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Step1 > Otology and Ophthalmology > Flashcards

Otology and Ophthalmology Flashcards

1
Q

Tonotropy

A

different frequencies lead to vibration at specific location on basilar membrane

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2
Q

low frequency sounds are heard at ?

A

apex near helicotrema (Wide and flexible)

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3
Q

high freq sounds are heard at ?

A

base of cochlea which is thin and rigid

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4
Q

Weber test: localized to affected ear

Rinne test: abnormal because bone conduction >air

A

conductive hearing loss

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5
Q

Weber test: localized to unaffected ear

Rinne test: normal, air >bone

A

sensorineural hearing loss

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6
Q

Noise induced hearing loss: damage to? loss of what freq first?

A

damage to the sterociliated cells in organ of corti

loss of high frequency first

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7
Q

Age related progressive hearing loss

A

presbycusis

destruction of hair cells at cochlear base (loss of high freq)

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8
Q

OVergrowth of desquamated keratin debris within the middle ear space

A

cholesteatoma

may erode ossicles, mastoid air cells resulting in conductive hearing loss

painless otorrhea

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9
Q

Meniere disease triad

A

sensorineural hearing loss vertigo
tinnitus

type of peripheral vertigo that involves inner ear etiology vs central that is a brainstem or cerebellar lesion

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10
Q

Layers of eye (inside to out)

A

Retina (inner)
Choroid (middle)
Sclera (outer)

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11
Q

Most common cause of conjunctivitis (inflammation of the conjunctiva –> red eye)

A

viral due to adenovirus

sparse mucous discharge, swollen preauricular node, self resolving

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12
Q

Hyperopia

A

farsighted

eye too short for refractive power of cornea and lens –> light focused behing retina

convex lens needed

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13
Q

Myopia

A

nearsighted

eye too long for refractive power of cornea and lens –> light focused in front of retina

concave (diverging) lens

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14
Q

Presbyopia

A

aging related impaired accomodation (focusing on near objects)

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15
Q

aqueous humor pathway

A

90% via the trabecular outflow

10% via the uveoscleral outfloq

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16
Q

trabecular outflow

A

drainage through trabecular meshwork –> canal of schlemm –> episcleral vasculature

increases with M3 agonist

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17
Q

Uveoscleral outflow

A

drainage into uvea and sclera

increases with prostaglandin agonist

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18
Q

Aq humour

A

produced by nonpigmented epithelium on ciliary body

decrease by beta blockers, alpha 2 agonists, and carbonic anhydrase inhibitors

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19
Q

Iris dilator muscle

A

alpha1

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20
Q

Iris sphincter muscle

A

M3

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21
Q

Patient presents with increased intraocular pressure and progressive peripheral visual field loss

A

Glaucoma

optic disc atrophy with characteristic cupping(thinning of outer rim of optic nerve head)

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22
Q

Open angle glaucoma

A

the angle in your eye where the iris meets the cornea is as wide and open as it should be, but the eye’s drainage canals/trabecular meshwork become clogged over time with WBC,RBC, retinal elements, causing an increase in internal eye pressure and subsequent damage to the optic nerve.

associated with increased age

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23
Q

Closed angle/narrow glaucoma

A

primary cause - enlargement or anterior movement of lens against central iris (pupil margin) causing obstruction of aq flow through pupil. Fluid builds up behind iris and pushes peripheral iris against cornea and impedes flow through trabecular meshwork

secondary cause-hypoxia from retinal disease induces vasoproliferation in iris that contracts angle

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24
Q

Chronic vs acute closed angle glaucoma

A

chronic -damage to optic nerve and peripheral vision
acute- true emergency. increased IOP pushes iris forward and closes the angle abruptly.

sudden vision loss, halos around lights, frontal headache, fixed and mid dilated pupil

mydriatic agents contraindicated

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25
Q

anterior uveitis? posterior uveitis?

A

anterior is iritis
posterior is choroiditis and or retinitis

may have hypopyon (accumulation of pus in anterior chamber) or conjunctival redness

associated with systemic inflammatory disorders like RA or HLA-B27 associated conditions

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26
Q

Age related macular degeneration

A

degeneration of macula (central area of retina) causes distortion (metamorphopsia) and eventual loss of central vision (Scotomas)

dry-nonexudative
wet-exudative

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27
Q

Deposition of yellowish extracellular material in between Bruch membrane and retinal pigment epithelium with gradual decrease in vision

A

dry age related macular degeneration

28
Q

Rapid loss of vision due to bleeding secondar to choroidal neovascularization

A

wet age related macular degeneration

treat with anti-VEGF (vascular endothelial growth factor) injections

29
Q

Type of diabetic retinopathy

A

nonproliferative- damaged capillaries leak blood and lipids and fluid seep into retina causing hemorrhages and macular edema

proliferative - chronic hypoxia results in new blood vessel formation with resultant traction on retina

30
Q

Flame shaped retinal hemorrhages, AV nicking, microaneurysms, macular star, cotton wool spots

A

hypertensive retinopathy

increased risk of stroke, CAD, kidney dz

presence of papilledema requires immediate lowering of BP

31
Q

Papilledema

A

is a condition in which increased pressure in or around the brain causes the part of the optic nerve inside the eye to swell

optic disc swelling that b/l due to increased ICP

enlarged blind spot and elevated optic disc with blurred margins

32
Q

Retinal vein occlusion

A

blockage of central of branch retinal vein due to compression from nearby arterial atherosclerosis

retinal hemorrhage and venous engorgement

“blood thunder appearance”

33
Q

Retinal detachment

A

separation of neurosensory layer of retina (photoreceptor layer with rods and cones) from outermost pigmented epithelium (important for protecting the retina from light) –> degeneration of photoreceptors –>vision loss

could be secondary to diabetic traction etc

crinkling of retinal tissue and changes in vessel direction

34
Q

Patient complains of flashes and floaters and then loss of vision in one eye as if a curtain was drawn down

A

SURGICAL EMERGENCY!

retinal detachment

35
Q

Central retinal artery occlusion

A

acute painless monocular vision loss

retina cloudy with attenuated vessels and cherry red spot at fovea (center of macula)

36
Q

Retinitis pigmentosa

A

inherited retinal degeneration

starts with night blindness (rods affected first)

bone spicule shaped deposits around macula

37
Q

Retinitis

A

retinal edema and necrosis leading to scar

38
Q

Pupillary control pathway for miosis

A

(constriction, parasympathetic)

first neuron: edinger-westphal nucleus to ciliary ganglion via CN III
2nd neuron: short ciliary nerves to spincter pupillae mm

“short ciliary nerves shorten the pupil diameter”

39
Q

Pupillary light reflex

A

light in either retina sends a signal via CN II to pretectal nuclei in midbrain to activate bilateral edinger-westphal nuclei–> pupil constrict bilaterally

illumination in one eye- causes bilateral pupillary constriction

40
Q

Mydriasis control pathway

A

(Dilation, sympathetic)

1st neuron: hypothalamus to ciliospinal center of budge (C8-T2)
2nd neuron: exit at T1 to superior cervical ganglion while traveling along cervical sympathetic chain
3rd neuron: plexus along internal carotid through cavernous sinus –> enters orbit as long ciliary nerve to pupillary dilatory muscles

long ciliary nerves make the pupil diameter longer

41
Q

Marcus gunn pupil

A

when the light shines into a normal eye, constriction of the ipsilateral (direct reflex) and contralateral eye (consensual reflex) is observed

when swung to affected eye, both pupils dilate instead of constrict due to impaired conduction of light signal along the injured optic nerve

42
Q

Horners syndrome

A

sympathetic denervation of face

Ptosis - slight drooping of eyelid due to superior tarsal mm

Anhidrosis - absence of sweating and flushing of affected side

Miosis- pupil constriction

43
Q

Horners syndrome lesion

A

sympathetic chain

1st neuron: pontine hemorrhage, lateral medullary syndrome, spinal cord lesion above T1

2nd neuron (stellate ganglion): pancoast tumor

3rd neuron: carotid dissection (painful)

44
Q

Lateral rectus innervation

A

CN 6

45
Q

Superior oblique innervation

A

CN 4

46
Q

Innervation of all eye mm except superior oblique and lateral rectus

A

CN 3

“LR6SO4R3 chemical formula”

47
Q

strongest action of superior oblique

A

depression when eye is adducted

when abducted it acts to intort the eye towards the nose

48
Q

ptosis and “down and out”

A

CN III damage on motor (Central)

49
Q

Diminished or absent pupillary reflex “blown pupil” often with down and out gaze

A

CN III damage on parasympathetic output

50
Q

Cavernous sinus thrombosis would affect what CNs

A

4,6,V1,V2

51
Q

Eyes move upward particularly on contralateral eye. When going down stairs the patient may tilt head in opposite direction to compensate

A

CN 4

cant see the floor with CN 4 damage

52
Q

Affected eye unable to abduct and is displaced medially in primary position of gaze

A

CN 6 damage

lateral rectus can function and therefore medial gaze dominates

53
Q

Right anopia

A

optic nerve lesion

complete loss in right eye

54
Q

Bitemporal hemianopia

A

pit lesion, chiasm

loss of left field in left eye
loss of right field in right eye

55
Q

Left homonymous hemianopia

A

optic tract lesion

loss of Left eye field in both eyes if lesion on R optic tract

56
Q

Left upper quadrantanopia

A

right temporal lesion, MCA @ meyer loop

57
Q

Left lower quadrantanopia

A

right parietal lesion, MCA @ dorsal optic radiation

58
Q

Left hemianopia with macular sparing

A

PCA infarct affecting the meyer loop and dorsal optic radiation on right side

59
Q

Central scotoma in left eye

A

macular degeneration in left eye

60
Q

Meyer loop

A

lower retina, loops around inferior horn of lateral ventricle

61
Q

Dorsal optic radiation

A

superior retina

takes shortest path via internal capsule

62
Q

Cavernous sinus

A

collection of venous sinuses on either side of pituitary

drains into internal jugular vein

CN 3,4,V1,6,V2, pupillary fibers en route to orbit all pass through cavernois sinus

cavernous portion of internal carotid

63
Q

Patient presents with variable ophthalmoplegia, decreased corneal sensation, horner syndrome, occasional decreased maxillary sensation

A

Cavernous sinus syndrome

CN 6 most susceptible to injury

64
Q

Medial longitudinal fasciculus (MLF)

A

pair of tracts that allows for crosstalk between CN 6 and CN 3 nuclei

coordinates both eyes to move in same horizontal direction

highly myelinated for fast communication between eyes

65
Q

MLF lesion seen classically in MS

A

lateral

66
Q

lesion in MLF

A

internuclear opthalmoplegia

a conjugate horizontal gaze palsy

lack of communication between two eyes - when CN 6 nucleus activates ipsilateral lateral rectus, contralateral CN 3 nucleus does not stimualte medial rectus to contract

abductng eyes gets nystagmus because CN 6 overfires to stimulate CN 3

right vs left INO refers to eye with nystagmus

67
Q

internuclear opthalmoplegia (INO)

A

ipsilateral adduction failure

Nystagmus in opposite eye

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