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PRIYA OPTHALMOLOGY > summary factoids > Flashcards

summary factoids Flashcards

1
Q

describe the circulation of aequous

A 
ciliary body
posterior chambre
pupil
norishes cornea
aqeuous reabsorped into scleral venous sinus (canal of schlemm) at iriocorneal angle (angle involved in glaucoma)
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2
Q

what does the inferior oblique do

A

when in addction, IO can only elevate

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3
Q

what does the superior oblique do

A

when in adduction, SO can only depress

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4
Q

which muscles can do pure elevation

A

SR and IO,

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5
Q

which muscles can do pure depression

A

SO and IR

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6
Q

what is the shape of the orbit

A

pyramidal with apex at optic canal posteriorly, base is anteriorlateral

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7
Q

what is the infraorbital nerve responsible for?

A

sensation in the mid face region

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8
Q

what does orbicularis oris do

A

external muscle of eye - CN7

orbital and palpebral

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9
Q

orbital orbicularis oris

A

tight closure of eye

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10
Q

orbicularis palpebral

A

dircectly on eyelid, gentle closure of eye

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11
Q

what does orbital septum do

A

helps prevent spread of infection from superfiical to deep

a tough layer of connective tissue

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12
Q

what is the tendon of LSP

A

attaches to tarus
mullens muscle (widens eye)
elevates upper eyelid

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13
Q

what does the tarsal gland do

A

secretes lipids + stops tears from flowing over eyes

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14
Q

describe the lacrimal apparatus

A

lacrimal gland > lacrimal fluid > medial angle > little hole > caniculi > lacrimal sac > nasolacrimal duct > nasal cavity > inferior nasal meatus > runny nose

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15
Q

what is the corneal reflex

A

blinking

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16
Q

sensory afferent limb of corneal reflex

A

sensory afferent via CN VI branches -> trigemial ganglion > CN V > pons

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17
Q

motor efferent limb of corneal reflex

A

AP conducted by CN VII to eyelid part of orbicularis oris

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18
Q

what is the vestibuloocular reflex

A

turns eye in opposite direction to head movement

stabilises gaze on object

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19
Q

what is the occulocardiac reflex

A

reflex bradycardia in respone to tension on extraocular muscles on pressure on eye

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20
Q

what happens in sympathetic reflex

A

wider
more light in
far objects

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21
Q

what happens in parasympatehtic reflex

A

less light in
nearer objects
reflex lacrimation

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22
Q

what happens when the eyes open wider

A

post synaptic sympathetic fibres travel via

  • superior cervical sympahtetic ganglia
  • internal carotid nerve
  • internal carotid plexus
  • axons carried on the ophtelamic artery
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23
Q

what does mitotic mean

A

constricted

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24
Q

eye symptoms of horners syndrome

A

mitotic

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25
Q

what does myadratic mean

A

enlarged

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26
Q

how are dilator pupillae aranged

A

radially

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27
Q

where do director pupillae attach to and from

A

originate around external circumference of iris (fixed)

insert around internal circumference of iris (mobile)

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28
Q

4 neurone chain of pupillary light reflex

retinal ganglion cells
pass via ipsilateral optic nerve
synapse in pretechtal nucleus
synapse in EW (location of cell bodies of parasympathetic axons of CN3)
pass from EW via CNS then its inferior division
synapse in ciliary ganglion
course in short ciliary nerves to sphincter papillae muscle

A
  1. reintal ganglion cells > pass via ipsilateral optic nerve > synapse in pretectal nucleus to next synapse in EW nucleus (location of cell bodies of parasympathetic axons of CN3)
  2. located entirely within midbrain + connect pretechtal nucleus to next synapse in EW nucleus (locataion of cell bodies of para axons of CN3)
  3. pass from EW nucleus via CN 3 then its inferior division, to synapse to ciliary ganglion
  4. course in short ciliary nerves to sphincted papillae muscles
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29
Q

basal tears

A 
corneal health
contain lysozone (hydrolyses bacteiral cell walls)
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30
Q

reflex tears

A

in response to mechanical or chemical sitmulation
afferent - CN V1 from cornea
efferent - parasympathetic axons from CN VII

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31
Q

treatmnet for bacterial conjunctivitis

A

chloramphenicol QTD

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32
Q

how not to treat herpetic keratitis

A

steroids - causes corneal melt

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33
Q

feature of herpetic keratis

A

dendritic ulcer

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34
Q

feature of adenoviral keratitis

A

subepithelial infiltrates

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35
Q

features of fungal keratitis

A

hypopyon

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36
Q

how to treat fungal keratiits

A

topical antifungal eg natamycin

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37
Q

what causes keratitis in contact lenses

A

acanthamoedema

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38
Q

what is oral cellulitis

A

direct extension from sinus

extension from orbital infection eg infection chalazion, dacrocystitis

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39
Q

what bug causes endophalamitits

A

staph epidermis

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40
Q

how to treat endophalamitis

A

intraviteal ameakin

inflam of intraocuar fluids

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41
Q

how to treat toxoplasmosis

A

clindamycin / azithryomycin + steroids

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42
Q

what can toxocara form

A

granulomas

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43
Q

how does chloramphenicol work

A

inhibits peptidyl transferase enzyme (therefore stops bacterial proteins being made)

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44
Q

when is chloramphenicol bacteriocidial

A

strep + haemophilus

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45
Q

when is chloramphenicol bacteriostatic

A

staph

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46
Q

side effects of chloramphenicol

A

allergy
irreversible aplastic anaemia
grey baby syndrome

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47
Q

which antibiotics inhibits the cell wall synthesis

A

penicillins + cephalosporins

beta lactam ring inhibits enzyme which make bacteriocidal cell wall (without cell wall, bacteria die)

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48
Q

which antibiotics inhibit nuclei acid synthesis

A

quinolones eg ofloaxin (inhibits DNA gyrase, an enzyme that compresses bacterial DNA into supercoils)
inhibition of DNA gyrase leads to unwinding of supercoils + cell death

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49
Q

how to treat bacterial keratitis

A

A-4 quinolone (ofloxacin) - treats gram neg

gentamicin and cefuromime (treats gram neg and positive

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50
Q

how to treat chlamydial conjunctiivits

A

oxytetracycline

via single median aparture and paired lateral appertures

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51
Q

pathway of CSF

A

ventircles > subarachnoid pace > absorped into venal circulation

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52
Q

when is the neural canal formed

A

at 3 weeks

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53
Q

which areas dont have a BBB

A

circumfrencicular organs + pineal glands

54
Q

where are colloid cysts found

A

at interventricular foramen

55
Q

where do ependymomas arise from

A

ependymal cells lining the ventricles

56
Q

what is a epidermal haematoma

A

arterial bleed between the skull + dura

57
Q

what is a subdural haematoma

A

venous bleed between dura + arachnoid

58
Q

what is a hydrocelphaus

A

accumualtion of CSF

59
Q

what does rhodopsin do when light hits

A

light converts 11-cis-retinal to all trans-retinal (activated form)

60
Q

what is the dark current

A

opens in the dark
permeable to Na+
keeps photoreceptor Vm more positive than most neurons
steady release of neurotransmitter

61
Q

which cells function in normal day light

A

cones

62
Q

what does lysozome do

A

destroys bacterial cell wall

63
Q

what are tear lipids antibacterial to

A

cell membranes

64
Q

what does secretory IgA do

A

prevent attachment

65
Q

what is the principle APC of the external eye

A

langerhans cell

66
Q

what are langerhans cells rich in

A

MHC class 2

67
Q

where are langerhan cells abundant

A

corneoslceral limbus

68
Q

where are langerhan cells absent

A

from central 1/3rd of cornea

69
Q

which part of the eye is the only part with lymphatic drainage

A

conjunctiva

70
Q

what are the APC cells in the conjunctiva

A

dendritic cells

71
Q

which area of the eye has MALT

A

conjunctiva

72
Q

what unique function does the cornea and sclera have

A

down regulated the immune environment

73
Q

what is ACAID

A

protects eyes + visual axis from collateral damage of an immune repsone to an ifnection by surpressing the response

74
Q

do corneal cells have MHC class 2

A

no

75
Q

primary mediators of sympathetic opthalamia

A

T cells

76
Q

eg of immediate hypersensitivity (1)

A

acute allergic conjunctivitis

77
Q

eg of direct cell killing (2)

A

ocular cicatricial pemphigoid

78
Q

eg of immune complex mediated (3)

A

autoimmune corneal melting

79
Q

eg of delayed (4)

A

corneal graft rejection

80
Q

monro kellie hypothesis

A

maintain balance of brain, blood and CSF

81
Q

what CN supplies dura matter

A

V

82
Q

how to acess subarachnoid space

A

L3/L4 or L4/L5

83
Q

when does subarachnoid space end

A

S2

84
Q

what is glaucoma

A

increased pressure of eye dye to increase in humour - blockage of trabecular meshwork / canal of schlemm

85
Q

what are primary open anled glaucoma

A

most common
poor drainage throuh trabecular meshwork
slow onset

86
Q

what is closed angle glaucoma

A

patent drainage
1/3 emergency
visual loss
headaches

87
Q

scleritis

A

rare
pain on movement
underlying autoimmune aetiology

88
Q

genetics of scelritis

A

HLA B27

89
Q

ARMD

A

accumulation of drusen

90
Q

dry ARMD

A

no significant vascular proliferation

91
Q

wet ARMD

A

vascualr proliferation
neovascularisation in choroid, mediated by VEGF
new vessels are small and leaky

92
Q

what type of vision loss is seen in wet ARMD

A

rapid central visual loss

93
Q

treatent of wet ARMD

A

monoclonal antibodies to VEGF

94
Q

what kind of pupil is seen in diabetes

A

prostitie

argyll robertson

95
Q

what causes cataracts

A

conversion of glucose to sorbiol in lens

96
Q

is epithelium lipophilic or phobic

A

philic

97
Q

is the stroma lipophilic or phobcic

A

phobic

98
Q

does cholarmphenicol have lipophilic or phobic properties

A

both

99
Q

when is prednisolone acetate used

A

post op

good penetration in uninflammed cornea

100
Q

is prednisolone phosphate hypodrophic or philic

A

philic

101
Q

what drug is used to lower IOP in glaucoma

A

0.03%

102
Q

when are steroids used

A

post op cataracts
uveitis
to prvent corneal grat rejection

103
Q

what is the glaucoma medication

A 
prostaglandins eg latanoprost
beta blockers
carbonic anhydrase inhibitors
alpha adrenergic agonists
parasympathetic mimetics
104
Q

what is fluroscein used for

A

to show corneal abraisons and dendritic ulcers

105
Q

eg of myadratics and what they do

A

tropicamide + cyclopentolate
pupil dilation by blocking para block to MS
cause cytoplasgie (stops lens from foccusing)

106
Q

what are sympathomimetics and give eg

A

act on sympa system to dilate pupil
optic neuropathy - ethambutol
maculopathy - chloroquine

107
Q

what happens in diabetic retinopathy

A

glycosylation of protein / basement membrane > loss of pericytes > microaneurysms = leakage and ischaemia

108
Q

what happens in hypertensive retinopathy

A 
attenuated blood vessels 
cotton wool spots
hard exudates
retinal haemorrhages
optic disc oedema
109
Q

symptoms of corneal retinal arteyr occlusion

A 
sudden painless loss of vision 
cherry red spot
RAPD
pale oedematous retina 
threadlike reintal vessels
110
Q

what causes corneal retinal artery occlusion

A

carotid artery disease + emboli from heart

111
Q

what causes cherry red spot in corneal retinal artery occlusion

A

retinal nerve fibre layer becomes swollen except at foeva

112
Q

symptoms of central retinal vein occlusion

A 
sudden painless visual loss
associaated with diabetes, hypertension + cancer
 retinal haemorrhages
dilated tortourous veins 
disc swelling + macular swelling
113
Q

symptoms of branch vein occlusion

A

painless disutbance in visual field

114
Q

sympotms of giant cell arteritis

A 
middle sized arteritis
headache 
jaw claudication
malaise
raised PV
blinding condition
115
Q

what is GCA associated with

A

polymyalgia rheumatic

116
Q

signs of sjorgens

A

keratoconjunctivitis sicca
xerostomia
RA
infiltration of lacrimal glands

117
Q

sympoms of RA eye disesase

A

keratoconjunctivitis sicca

118
Q

sympyoms of SJ syndrome

A

symniblepharon
occlusion of lacrimal glands
corneal ulcers

119
Q

3 types of retinal artery occlusion

A

branch
amarosis fugax (curtain coming down, 5 mins)
ION

120
Q

what is ION (ischaemic optic neuropathy)

A

can be caused by temporal arteiits
posterior cilliary arteries affected (walls become so infamed that the lumen becomes occluded)

blood doesnt flow properly to optic nerve
sudden loss of vision

121
Q

what cuases sudden vision loss in ION

A

occlusion of optic nerve head circulation

occlusion of posterior ciliary arteries

122
Q

signs of vitreous haemorrhage

A

loss of vision
floaters
loss of red reflex

123
Q

signs of retinal detachment

A

painless loss of vision

sudden onset floaters

124
Q

signs of closed angle glaucoma

A

cupped disc (loss of retinal ganglion cells)

125
Q

types of cataracts

A

nuclear
posterior subscapular cataract
christmas tree - polchroatic
congenital cataract

126
Q

what happens in refractive error

A 
eye cant focus
myopia (short sighteD) 
hypermenopia (long sighted) 
astigmatism - irregular corneal curvature
presbyopia - age related
127
Q

painful 3rd nerve palsy

A

aneurysm

128
Q

4th nerve palsy

A

congenital trauma

129
Q

6th nerve palsy

A

cranial pressure

130
Q

what is optic neuritis

A

progressive visual loss (unilateral )
pain behind eye on movement
occular desaturation
central scotoma - depressed vision at point of fixiation - suggests a lesion between optic nerve head and chiasm ( can be caused by MS)

PRIYA OPTHALMOLOGY (7 decks)

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