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Opthamology > Week 1- Science > Flashcards

Week 1- Science Flashcards

1
Q

Name the junction between the cornea and sclera

A

corneoscelral junction (limbus)

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2
Q

Where is the lacrimal gland located?

A

superolateral to eye

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3
Q

What are the two components of the fibrous layer of the eye?

A

Cornea

Sclera

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4
Q

Name the three parts of the uvea

A

Iris
Ciliary body
choroid

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5
Q

What is the purpose of the choroid?

A

Nutrition and gas exchange to eye

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6
Q

Which part of the eye is the posterior segment and which is the anterior segment?

A

anterior- anterior to lens

posterior- behind the lens and contains the vitreous humour

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7
Q

Name the fluid secreted by the ciliary body and name the structures it supplies with nourishment. Into what chamber is the fluid reabsorbed?

A

Aqueous humour

scleral venous sinus in the iridocorneal angle

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8
Q

Name the branch of the internal carotid artery (enters through carotid canal) which is the main blood supply to the eye. Through which foramen does this pass? Which arteries emerge from this artery to supply the choroid?

A

Ophthalmic artery
Optic canal
ciliary artery

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9
Q

What is the fundus?

A

The posterior area surface of the eye where light is focused.

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10
Q

Name the three veins which drain the orbit

A

superior ophthalmic
inferior ophthalmic
facial vein (valve less vein)

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11
Q

Name the 7 bones that make up the orbit

A 
frontal
maxilla
zygomatic 
nasal
sphenoid
lacrimal
ethmoid
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12
Q

What is a blowout fracture?

A

Fracture of the medial wall and orbital floor

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13
Q

Name the muscle responsible for the closing of the eyelids. Which nerve innervates it?

A

orbicularis oculi

CN VII

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14
Q

Name the muscle responsible for the opening of the eyelid.

A

levator palpebrae superioris

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15
Q

What nerve stimulates the lacrimal gland? What vessels drain the lacrimal fluid to the lacrimal sac?

A

Parasympathetic division of facial nerve

Lacrimal puncta

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16
Q

Name the 7 extraocular muscles

A

superior, inferior, medial and lateral rectus
superior and inferior oblique
levator palpebrae superioris

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17
Q

How are the extraocular nerves innervated

A

LR6 SO4 AO3
Lateral Rectus CNVI
Superior Orbital CNIV
All Others CNIII

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18
Q

What provides parasympathetic innervation to the eye?

A

Ciliary ganglion

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19
Q

What is the conjunctival fornix?

A

The folds that connect the conjunctival membrane lining the inside of the eyelid to the eye itself

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20
Q

What is the macula and the fovea?

A

Macula- area of greatest density of cones

Fovea- centre of macula

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21
Q

light from objects in the right visual field is processed by the ____primary visual cortex.
light from objects in the lower visual field is processed by the ______ part of the primary visual cortex.

A

left

upper

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22
Q

Which of the rectus muscles depress the eyeball and which elevate the eyeball?

A

elevation- superior rectus and inferior oblique

depression- inferior rectus and superior oblique

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23
Q

Name the three nerves that supply sensory innervation to the face

A

CNV1- Ophthalmic
CNV2- Maxillary
CNV3- mandibular

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24
Q

What reflex is blinking?

A

The corneal reflex

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25
Q 
Corneal Reflex:
Sensory (afferent) limb : 
Action potentials conducted from cornea via CN \_\_\_\_\_branches to \_\_\_\_\_\_\_\_\_\_\_ ganglion, then along CN V to pons. 
Motor (efferent) limb:
Action potentials conducted via CN \_\_\_\_
To eyelid part of \_\_\_\_\_\_\_\_\_ oculi.
A

V1
Trigeminal
VII
Orbicularis

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26
Q

What is the vestibulo-occular reflex?

A

Where eyes turn in the opposite direction to the movement of the head to stabilize the gaze on a particular object.

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27
Q

What is the occulocardiac reflex?

A

Reflex bradycardia when strain on extraocular muscles

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28
Q

What is the effect of autonomic stimulation of the eye? 1.Sympathetic 2. Parasympathetic

A
  1. Dilate pupils- more light, eyes open wider (Levator palpebrae superioris), far vision, emotional tears
  2. Constrict pupils- less light, short vision, reflex lacrimation
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29
Q

After passing through the superior cervical ganglion how does sympathetic stimulation reach the levator palpebrae superioris?

A

Internal carotid nerve- internal carotid plexus- on ophthalmic artery and branches

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30
Q

Which muscles of the iris are stimulated by parasympathetic stimulation? What effect does this have?

A

Sphincter pupillae

constriction of the pupil

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31
Q

Sympathetic innervation innervates which muscle of the iris? When may the contraction of this muscle occur?

A

Dilator pupillae

sick patient, low light

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32
Q

What is the name for a non-physiologically 1. enlarged and 2. dilated pupil

A
  1. Mydriatic pupil

2. Miotic pupil

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33
Q

What may result in a pin-point pupil?

A

Pathological sign of opiate drugs

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34
Q

Sensory stimulation of the pupillary light reflex is from CN ____ and action is by CN _____

A

CNII

CNIII

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35
Q

Describe the components of the accommodation of far vision and near vision

A

Far vision- light arrives in parallel, ciliary muscle relaxes, suspensory ligaments taut, lens flattens
Near vision- light arrives at an angle, ciliary muscle contracts, suspensory ligaments lax, lens becomes spherical

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36
Q

Identify the three types of tears and their purposes

A

Basal tears- maintain corneal health- nourish and protect with lysosymes
Reflex tears- response to chemical/mechanical stimulation
Emotional tears

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37
Q

What is the origin of the rectus muscles?

A

Common tendinous ring which is attached to the sphenoid (the origin of the superior oblique)

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38
Q

What are the two parts of the orbicularis oculi?

A

Palpebral and orbital

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39
Q

Into which chamber does the nasolacrimal duct drain?

A

Inferior meatus

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40
Q

What muscle that is under sympathetic control opens the eyelid?

A

Mullers muscle

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41
Q

Name the two nuclei of the midbrain that are involved in the pupillary reflex. What is the afferent nerve and what is the efferent nerves?

A

Pretectal nucleus
Edinger-Westphal nucleus
Afferent- CNII
Efferent- CNIII

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42
Q

What is meant by consensual response? What about direct response?

A

Shining light in one eye causes equal constriction of the pupil in both eyes. Therefore Optic and Oculomotor are working
Direct is just testing a single eyes response

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43
Q

What is a RAPD?

A

Relative Afferent Pupillary Defect

Dilation in response to light to one of the eyes indicates defect of optic nerve

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44
Q

What secretes cerebrospinal fluid?

A

The secretory epithelium of the Choroid plexus

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45
Q

What are the three main functions of the cerebrospinal fluid?

A

Shock-absorbing protection of the brain
Homeostasis- pH effects pulmonary ventilation and cerebral blood flow
Circulation- medium for exchange of nutrients and waste products between blood and brain tissue

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46
Q

What is the choroid plexus?

A

Networks of capillaries in the walls of the cranial ventricles that secrete Cerebrospinal fluid

47
Q

Through which foramen does the CSF drain into the subarachnoid space? Then where does the fluid drain?

A

Foramen of Luschka
Foramen of Magendie
Dural venous sinuses to heart and lungs

48
Q

Name the barrier that separates the blood from the CSF

A

Blood-Brain barrier

49
Q

Name the two layers which separate enclose the subarachnoid space

A

Pia Mater

Dura Mater

50
Q

Name the three components that make up the blood brain barrier

A

Capillary endothelium
basement membrane
Perivascular astrocytes

51
Q

What is hydrocephalus?

A

Accumulation of CSF in the ventricular system of the subarachnoid space (either due to obstruction or overproduction)

52
Q

What is papilloedema?

A

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

53
Q

The aqueous humour is secreted by the ________ _______ then it passes between the _____ and the _____ through the pupil into the scleral venous sinuses and (the canal of _______). This is located in the __________ angle.

A 
Ciliary body
lens
iris
Schlem
Iridocorneal angle
54
Q

Describe the formation of the aqueous humour

A

Fluid drains from the capillaries into the pigmented ciliary epithelial cells and then into the non-pigmented epithelial cells before draining into the anterior chamber of the eye.

55
Q

What enzyme is inhibited to block aqueous humour production?

A

Carbonic anhydrase

56
Q

The right and left eye have their own __________ visual fields and the area of overlap is their ___________ visual field.

A

Monocular

Binocular

57
Q

The retina is divided in half at the _______ into the _______ and _______ visual fields.

A

fovea
temporal
nasal

58
Q

What nucleus does the optic nerve pass through before reaching the striate cortex?

A

Lateral Geniculate Cortex

59
Q

In the retina signals travel from the ___________ to the ___________ and then to the ___________. __________ cells and ____________ cells bridge between them.

A 
photoreceptors
bipolar cells
ganglion cells
Amacrine cells
horizontal cells
60
Q

At rest photoreceptors have a __________ Vm (_______ ________ __________) of around -20mv. With light exposure , Vm ____________. The positive Vm is because of the dark current, a __________ ____ channel that is _____ in the dark and closed in the light.

A

Depolarized
resting membrane potential
Hyperpolaizes
cGMP gated Na+ channel

61
Q

In the dark, Na+ influx is _____to K+ efflux. In the light, Na+ influx is reduced and so ___ ______ causes hyperpolarisation.

A

equal

K+ efflux

62
Q

What pigment is contained within the rods? What makes up this pigment?

A 
Rhodopsin
Retinal (derivative of vitamin A)
and Opsin (GPCR)
63
Q

Process of hyperpolarization: Light stimulates rhodopsin. All-trans-retinal activates _________. causes a molecular cascade that decreases _____ leading to closure of ______ gated Na+ ion channel leading to ________________.

A

Transducin
cGMP
cGMP
Hyperpolarization

64
Q

Define visual acuity? What determines this?

A

The ability to distinguish between two near points. Determined largely by photoreceptor spacing and refractive power.

65
Q

Unlike cone cells, a number of rod cells converge on a single ganglion cell. This high __________ results in increased _________ to light but decreased __________.

A

Convergence
Sensitivity
Acuity

66
Q

Which three types of cone cells are there?

A

Those that detect Red, blue and green light

67
Q

What is the most commonly used topical antibiotic in ophthalmology? What is its mode of action?

A

Chloramphenicol

Inhibits peptidyl Transferase enzyme preventing protein synthesis

68
Q

Give three possible side effects of chloramphenicol

A

Allergic reaction
Grey baby syndrome in neonates
irreversible aplastic anaemia

69
Q

Name two types of antibiotics that inhibit cell wall synthesis and have a beta lactam ring

A

Penicillins

cephalosporins

70
Q

Name the four layers of the meninges

A

Dura mater
arachnoid mater
subarachnoid space
pia mater

71
Q

Which cranial nerve innervates the dura mater?

A

CNV Trigeminal

72
Q

At what vertebral level does the subarachnoid space end?

A

S2

73
Q

Name the septa that divides the two cerebral hemispheres

A

Flax cerebri

74
Q

Name the septa that creates the supratentorial and infratentorial space

A

Tentorium cerebelli

75
Q

Name the vessels enclosed by the dura mater

A

Dural venous sinuses

76
Q

How is it best to extract a sample of the CSF from the subarachnoid space?

A

Lumbar puncture at L3/L4 or L4/L5 IV disc.

77
Q

How many ventricles are in the cranium?

A

4 ventricles
Right and left lateral
3rd ventricle
4th ventricle

78
Q

Name the channel that connects the 3rd ventricle to the fourth ventricle.

A

cerebral aqueduct

79
Q

Where is the choroid plexus located?

A

The right and left lateral ventricles and the 3rd ventricle

80
Q

How is CSF reabsorbed?

A

It is reabsorbed by the arachnoid granulations into the Dural venous sinuses.

81
Q

Broadly speaking identify 4 possible adverse effects of raised intracranial pressure

A

Damage to tissues
shifts in tissues
herniation
compression of blood vessels

82
Q

How come the optic nerve can be effected by increased intracranial pressure?

A

It is also surrounded by the meninges and so the subarachnoid space can fill with excess fluid and effect the nerve

83
Q

As well as compressing the optic nerve, what else is compressed in papilloedema?

A

The central vein and artery of the retina

84
Q

What are the effects of Oculomotor nerve compression?

A

Ptosis- Levator palpebrae superioris paralysis
Inferolateral gaze- extraocular muscles paralysis
dilated pupil- Sphincter pupillae paralysis

85
Q

What is ptosis?

A

A droopy eyelid

86
Q

What would a presentation of abducent nerve palsy look like?

A

Medial deviation of the eye

87
Q

Name some of the chemical properties of the tears that make them useful in providing immune protection

A 
Lyzozymes- anti gram - bacteria
lactoferrin and transferrin- anti gram + bacteria
tear lipids- antimicrobial
angiogenin- antimicrobial
secretory IgA 
interleukins
complement proteins
88
Q

What immune cells are found in the tears?

A 
Neutrophils, macrophages, conjunctival mast cells
Langerhans cells (principle APC of external eye)
89
Q

What are Langerhans cells and where are they situated?

A

Antigen Presenting cells found mainly in the corneoscleral limbus

90
Q

Which part of the eye possesses lymphatic drainage

A

Conjunctiva only

91
Q

Both the lacrimal drainage system and the Conjunctiva possess _______ __________ _________ __________.

A

Mucosa Associated Lymphoid Tissue (MALT)

92
Q

Apart from the conjunctiva, tears, lacrimal glands and lacrimal drainage system, the rest of the eye has a ______________ ________ ___________. Therefore there is the potential for severe damage

A

Downregulated immune environment

93
Q

What is meant by immune privilege?

A

They are tissues that are able to tolerate the introduction of antigens without eliciting an inflammatory immune response

94
Q

Which five sites in the eye are said to be immune privileged?

A 
cornea
subretinal space
lens
anterior chamber
vitreous cavity
95
Q

Identify 4 characteristics of occular immune privilege

A

blood-tissue barrier
lack of direct lymphatic drainage
immunosuppressive molecules
inhibitory cell surface molecules

96
Q

Identify the four types of hypersensitivity reactions- what cells are used in each?

A

1- Immediate hypersensitivity- mast cells, B and T cells
2- cytotoxic- Macrophages, NK cells, Complement proteins
3- Immune complex mediated- Antibodies form B cells
4- delayed type hypersensitivity- T helper cells

97
Q

What type of hypersensitivity is shown in the following: 1. Corneal graft melting 2. Corneal graft rejection

A
  1. Type III

2. Type IV

98
Q

In what way is the lens similar to the skin?

A

The cell matures and its contents (nucleus etc) is replaced leaving behind a fibrous outline

99
Q

Identify some factors that effect corneal penetration

A

It is a lipid (epithelium) : water (stroma) : lipid (epithelium)
Lipid soluble drugs penetrate lipid layer (epithelium)
Water soluble drugs penetrate water layer stroma

100
Q

What makes Chloramphenicol suitable for corneal penetration?

A

Possess’ both hydrophilic and lipophilic properties

101
Q

What is added to topical steroids to make them 1. hydrophobic and 2. Hydrophilic

A
  1. Alcohol or acetone

2. Phosphate

102
Q

Name a preservative that is used to enhance corneal penetration

A

Benzalkonium Chloride

103
Q

State a simple way of avoiding systemic absorption of topical steroids to the eye.

A

Occlusion of the lacrimal puncta using fingers

104
Q

State 5 routes of ophthalmic drug administration

A 
Topical (drops/ointment)
subconjunctival
subtenons- between capsule and sclera
intravitreal- into vitreous humour
intracameral- into anterior chamber
105
Q

Identify three local side effects to topical steroid use in the eye

A

Cataracts
glaucoma
exacerbate viral infection

106
Q

Identify some steroid eye drops used in ophthalmology

A 
FML (Fluorometholone)
Prednisolone phosphate
prednisolone acetate
betamethasone
dexamethasone
107
Q

How does local anaesthetic act?

A

Blocks sodium channels thus impeding nerve conduction

108
Q

Name the main diagnostic dye used in ophthalmology

A

Fluorescein

109
Q

Give 6 uses of fluorescein

A 
Show corneal abrasion
dendritic ulcers
identify leaks
tonometry
angiography
diagnosing nasolacrimal duct obstruction
110
Q

Name two mydriatic drugs

A

tropicamide

cyclopentolate

111
Q

Give two possible side effects of mydriatic drugs

A

blurring of vision

AACG

112
Q

How do mydriatic drugs cause pupil dilation

A

Block parasympathetic supply to iris

113
Q

What type of drugs result in a miotic pupil?

A

Sympathomimetics

Opthamology (2 decks)

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