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Year 1 Medicine > Week 130 - Ophthalmology General > Flashcards

Week 130 - Ophthalmology General Flashcards

1
Q

What is emmetropia?

A

Normal refractive state of the eye (aka normal vision)

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2
Q

What lens do you use to correct hypermetropic vision?

A

(long-sighted) - Convex lens

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3
Q

What lens do you use to correct myopic vision?

A

Concave lens

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4
Q

What receptors are situated on the circular muscle of iris?

A 
M3 receptors (parasympathetic)
-> constricting pupil
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5
Q

What receptors are situated on the radial muscle of iris?

A

β1 receptors (sympathetic)

-> dilating pupil

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6
Q

At what receptor does Atropine act and what are its effects (with regards to the eye).

A

M3 (antagonist) - Pupil dilation

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7
Q

At what receptor does Homatropine act and what are its effects (with regards to the eye).

A

M3 (antagonist) - Pupil dilation

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8
Q

At what receptor does Cyclopentolate act and what are its effects (with regards to the eye).

A

M3 (antagonist) - Pupil dilation

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9
Q

At what receptor does Tropicamide act and what are its effects (with regards to the eye).

A

M3 (antagonist) - Pupil dilation

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10
Q

At what receptor does Phenylephrine act and what are its effects (with regards to the eye).

A

α1 (agonist) - Pupil dilation

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11
Q

The anterior retina is supplied by which artery?

A

Central Retinal artery

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12
Q

What is supplied by the posterior ciliary arteries?

A

Optic nerve head, fovea/macula, posterior retina and the photoreceptors
Also Choroid

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13
Q

What visual acuity is considered as “legally blind”?

A

6/60

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14
Q

What is scintillating scotomata?

A

“water running down window, kaleidoscope pattern” (symptom of migraine (the aura), emboli and giant cell arteritis)

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15
Q

A 63-year old male attended his optometrist complaining of “spots before the eyes”. Suggest two causes of these symptoms.

A

1) Posterior vitreous detachment
2) Vitreous haemorrhage
3) Posterior segment inflammation (uveitis)

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16
Q

A 30 year old male presents with blurred vision in R eye, dull ache + red (acute). He takes mesalazine for UC. Likely diagnosis?

A

Uveitis

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17
Q

Name THREE glands in the eyelid

A 
Sebaceous glands (glands of Zeis)
Ciliary glands (glands of Moll) - modified sweat glands
Tarsal glands - pour oily secretion onto the margin of lid
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18
Q

Name TWO muscles of the eyelids

A

Orbicularis oculi - closes eyelids

Levator palpebrae superioris - raises the upper lid

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19
Q

What passes through the nasolacrimal canal?

A

Nasolacrimal duct - carries tears from lacrimal sac into the nasal cavity

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20
Q

What passes through the Inferior Orbital fissure?

A

Zygomatic Branch of Maxillary Nerve
Inferior ophthalmic vein
Sympathetic Nerves

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21
Q

What passes through the Superior Orbital fissure?

A

Lacrimal Nerve, Frontal Nerve
Trochlear Nerve, Oculomotor Nerve, Abducent Nerve
Nasociliary Nerve, Superior Ophthalmic Vein

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22
Q

Where is Aqueous Humour found and where is it secreted from?

A

Anterior + Posterior Chambers
Secretion from ciliary processes
It then ends up flowing into the canal of Schlemm
Nourishes cornea + lens

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23
Q

Where is Vitreous Humour found and where is it secreted from?

A

Transparent gel filling eyeball

Not actively replaced

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24
Q

What is an EFFERENT PUPILLARY DEFECT, and what is signifies?

A

One eye remains dilated regardless of which eye light is shone into. Lesion in efferent limb (e.g. third nerve palsy)

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25
Q

What is a Relative AFFERENT PUPILLARY DEFECT, and what it signifies?

A

Both eyes dilate when light is swung across from normal eye, and shone into affected eye. Lesion anterior to chiasm

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26
Q

Which muscles insert into the Annulus of Zinn?

A

Lateral Rectus, Medial Rectus, Superior Rectus, Inferior Rectus, Superior Oblique

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27
Q

What is the innervation of the muscles of the orbit?

A

LR6 SO4 3

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28
Q

Where does the occulomotor nerve originate (names of nuclei)?

A

Somatic Motor Nucleus (voluntary)

Edinger Westphal Nucleus (accomodation + constriction)

29
Q

Which nerve is most commonly injured when Intra-cranial pressure rises?

A

Abducent Nerve - causes medial deviation of eye + diplopia

30
Q

What are the functions of Ciliary Ganglion?

A

Sensation of part of eye
Pupilary dilation + elevation of upper eyelid (sympathetic)
Pupillary constriction and accomodation (parasympathetic)

31
Q

What are the symptoms (3) of Horner’s Syndrome?

A

Ptosis, Miosis (constriction of pupils), Anhidrosis (lack of sweat)

32
Q

What are the causes of Horner’s Syndrome?

A

1) Pancoast tumour of lung
2) Thoracic aortic aneurysm
3) Trauma
4) Compression along sympathetic chain

33
Q

What would the position of eye be in occulomotor nerve palsy?

A

Dilated pupil + eye down and out

34
Q

What is hypertensive retinopathy?

A

damage to retina due to HIGH BP

35
Q

What is Optic Neuritis?

A

Inflammation of optic nerve (may cause complete or partial loss of vision)

36
Q

What is Strabismus?

A

Eyes not properly aligned with each other

37
Q

What is Nystagmus?

A

Eye moving in a “jerky” fashion

38
Q

What are the two types of Glaucoma?

A

Open Angle - canal of Schlemm blocked

Closed Angle - iris obstructs trabecular network and subsequently the canal of Schlemm

39
Q

What are the secondary causes of Glaucoma?

A

Inflammation/uveitis
Trauma
Drugs (e.g. steroids)
Diabetes/neovascular

40
Q

What is the most common malignant intraocular tumour of children?

A

Retinoblastoma (Flexner-Wintersteiner rosettes on inspection)

41
Q

What is a cataract?

A

Opacification of the lens due to denaturation of proteins in lens fibres - loss of visual acuity and contrast

42
Q

What is Giant Cell Arteritis?

A

Inflammation of large + medium sized arteries (usually of head and neck). Leads to blurred vision or sudden blindness, headaches, tender temporal artery. Emergency - high dose steroids

43
Q

Name (3) the branches of V1

A

1) Frontal Nerve (i)Supraorbital nerve (ii) Supratrochlear nerve
2) Lacrimal Nerve
3) Nasociliary Nerve

44
Q

What is Anisocoria? and name two types

A

Difference in pupil sizes

1) Adie pupil - parasymp defect = large atonic pupil
2) Horner’s syndrome - symp defect = small pupil

45
Q

What is sympathetic ophthalmitis?

A

v. rare complication of eye trauma. antigens exposed -> autoimmune reaction = can go blind

46
Q

What is a hyphaema?

A

Bleeding between iris and cornea (i.e. anterior chamber)

47
Q

What are the two types of macular degeneration?

A

Acute (“wet”) macular degeneration - neovascular

Non-neovascular (“dry”) - little impact on vision

48
Q

What is the treatment for neovascular (“wet”) macular degeneration?

A

Anti-VEGF (Ranibizumab (Lucentis))

49
Q

What is Charles Bonnet Syndrome?

A

Visual hallucinations in people with macular degeneration

50
Q

What is the process that occurs in Rods/Cones in the DARK?

A

GTP is converted to cGMP (by guanylate cyclase).

cGMP keeps Na+/Ca2+ channels open -> cell depolarised

51
Q

What is the process that occurs in Rods/Cones in the LIGHT?

A

Photon hits Rhodopsin (11-cis retinal -> all-trans retinal)
Opsin is activated -> activates phosphodiesterase
cGMP->GMP = Ca/Na channel closes
Na/Ca exchanger removes Ca -> membrane Hyperpolarised (less glutamate released)

52
Q

How does the photoreceptor:bipolar cell ratio vary?

A

Periphery - many photoreceptors:bipolar cell

Centre - single photoreceptor:bipolar cell

53
Q

What is used to assess colour vision defects?

A

Ishihara pseudoisochromatic plates

54
Q

Name three photosensitive cells?

A

Rods
Cones (three types - colour)
Photosensitive retinal ganglion cell (regulation of diurnal rhythms)

55
Q

What clinical feature will be present in retrobulbar neuritis (common in MS)?

A

Relative afferent pupillary defect

56
Q

What are the differential diagnoses in a patient with light-near dissociation?

A

Dorsal midbrain syndrome -causes include pineal tumour, MS, brainstem infarction. (neurosyphilis)

57
Q

What are the divisions of the Lateral Geniculate Nucleus?

A

6 laminae
1,2 = magnocellular (movement, temporal contrast)
3-6 = parvocellular (colour, spatial contrast)
1-6 = Koniocellular (blue-yellow contrast)

58
Q

What does conjunctiva line?

A

Eyelid + anterior eyeball

59
Q

What keeps the cornea transparent?

A

Ion pump in the endothelium keeps the collagen fibrils within the stroma in a state of dehydration

60
Q

What happens in accommodation?

A

Pupil constriction (circular muscle (sphincter pupillae) contraction)
Lens becomes more convex (contraction of muscles of ciliary body)
Controlled by parasympathetic fibers (CN III) from the Edinger-Westphal nucleus

61
Q

What does vitreous humour consist of?

A

99% water

Collagen fibrils & hyaluronan

62
Q

What else can shingles on the end of the nose affect?

A

Nasociliary nerve - branch to eyeball also supplies tip/side of nose
VZV infection can affect both

63
Q

What kind of vision defect would a pituitary tumour cause?

A

Bitemporal hemianopia

64
Q

What are the main causes of conjunctivitis?

A

Bacterial (e.g. chlamydia), Viral (Adenoviruses, HSV)

65
Q

What are the main features of glaucoma?

A

Optic disc cupping
↑intraocular pressure
?Visual field loss

66
Q

What is the most common type of glaucoma?

A

Acquired Primary Open Angle Glaucoma (POAG)

67
Q

What are the treatments for glaucoma?

A

1) topical β-blockers (e.g. timolol)
2) carbonic anhydrase inhibitors (e.g. dorzolamide)
3) α-adrenergic agonist (e.g. apraclonidine)
4) parasympathomimetic (pilocarpine)

68
Q

What are the main causes of Retinal Detachment?

A

Tractional - retina is pulled
Exudative - caused by breakdown of the blood-retinal barrier, allowing fluid to accumulate in subretinal space
Rhegmatogenous - caused by tear or hole

Year 1 Medicine (12 decks)

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