Anatomy Flashcards
(186 cards)
1
Q
What does the frontal nerve divide into?
A
- Supraorbital nerve
2. Supratrochlear nerve
2
Q
What does the frontal nerve innerviate?
A
- Medal canthus
- Upper eyelid
- Forehead
3
Q
What controls parasympathetic innervation?
A
The SHORT posterior ciliary nerves after SYNAPSING in the ciliary ganglion
4
Q
What does parasympathetic innervation do for the eye? How does it enter the eye?
A
- Accommodation
- Pupillary constriction
- LACRIMAL GLAND STIMULATION
Enters the eye as the short posterior ciliary nevers after SYNAPSING with the ciliary ganglion
5
Q
What does sympathetic innervation do for the eye? How does it enter the eye?
A
- Controls pupillary dilation
- Vasoconstriction
- Controls smooth muscle function of eyelids -Muellers Muscle
- Hidrosis
The nerve fibers follow the arterial supply to the pupil, eyelids, and orbit in a/w the LONG ciliary nerves.
6
Q
What route do the sympathetic fibers take?
A
Follow arterial supply and LONG CILIARY nerves
7
Q
What is the strongest orbital wall?
A
LATERAL wall
8
Q
Which bone in the orbit is not made up of bone?
A
Lesser wing of sphenoid (cartilage)
9
Q
How many bones make up the medial wall?
A
FOUR - “SMELL”
- Ethmoid
- Maxillary
- Lacrimal
- Sphenoid - lesser wing
10
Q
The Frontal sinus drains into which meatus?
A
Middle
11
Q
Which sinus reaches full size after puberty?
A
Sphenoid
12
Q
How many fat pads are in the upper eyelid and which is paler?
A
2, NASAL
13
Q
What embryological tissue makes up the orbital septum?
A
Mesoderm
14
Q
What divides the 2 lobes of the lacrimal gland?
A
Levator aponuerosis
15
Q
What are the 3 types of innervation for the lacrimal gland?
A
- Secremotor - CN 7
- Sensory - CN 5
- Sympathetic - superior cervical ganglion
16
Q
Upper eyelid approximates what structures?
A
Levator aponeurosis to the PRETARSAL Orbiuclaris and skin (not just to the superior border of the tarsus)
17
Q
Muscle of Riolan is made up of which muscle?
A
Pretarsal orbicularis
18
Q
Horner’s muscle is made up of which muscle?
A
MEDIAL deep head of pre tarsal orbicularis
19
Q
What cranial nerve innervates the frontalis muscle?
A
CN7
20
Q
What muscle pulls the EYEBROW medially and inferiorly producing the vertical glabellar wrinkle?
A
Corrugator - CN7
21
Q
What muscle pulls the FOREHEAD medially and medial eyebrow inferiorly producing horizontal lines in the nose?
A
Procerus - CN7
22
Q
What orbital bone does the legator palpebrae originate and where?
A
From the LESSER wing of the sphenoid bone Above the annulus of zinn.
23
Q
Where does the Muellers muscle originate?
A
at the level of Whitnall’s ligament originating from the undersurface of the levator.
24
Q
Where is the peripheral arterial arcade found?
A
Between aponeurosis and muellers muscle?
25
Which limb of the medial canthal tendon is more important for appearance and function?
Posterior limb
26
Does the medial or lateral canthan tendon insert higher?
Lateral - 3mm
27
Sebaceous carcinoma orginates from which glands of the eyelid?
1. Zeiss
| 2. Meiobian
28
What are the glands of the caruncle?
1. Zeiss
| 2. Goblet cell
29
Which MRI image offers the best anatomical detail and has shorter acquisition times and less artifact?
T1
30
Which MRI image can differentiate a melanotic lesion from hemorraghic process of the choroid?
T2
31
Which fungal organism is non-septated, large branching hyphae that causes painful orbital apex syndrome and retinal vascular occlusions?
Mucormycosis
32
Which fungal bug causes necrotizing angitis, endophthalimitis and is septated branching hyphae?
Aspergillus
33
IOI in kids is U/L or B/L and what is associated?
- 33% B/L
| - Papillitis and iritis
34
What are the optic nerve lengths?
```
125-1017
1 - Intraocular
25 - orbital
10 - intracanalicular
17 - intracranial
```
35
What are the 7 things that are transmitted through the SOF?
1. CN3
2. CN4
3. V1
4. SOVein
5. CN6
6. Sympathetic fibers to the iris dilator
7. NASOCILLARY NERVE
36
What bone is the optica canal located in?
Lesser wing of sphenoid
37
How long is the optic canal?
10mm
38
What does the optic canal transmit?
1. CN2
2. Ophthalmic Artery
3. Sympathetic fibers to the blood vessels (from the internal carotid plexus)
39
Foramen ovale transmits?
V3
40
Foramen rotundum transmits?
V2
41
How many mm does the central retinal artery enter posterior to the globe?
13mm
42
How many mm does the central retinal vein enter poster to the globe?
10mm
43
What are the 3 divisions of CNV1?
1. NASOCILLARY (inside cone)
2. Frontal
3. Lacrimal
44
Does the short ciliary nerve of the nasocillary nerve synapse with the ciliary ganglion?
NO
45
In IOI on CT what is the ring sign?
Contrast enhanced sclera
46
Which muscles are mostly affected in orbital myositis?
MR + LR (33%) each
47
Which disease process has less pain and proptosis?
Orbital myositis
48
Sclerosing orbital pseudotumor is a/w which systemic condition?
Retroperitoneal fibrosis
49
What is Von Graffe sign?
Lid lag on DOWNGAZE
50
Recession of inferior rectus can cause increase or decreased lower lid retraction?
Increased because inferior rectus is connected to lower eyelid retractors.
51
What type of trauma is most common with direct (or high flow) CC fistulas?
Basal skull fracture
52
In low flow (or dural) CC fistulas what is the vascular communication?
carotid artery meningeal branches and dural walls of the cavernous sinus
53
Where are hemangiopericytoma located, in who, reflectivity, systemic status?
Superior orbit, women, metastasize to lung, bone, and liver.
54
Which sinus is most common for a mucocele to form?
Frontoethmoid sinus
55
How does botox work on the molecular level?
Stops release of ACH by disrupting Ca metabolism
56
What herniates in blepharochalsis?
Lacrimal gland
57
What are the 3 causes of involutional ENTROPION?
1. Canthal tendon laxity
2. Over-riding preseptal orbicular is
3. Capsule palepebral fascia dehisence
58
Paralytic ECtropion is due to what?
CN7 Palsy
59
Appocrine vs Eccrine hydrocytomas, which has pigmented fluid?
Apocrine
60
Muir-Torre syndrome has what 3 things?
1. Keratocanthoma
2. GI viseral tumors
3. Multiple sebaceous neoplasms
61
What eyelid lesion appears as a blue lesion above the skin with blue basaloid cells and keratin cysts and squamous eddies?
Seborrehic keratosis
62
What is pilomatrixoma a/w?
1. Myotonic Dystrophy
| 2. Gardner's syndrome
63
Actinic keratosis can evolve into what?
1. BASAL cell CA
| 2. Squamous cell
64
Which nevi are pigmented?
1. Junctional
| 2. Compound
65
Name 3 umbilicated lesions?
1. Keratocanthoma
2. BCC
3. Mulloscum
66
How does SqCC spread?
1. Direct extension
| 2. Metastsize via lymphatics and hematogenously
67
Give the order - most to least - common eyelid malignancy?
1. BCC 2. SEBACEOUS 3. SqCC 4. Melanoma
68
What is the pathological description of Sebaceous Adenomacarcinoma of the eyelid?
1. Skip areas
| 2. Pagetoid spread (spread of tumor into conj)
69
Lentigo Malinga has pigmentation where?
Acquired periocular and conjunctival not episcleral.
70
What is a rare, vascular tumor of the upper eyelid that metasizes in 30% of patient's with neurogenic origin?
Merkel cell tumor
71
What Dx has confluent, waxy, yellow papules that may hemorrhage with minor trauma?
Amyloidosis (stains with congo red)
72
Is proptosis seen in both high & dural flow fistulas?
YES
73
What is the most common primary lacrimal sac tumor?
Squamous Papilloma
74
What is the natural course of orbital lymphangioma in kids?
Sponeteous regression - so observe
75
In 4 lid blephroplasty which muscle is most commonly responsible for vertical diplopia?
Inferior Oblique - b/c connection to capsulpalpebra fascia)
76
What is the treatment for pleomorphic adenoma?
Excision to prevent malignant transformation
77
Capsolopalpebral fascia disinsertion causes what?
ENTROPION
78
Lymphoma causes proptosis or enophthalmosis?
Proptosis
79
What are the characteristics of a junctional nevi?
Darker and thin
80
What are characteristics of a compound nevi?
Lighter and elevated
81
What is a keratincanthoma filled with?
Keratin NOT LIPID - can transform to SqCC
82
Culter-Beard does what?
Replaces the upper eyelid with the lower eyelid transposition
83
Hugh's flap does what?
Transposes a bridge flap of tarsus and conj from the upper lid to fill a gap in the lower lid
84
Does the conj or the orbit contain lymphatic vessels or nodes?
conj
85
Xanthelesma is found in what layer of the skin and what percentage has a systemic association?
Dermis; 25% ; can have proptosis and has a perivenular distribution
86
Give example of a Eccrine gland?
Aqueous glands
87
Give an example of a holocrine gland?
Oil glands, goblet
88
Steatoblepharon is what?
Bulging of orbital fat occuring with age or attenuation of the orbital septum
89
Which turbinate is used for the DCR?
Middle turbinate - which is 10 mm within the cribiform plate
90
What is the primary malignancy of the lacrimal sac and the second most common?
1. SqCC
2. Lymphomas
Others - transitional cell and mixed
91
Which Jones test accesses the functioning of a surgical osteotomy site Post DCR?
Jones 3
92
Which Jones test has a high false negative rate?
Jones 1
93
In Jones 2 testing, what does it mean when clear fluid is recovered vs dye fluid recovered?
Clear fluid - obstruction before the lacrimal sac
| Dye - Lower system obstruction
94
What bug causes acute dacroyscystitis in adults?
Strep Pneumo
95
Retraction of the lower lid retractors makes the inferior cul da sac what?
Deeper
96
Cavernous hemagioma has what type of internal reflectivity and why?
HIGH - c/w nonhomogenous tissue
97
How do you treat Rhabdomyosacroma?
First - chemo
| Second - Radiation
98
What is treatment for Adenoid cystic CA?
Exenteration
99
What is commonly seen in an orbital varix?
Phlebolith
100
In lymphoma with polyclonal dx, what does that equate to?
Reactive lymphoid hyperplasia
101
What is the most common location of lymphoma?
Lacrimal fossa
102
How does optic nerve mengioma present in kids?
Lower eyelid edema and chemises - usually a/w NF2
103
What percentage of congenital nevi convert to melanoma?
5-10%
104
What is the most common cause of vision loss in CC FISTULA?
elevated IOP and GL
105
What type of ptosis do you get with Horner's?
BLEPHAROptosis (in horners, lesion BELOW cartoid artery bifurcation)
106
What type of imaging is best to r/o Organic FB?
MRI
107
What kind of striations are seen in Rhabo?
CROSS striations
108
Late lung mets are seen in what LG tumor?
Adenoid cystic CA
109
What causes indentation of the glob and is a/w choroidal folds and hyperopic shift?
Cavernous hemangioma
110
What is used from spastic ENTROpion for the lower lid?
Quickert suture - insite scar between retractor and orbicular is muscle preventing preseptal orbicularis overide
111
Lymphoma typically presents with?
Proptosis
112
Silent sinus syndrome is what?
Progressie shrinking of the maxillary sinus with secondary NEGATIVE pressure in the sinus - causes U/L enophthalmos
113
What are 4 characteristics of blepharoptosis?
1. Fat atrophy
2. LG prolapse
3. ECTROPION
4. Canthal ligament laxity
114
Perineural spread of malignancy is characteristic of what dx?
SQUAMOUS cell CA
115
Pagetoid spread is common for waht dx?
Sebaceous cell ca (intraepidermal)
116
Prednisone is a/w what 3 SE?
1. Psychosis
2. HTN
3. Increased in NA
117
Which imaging device is better at picking up tissue Calcification?
CT
118
What are the #1 and #2 ocular manifestations in Graves dz?
1. Eyelid retraction
| 2. Proptosis
119
Orbicularis muscle is innervated by what CN?
7
120
Levator muscle is innervated by what CN?
3
121
Orbital septum fuses how many mm above and below the tarsal bordre
Upper eyelid - 4 mm
| Lower eyelid - 1 mm
122
Which CN is most commonly affected by sarcoid?
Facial - CN 7 ( Second is optic nerve)
123
Which fungi takes weeks to months to progress?
Aspergiullus
124
Which fungi takes hours to progress?
Mucor
125
What can cause enophthlmos at rest and proptosis?
Orbital varix
126
Which has orbital disease: Wegners or Polyartertis Nodosa?
Wegener's
127
"Standing Room Only" is the pneomic for what?
Trigeminal nerve openings:
V1 -
V2 - Rotundum
V3- Ovale
128
What are 2 bad prognostic characteristics for Conj melanoma?
1. Arising de novo
| 2. not involving the limbus
129
Which eyelid disease resembles Verccua?
Trichilemmoma
130
What appers as a flesh colored plaque with overlying teleangectasia and can be confused with BCC?
Trichepitheleoma
131
What appears as a reddish purple subcutaneous mass?
Pilomatricoma
132
What is the name of the procedure that has a direct resection and then repair of the lower eyelid margin just before the lateral canthal angle (Ectropion)?
BICK procedure
133
What is the Tenzel procedure?
Tarsal fracture for cicatricial ectropion
134
Where does the frontal and anterior and middle ethmoid air cells drain?
Middle meatus
135
Where does the sphenoid sinus drain?
Sphenoethmoidal recess
136
Where does the posterior ethmoid sinus drain?
Superior meatus
137
Where does the maxillary sinus drain?
Middle meatus
138
Eczematous lesion over the eyelids equals?
Mycosis fungoides (T cell lymphoma)
139
Which MRI has the best anatomical detail of the orbit?
T1 - require shorter acquisiton times than T2 so less artifact
140
Which MRI has the advantage of showing methemoglobin brighter than melanin and can help differeriate melanotic lesions from heme process in the choroid?
T2
141
Vitreous is dark in?
T1
142
What provides better spatial resolution and precise location of a lesion?
CT
143
Which test allows for better tissue contrast?
MRI (helpful in the evaluation of demyelination and in vascular and hemorrhagic lesions.)
144
What helps differentiate between fresh and old hemorrhage?
MRI
145
How do you treat Wegner's?
Cyclophosphamide and prednisone
146
Vasculitis is what type of hypersentivity run?
III
147
How do u treat Wegeners?
Bactrim (prednisone alone may cause high rate of mortality )
148
What distinguishes a menigioma from fibrous dysplasia?
A dural tail helps distinguish a menigoma. (seen on MRI)
149
Deep superior sulcus deformity occurs why?
Decreased orbital volume. Fix by putting bigger implant.
150
What muscle depresses the eyebrows and closes the eyelids?
Orbicularis oculi
151
What causes forehead skin wrinkles?
Contraction of the frontalis muscle.
152
Which accessory LG is located in the superior fornix?
Krause glands (found in upper and lower eyelids!!)
153
Which accessory LG is located at the top of the upper eyelid tarsus?
Wolfring glands (found in upper and lower eyelids!!)
154
A superior division palsy of the THIRD CN results in what and implies what?
Ptosis and decreased up gaze.
| Implies an intraorbital disruption of the third CN.
155
The posterior surface of the levator aponeurosis inserts where?
Firmly onto the anterior surface of the lower half of the tarus 3 mm above the eyelid margin and only very loosely attached to the superior 2-3 mm of the tarsus.
156
When should coumadin be stopped before surgery?
4 days
157
When should ASA be stopped before surgery?
5 days
158
When should NSAIDS be stopped before surgery?
72 hours before
159
What are small flesh colored papules with occasional telangiectasias that occur on the eyelids or forehead? May look like BCC.
Trichoepitheliomas
160
What is a single, sometimes umbilicated lesion found mainly in adults?
Trichofolliculoma
161
What lesion resembles verrucae?
Trichilemmoma
162
What lesion affects young adults and usually occur in an eyebrow and central upper eyelid as a reddish purple subcutaneous mass?
Pilomatricoma
163
What is a freckle?
Hyperpigmentation of the basal layer of the epidermis. The number of epidermal melanocytes is NOT increased.
164
What is lentigo simplex?
Pigmented spots larger than freckles where the number of epidermal melanocytes are INCREASED.
165
Dermal melanocytes in the nevus of ota proliferate where?
In the region of the first and second dermatomes of CNV.
166
What is the name of SqCC in situ with elevated lesions non healing and erythematous in nature?
Bowen disease - NO dermal invasion. 5% of patients progress to vertically invasive SqCC.
167
What is the name of the premalignant melanocytic lesion that is flat, irregularly shaped, unevenly pigmented, slowly enlarging that typically occurs on the malar region in older white patients?
Lentigo maligna (hutchinson melanotic freckle)
168
What has strong prognostic implications for malignant melanoma?
tumor thickness (>1.5mm - 50% survivial rate)
169
Marcus Jaw Wink is a synkinesis betwn what two nerves?
CN3 (Levator) and motor division of CN V (CONTRALATERAL ptyergoid muscle)
170
What has a quicker onset and greater diffusion into tissues, but duration of action is shorter: BoTox A or B?
B
171
What 3 muscles are involved in Benign Essential blepharospasm?
1. Orbicularis oculi
2. Procerus
3. Corrugator muscles
172
Which occurs during your sleep: BEB or Hemifacial spasm?
Hemifacial spasm (a/w ipsilateral facial nerve weakness)
173
What are the 3 main complications?
1. Retrobulbar heme
2. Diplopia
3. Lagophthalmos - from excessive skin removal.
174
The afferent (sensory pathway) of the reflex tear arc is controlled by what nerve?
CN V1
175
What muscles cause vertical wrinkles between the eyebrows?
Corrugator
176
What muscle causes horizontal wrinkles between the eyebrows?
Procerus
177
When the lower eye lid retractors disinsert what happens to the inferior fornix?
It deepens
178
What is the thinnest portion of the maxillary bone?
Posterior medial
179
What is the first step in managment for a keratocanthoma?
Incisional bx for tissue dx. Once that is done then complete surgical removal is recommended.
180
Acute infections to the glands of Zeiss are called?
External Hordeloum or styes
181
Acute infections to the orfice of the meibomian glands are called?
Internal hordeloum
182
What is the main protractor of the eye lid and what is it innervated by?
Orbicularis and CN 7!! (CLOSES the eyelid)
183
Where is the most common location of the lacrimal fistula ?
Inferonasal to the medial can thus area
184
What is Meige's syndrome?
Blepharospasm with facial dystonia
185
What % of patients with hyperthyroidism develop TAO?
30%
186
List in order of greatest to least common incidence of eyelid tumors?
Bcc> squamous > melanoma > sebaceous
