Thursday, 4-7-CIS (Neal/Stephens)

Question 1

Regarding lacrimal innervation:

The sympathetic trunk sends preganglionic sympathetic fibers to the ___ ganglion where they synapse. The postganglionic sympathetic fibers travel through the __ ganglion but do NOT synapse.

Answer 1

Superior cervical

Sphenopalatine

Question 2

If a pt has oculomotor nerve palsy, explain what the right eye would be doing if the left eye was “normal”:

Answer 2

Right eye will have a downward and outward gaze, dilated pupil, eyelid would have to be manually elevated due to ptosis

Question 3

List the extra ocular muscles and their innervation:

Answer 3

Superior rectus: III
Inferior rectus: III
Lateral rectus: VI
Medial rectus: III
Superior oblique: IV
Inferior oblique: III

SO4 LR6 remainder 3

Question 4

Loss of innervation to what muscle can cause complete ptosis?

Answer 4

Levator palpebre superioris

Question 5

Destruction of __ nerve or one of its branches to the levator palpebrae superioris reults in paralysis and complete ptosis

Answer 5

III

Question 6

Mydriasis seen in occulomotor n. Palsy is caused by disruption of what neural pathway?

Answer 6

Parasympathetic fibers to the sphincter pupillae muscle

Question 7

Pupillary constriction (sphincter pupillae m.) and thickening of the lens (near vision, ciliary m.) are ___ responses

Answer 7

Parasympathetic

Question 8

Injury to the nerve supplying the levator palpebrae superioris causes __

Answer 8

Complete ptosis

Question 9

Injury to the nerve supplying superior rectus causes ___

Answer 9

Inability to abduct and elevate the affected eye

Question 10

Injury to the nerve supplying medial rectus results in ___

Answer 10

Inability to adduct the affected eye

Question 11

Injury to the nerve supply inferior rectus results in __

Answer 11

Inability to abduct and depress the affected eye

Question 12

Injury to the nerve supplying the inferior oblique results in___

Answer 12

When adducted, you can’t elevate the affected eye

Question 13

Injury to the nerve supplying superior oblique results in ___

Answer 13

When adducted, can’t depress affected eye

Question 14

Injury to the nerve supplying lateral rectus results in ___

Answer 14

Inability to abduct affected eye

Question 15

List the signs and symptoms of CN III palsy:

Answer 15

• Down and out eye–> due to loss of extraocular m. Innervation. Innervation to SO and LR intact
• Complete ptosis–> loss of innervation to levator palpebrae superioris
• Pupil dilation–> loss of parasympathetic innervation to pupil

Question 16

An 82 year old female is brought to the ED presenting with signs of stroke. With light reflex exam, the direct light reflex is intact bilaterally but there is a loss of consensual light reflex bilaterally. Which area of the brain is most likely infarcted in this patient?

Answer 16

Posterior commissure

Question 17

Describe the “triad” of symptoms in Horner’s syndrome

Answer 17

Slight ptosis
Miosis –> pupillary constriction due to paralysis of the dilator pupillae muscle
Andhydrosis

Question 18

This muscle is innervated by postganglionic sympathetic fibers and is usually paralyzed in Horner’s syndrome

Answer 18

Tarsal muscle of Muller

Question 19

__ pupil is when the pupil does not constrict with light but constricts when an object is brought toward the eyes (unreactive to light with normal accomodation)

Answer 19

Argyll robertson –> seen with syphillis (treponema pallidum)

Question 20

During accomodation, pupillary constriction and thickening of the lens is via the __ nucleus and the convergence of gaze is via the __ nucleus

Answer 20

• Edinger-westphal

- Occulomotor

Question 21

What is the triad of accomodation?

Answer 21

• convergence of gaze
• pupillary constriction
• thickening of lens

NEAR VISION

Question 22

__ pupil is a tonically slow reacting pupil to light with a normal response to accomodation. It is usually caused by inflammation residual from infection

Answer 22

Holmes-Adie pupil

Question 23

What vessel is involved in Hyphema?

What vessel is involved in Subconjunctival hemorrhage?

What vessel is involved in Conjunctivitis?

Answer 23

• arterial circle of iris
• Deep pericorneal plexus
• superficial corneal plexus

Question 24

___ is the presence of blood in the anterior chamber of the eyeball usually due to trauma and rupture of the great arterial circle of the iris. This condition represents a serious medical emergency

Answer 24

Hyphema

Question 25

___ is usually due to a rupture of the deep pericorneal plexus. The bleeding is restricted to the subconjunctival tissue or bulbar fascia

Answer 25

Subconjunctival hemorrhage

Question 26

__ is a brick-red inflammation or irritation of the conjunctiva. Usually it is more noticeable at the fornices. When touched, the redness does not fade and the vessels are moveable

Answer 26

Conjunctivitis

Question 27

___ is a horizontally maxillary fracture, separating the teeth from the upper face. The fracture line passes through the alveolar ridge, lateral nose and inferior wall of maxillary sinus

Answer 27

Le Fort 1

Question 28

___ is a pyramidal fracture, with the teeth at the pyramid base and the nasofrontal suture at its apex. The fracture passes through the alveolar ridge, lateral walls of maxillary sinuses, inferior orbital rim and nasal bones

Answer 28

Le Fort 2

Question 29

__ is a craniofacial disjunction. The fracture line passes through nasofrontal suture, maxillo-frontal suture, orbital wall and zygomatic arch

Answer 29

Le Fort 3

Question 30

List the bones that make up the orbit:

Answer 30

``` Zygomatic Maxilla Lacrimal Ethmoid Sphenoid Frontal ```

Question 31

List clinical findings of Blow Out fractures-Orbit floor fractures:

Answer 31

Enopthalmos-d/t increased orbital volume (posterior displacement of eye Diplopia-d/t extra-ocular muscle entrapment Orbital emphysema-especially when fracture is into an adjacent paranasal sinus Malar region numbness-d/t injury to the inferior orbital n.

Question 32

Where do you find the central retinal artery?

Answer 32

Within the sheath of the optic n. It is a branch off of the Opthalmic a. (Off of ICA) The intracanalicular portion of the optic nerve is vulnerable to ischemia secondary to orbital fracture

Question 33

The classical presentation of this particular disorder causes extreme, sporadic, sudden burning or shock-like facial pain that lasts anywhere from a few seconds to as long as 2 minutes per episode. The intense flashes of pain can be triggered by vibration or contact with the cheek, brushing teeth, eating, drinking, talking, or being exposed to the wind

Answer 33

Trigeminal neuralgia

Question 34

__ exits the superior orbital fissue and has nasociliary, frontal (supratrochlear and supraorbital), and lacrimal branches. It provides sensory innervation.

Answer 34

V1--Opthalmic

Question 35

___ is a sensory nerve that exits the foramen rotundum

Answer 35

V2--Maxillary

Question 36

___ is sensory and motor and exits the foramen ovale. It supplies the temporalis, masseter, lateral and medial pterygoid, tensor veli palatini, tensor tympani, mylohyoid, and anterior digastric muscles (MUSCLES OF MASTICATION)

Answer 36

V3--Mandibular

Question 37

What is the afferent component of the corneal reflex? What is the efferent component of the corneal reflex?

Answer 37

Afferent-Nasociliary (V1) Efferent-Temporal and zygomatic branch of VII IN BY 5 OUT BY 7

Question 38

A pituitary macroadenoma that expands into the cavernous sinus can impair which neurovascular structures?

Answer 38

-III, IV, VI, V1, V2, ICA

Question 39

Regarding lacrimal innervation: The ___ nucleus send preganglionic parasympathetic fibers to the sphenopalatine ganglion where they synapse. The preganglionic parasympatheti fibers travel on CN __. The postganglionic parasympathetic fibers from innervate the lacrimal gland and travel via ___

Answer 39

Superior salivatory VII V2 and lacrimal n.