect in the Sensory Retina

327
Q

Posterior Vitreous Detachment: Hole occurs due to what?

A

Chronic Retinal Atrophy

328
Q

Posterior Vitreous Detachment: Tear occurs due to what?

A

Dynamic vitreoretinal traction

329
Q

Retinal Detachment

A

Separation of the sensory retina from the RPE by sub-retinal fluid

330
Q

Retinal Detachment: Rhgmatogenous occurs due to what?

A

Retinal break

331
Q

Retinal Detachment: Two components of retinal break formation

A

Acute posterior vitreous detachment
Predisposing peripheral retinal degeneration

332
Q

Fresh Rhegmatogenous Retinal Detachment: Presentation (5)

A

Convex deep mobile elevation that extends to the ora serrata
Slightly opaque retina
Dark blood vessels
Loss of choroidal pattern
Retinal breaks

333
Q

Exudative Retinal Detachment

A

Damage to the RPE by subretinal disease that allows the passage of fluid from the coroid into the subretinal space

334
Q

Exudative Retinal Detachment: Aetiologies - Intraocular Inflammation (2)

A

Harada disease
Posterior scleritis

335
Q

Exudative Retinal Detachment: Aetiologies - Systemic (2)

A

Toxoaemia of Pregnancy
Hypoproteinaemia

336
Q

Exudative Retinal Detachment: Aetiologies - Iatrogenic (2)

A

RD surgery
Excess retinal photocoagulation

337
Q

Exudative Retinal Detachment: Signs (3)

A

Convex with smooth elevation
Mobile and deep with shifting fluid
Subretinal pigment after flattening

338
Q

Central Retinal Artery Occlusion: Impact

A

Severe vision loss

339
Q

Central Retinal Artery Occlusion: Leading cause of death in these patients?

A

Cardiovascular disease

340
Q

Central Serous Chorioretinopathy: Typical Patient

A

Healthy 30-50 year old male

341
Q

Central Serous Chorioretinopathy: Most common angiographic finding

A

Small focal hyperfluorescent RPE leak with a smokestack

342
Q

Epiretinal Membrane: Mainly associated with what disease?

A

PVD

343
Q

Epiretinal Membrane: Two stages

A

Subretinal fluid
Cystic

344
Q

Epiretinal Membrane: Features (3)

A

Metamorphopsia
Decreased acuity
Retinal striae

345
Q

Vitreomacular Traction: Features (4)

A

Metamorphopsia
Decreased vision
Partial posterior vitreous detachment
Vitreous traction on the macula with subretinal fluid accumulation

346
Q

Macular Hole: Ia Staging

A

Foveolar detachment

347
Q

Macular Hole: II Staging

A

Full thickness defect less than 400 micrometers

348
Q

Macular Hole: III Staging

A

Full thickness defect more than 400 micrometers with no PVD

349
Q

Macular Hole: IV Staging

A

III with PVD

350
Q

Cystoid Macular Oedema

A

Fluid collection in the outer plexiform

351
Q

Emmetropia

A

No refractive error - the light is focused on to the retina

352
Q

Ametropia

A

Refractive error is present - the light is focused behind or in front of the retina

353
Q

Anisometropia

A

Significant difference between the right and left ametropia

354
Q

Myopia

A

Light is focused in front of the retina

355
Q

Myopia: Impact on distance targets?

A

Blurred

356
Q

Myopia: Impact on close targets?

A

None

357
Q

Myopia: What lenses are required?

A

Negative - image magnification required

358
Q

Hypermetropia

A

Light is focused behind the retina

359
Q

Hypermetropia: Impact on distant vision?

A

Nothing

360
Q

Hypermetropia: Impact on near vision?

A

Blurred

361
Q

Hypermetropia: Lenses

A

Positive - image magnification required

362
Q

Astigmatism

A

Eye has unequal refractive powers at different meridia to cause a distorted vision

363
Q

Astigmatism: Lenses required

A

Cylindrical lenses

364
Q

Presbyopia

A

Reduction in the ability of the eye to accomodate for close-work with age

365
Q

Presbyopia: Requires what lens?

A

Supplementary converging or positive lens to focus on light from a near object onto the retina

366
Q

Vision

A

Smallest letter on a chart that a patient can read without the aid of spectacles or contact lenses

367
Q

Visual acuity

A

Smallest letter on the chart a patient can read with the best spectacle or contact lens correction

368
Q

Pinhole Acuity

A

The smallest letter visible when viewing through a pinhole

369
Q

The appearance of the retina with an arterial occlusion

A

Pale

370
Q

The appearance of the retina with a vein occlusion

A

Dark red/purple

371
Q

ARMD

A

Age-related macular degeneration

372
Q

Causes of Sudden Visual Loss (6)

A

Vascular occlusion - retinal artery, vein or optic nerve head circulation
Haemorrhage
Vitreous haemorrhage
Retinal detachment
Age Related Macular Degeneration - Wet Type
Closed angle glaucoma

373
Q

Aetiologies of Gradual Vision Loss (5)

A

Cataract
Age Related Macular Degeneration - Dry Type
Refractive error
Glaucoma
Diabetic Retinopathy

374
Q

VIth Nerve Palsy: Four main causes

A

Microvascular
Raised intracranial pressure
Tumour
Congenital

375
Q

VIth Nerve Palsy: Pathophysiology

A

False localising sign and as the pressure increases the brain descends to push the sixth nerve over the edge of the petrous bone

376
Q

VIth Nerve Palsy: Clinical Presentation (3)

A

Papilloedema
Lateral Rectus Palsy - the impacted eye cannot abduct as medial rectus
Double vision

377
Q

IVth Nerve Palsy: Aetiologies (4)

A

Congenital Decompensated
Microvascular
Tumour
Bilateral - due to closed head trauma

378
Q

IVth Nerve Palsy: Clinical Presentation (3)

A

Superior Oblique Muscle Plasy - causes intorsion and depression whilst in adduction of the eye and abduction is weak
Vertical double vision
Head Tilt due to incyclo-torsion to compensate vision (tilted to impacted eye)

379
Q

IVth Nerve Palsy: Clinical Presentation due to blunt head trauma (3)

A

Torsion
Chin is depressed
Asthenopia

380
Q

IIIrd Nerve Palsy: Two branches of the nerve

A

Superior
Inferior

381
Q

IIIrd Nerve Palsy: Aetiologies (5)

A

Microvascular
Tumour
Aneurysm - causes a blown pupil
Multiple Sclerosis
Congenital

382
Q

IIIrd Nerve Palsy: Impacts what muscles? (6)

A

Medial rectus
Inferior rectus
Superior rectus
Inferior oblique
Sphincter pupillae
Levator palpebrae superioris

383
Q

IIIrd Nerve Palsy: Clinical Presentation (2)

A

Ocular depression and lateral eye movement
Blown pupil - dilation

384
Q

IIIrd Nerve Palsy: Most common artery impacted by aneurysm?

A

Posterior communicating artery to press the superficial parasympathetic around the nerve

385
Q

Macular sparing

A

Visual field loss thay preserves vision in the centre of the visual field

386
Q

IIIrd Nerve Palsy: When does macular sensing appear?

A

Damage to one hemisphere of their visual cortex

387
Q

Optic Nerve Defects: Aetiologies (3)

A

Ischaemic Optic Neuropathy
Optic neuritis
Tumours - Meninioma, Glioma or Hemiangioma

388
Q

Optic Nerve Defects: Pathophysiology

A

Complete or abide the horizontal

389
Q

Optic Neuritis

A

Progressive visual loss with pain behind the eye on movement

390
Q

Optic Nerve Defects: Clinical Presentation (3)

A

Colour desaturation
Central Scotoma
Gradual recovery within weeks or months

391
Q

Optic Nerve Defects: Signs on Examination (2)

A

Optic atrophy
Optic nerve haemangioma

Ophthamology (4 decks)

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