Anatomy/Physiology/Pathology

Question 1

Identify the right answer and justify what’s wrong: Among domestic animals, two of them have an enclosed orbit, and two of them have an opened orbit…
1. Horse and pigs; dogs and goats
2. Sheep and goats; pigs and cattle
3. Cattle and pigs; dogs and cats
4. Sheep and goats; pigs and dogs

G

Answer 1

1 False wrong: pigs and goats.
2. False wrong: cattle.
3. False wrong: pigs.
4. Correct.

Question 2

Canine orbit: Identify the bones

GELATT: ophthalmic anatomy p. 43

Answer 2

Frontal
Palatine
Sphenoid
Zigomatic
Maxillary
Lacrimal

Question 3

Orbital bones of dogs, cats, ox and sheep?

GELATT ophthalmic anatomy p. 43

Answer 3

Lacrimal
Zygomatic
Frontal
Sphenoid
Palatine
Maxillary

Question 4

Orbital bones of horse and rabbit?

GELATT: ophthalmic anatomy p. 43

Answer 4

Lacrimal
Zygomatic
Frontal
Sphenoid
Palatine (same as the others)
Temporal

Question 5

Goat has less orbital bones, 5 in total.
identify them.

GELATT: ophthalmic anatomy p. 43

Answer 5

lacrimal, zygomatic, frontal, sphenoid, palatine.

Question 6

Within the orbit, various foramina and fissures provide osseous pathways for blood vessels and nerves: identify them.

GELATT: ophthalmic anatomy p. 42

Answer 6

Rostral alar, ethmoidal, lacrimal, orbital, ovale, optic, rotundum, supraorbital, maxillary, caudal palatine, sphenopalatine

Question 7

Orbital fissure and foramen rotundum are typically fused to form the foramen orbitorotundum in which specie?

GELATT: ophthalmic anatomy p. 42

Answer 7

Cattle

Question 8

Identify the three anatomic components of orbital fascia

GELATT: ophthalmic anatomy p. 42

Answer 8

Periorbita
Tenon’s capsule (or fascia bulbi)
Extraocular muscle fascial sheaths

sheath = bainha

Question 9

Only species that has ethmoid bone as an orbital bone

GELATT: ophthalmic anatomy p. 43

Answer 9

Pig and human

Question 10

Name the extraocular muscles and its related nerves

GELATT: ophthalmic anatomy p. 44

Answer 10

Dorsal rectus = Oculomotor (CNIII)
Ventral rectus = Oculomotor (CNIII)
Medial rectus = Oculomotor (CNIII)
Ventral oblique = Oculomotor (CNIII)
Dorsal oblique = Trochlear (CNIV)
Lateral rectus = Abducens (CNVI)
Retractor oculli = Abducens (CNVI)

Question 11

The distribution of globets cells in the conjunctiva is heterogeneous. Identify the highest densities of GC in dogs and cats.

GELATT: ophthalmic anatomy p. 48

Answer 11

Dog: Lower nasal and middle fornix; lower tarsal portion of the palpebral conjunctiva

Cat: anterior surface of nictitating membrane and conjunctival fornices

Question 12

What are the two layers of the conjunctiva?

GELATT: ophthalmic anatomy p. 48

Answer 12

Superficial = adenoid layer with lymphatic follicles and glands

Deep = fibrous layer with conjunctival nerves and vessels

Question 13

The cornea is innervated by the ____________________, which are derived from the ophthalmic branch of the trigeminal nerve.

Answer 13

Long ciliary nerves

Question 14

“In general, the most superficial layers are primarily innervated with ____, whereas more ____ are found in the stroma. This explains why a superficial corneal injury is often more painful than a deeper wound.”

GELATT: ophthalmic anatomy p. 54

Answer 14

pain receptors
pressure receptors

Question 15

a) Identify the types of collagen and glycans in the stroma
b) Considering collagen types, which one is the most prevalent?

GELATT: ophthalmic anatomy p. 58

Answer 15

a) I, III, V, VI, XII
chonroitin 6- and 4 sulfates, dermatan sulfate, keratan sulfate

b) Collagen type I

Question 16

Principal support structure of the cornea?

GELATT: ophthalmic anatomy p. 58

Answer 16

Colaggen fibrils
Proteoglycans
GAGS (heparan sulfates, chondroitin 4 and 6 sulfates, keratan sulfates, dermatan sulfates)
glycoproteins

Most abundant GAG? keratan!

Question 17

Considering Descemet’s membrane, judge the following statements as false or True. Justify what’s wrong!
a) PAS - positive, homogenous, cellular membrane
b) Descemet’s membrane ends at the apex of the trabecular meshwork in the limbal region
c) Basement membrane of the posterior endothelium
d) Descemet’s membrane and iridocorneal angle share the same collagen type: VII.

GELATT: ophthalmic anatomy p. 60

Answer 17

a=False: it’s acellular
b=True
c=True
d=False: Type VIII

Question 18

Cite the collagen types of Descemet’s membrane

GELATT: ophthalmic anatomy p. 60

Answer 18

III, IV, V, VI, VIII

Question 19

Who am I?
I) I’m a single layer of flattened cells
II) My regerative ability varies with species
III) My active mitosis occurs primarily in the immature animal
IV) In adults my cells are usually hexagonal shaped
V) I can change the overall corneal thickness
VI) In young dogs my density is greater than 3000 cells/² but it can decrease to between 500 and 800 cells/mm² within age

GELATT: ophthalmic anatomy p. 60

Answer 19

Yasss, I’m Endothelium
(and I rule!)

Question 20

The cornea is an exquisitely sensitive tissue: upon stimulation of the cornea, involuntary blinking occurs via intermediate relay from the ophthalmic branch of the ____ to orbicularis oculi innervation from the ____ nerve. This reaction is well known as ____.

GELATT: ophthalmic anatomy p. 131

Answer 20

trigeminal nerve

facial nerve

corneal or blink reflex

Question 21

Concomitant with the blink reflex is reflex tearing from____ innervation to the ___________.

GELATT: ophthalmic anatomy p. 131

Answer 21

parasympathetic

lacrimal gland

Question 22

False or True? justify.
a) Cochet-Bonnet esthesiometer shows that corneal sensitivity in dogs was highest, intermediate and lowest in the dolichocephalic, mesatocephalic and brachycephalic skull types
b) Corneal sensitivity is greatest in the peripheral cornea and lower in the central cornea
c) Corneal nerves fibers are sensory in origin with small proportion of sympathetic or parasympathetic in origin
d) Corneal nerve fibers respond to mechanical, chemical and thermal stimuli via facial nerve, hence are known as polymodal nociceptors
e) Corneal nerves maintain corneal epithelial health through the secretion of trophic factors and maintenace of basal tear secretions
f) All mammalian corneas contain a dense limbal plexus, multiple radially directed stromal nerve bundles, dense anastomotic subepithelial plexus and poorly innervated epithelium

GELATT: ophthalmic anatomy p. 132, 133, 134

Answer 22

a)True
b)False: it’s greater in the central and lower in the peripheral
c)True
d)False: via ophthalmic branch of the trigeminal nerve
e)True
f)False: richly innervated epithelium

Question 23

As we know, corneal nerves maintain corneal epithelial health through the secretion of trophic factors and maintenace of basal tear secretions. Cite these trophic factors:

GELATT: ophthalmic anatomy p. 134

Answer 23

Acetylcholine
Vasoactive intestinal peptide
Neurotensin
Substance P
Calcitonin gene-related protein

Question 24

Even an isolated corneal lesion can cause clinical signs as conjunctival hyperemia and anterior uveitis (miosis, ocular hypotension, aqueous flare). Explain the physiopathologic events related with this condition.

GELATT: ophthalmic anatomy p. 134

Answer 24

Question 25

a) Quais os componentes da barreira hemato-ocular? b) Considere as seguintes especies e ordene em grau de fragilidade da barreira- do menos ao mais fragil: equino, canino, humano, coelho, gato

Answer 25

a)**barreira hemato- aquosa e hemato-retiniana** b)**Humanos/ primatas** **cão** **gato** **equino** **coelho**

Question 26

Em relação aos linfòcitos T Helper, julgue as seguintes afirmações como verdadeiras ou falsas e justifique as falsas: I) Os TH1 e TH2 inibiem a inflamação enquanto o TH17 causa inflamação crônica e leve; II) TH1 libera as citocinas IFN-y com o objetivo de ativar macròfagos e produção de IgG para defesa de microorganismos intracelulares, tendo papel nas doenças autoimunes; III) IL- 4, IL-5, IL-13 são citocinas liberadas pelos TH2; IV) TH2 participa da ativação de mastòcitos, eosinòfilos e produz IgG; V) As citocinas IL- 4, 5 e 13 atuam na defesa de parasitas, helmintos e estão relacionados com casos de alergia; VI) IL-17 A, F e IL-22 atuam na defesa contra bactèria intracelulares e fungos

Answer 26

**Falso= aguda e grave** **Verdadeiro** **Verdadeiro** **Falso= produz IgE** **Verdadeiro** **Falso= extracelulares**

Question 27

Quais os componentes da imunidade inata na oftalmologia?

Answer 27

**Barreiras epiteliais** **mucina, especialmente em felinos** **macrófagos, neutrófillos e células NK** **peptideos microbianos**

Question 28

Identifique os receptores toll-like presentes em: a) epitélio da córnea b) estroma

Answer 28

a)**TLR4 e TLR5** b)**TLR1, 3, 4, 6, 7 e 9**

Question 29

Identifique os TLR para cada caso: a) KCS qualitativa

Answer 29

a)** 2, 4, 5, 9**

Question 30

Componentes da imunidade adaptativa ocular?

Answer 30

**Tecido Linfoide Associado ao Olho** **Células Apresentadoras de Antigeno**

Question 31

Descreva os componentes da Unidade Funcional Lacrimal

Answer 31

**Córnea** **Tec. linf. associado a conjuntiva** **Tec. linf. difuso na conjuntiva** **vasos conjuntivais sanguíneos e linfáticos** **Glândulas lacrimais, meibomio** **Cels. conjuntivais de Goblet** **Cels. epiteliais** **associação com nervos: V e VII + LDALT**

Question 32

Quais os fatores solúveis e celulares que participam da imunorregulação da superfície ocular?

Answer 32

**nTregs: CD4+, CD8+, Grupo gama, NK** e **TGF-B**

Question 33

Sobre o estresse na superfície ocular e a resposta autoimune: ____ altera as mucinas nas células epiteliais da córnea. Causa, por exemplo, ______, _______ e metaplasia escamosa.

Answer 33

**IFN-y** **Apoptose de células epiteliais** **Perda de células caliciformes**

Question 34

Sobre o estresse na superfície ocular e a resposta autoimune: IL-17 aumenta a expressão de ___ e ____. Também induz disfunção da barreira epitelial da córnea.

Answer 34

**MMP 3 e MMP 9**

Question 35

Sobre o estresse na superfície ocular e a resposta autoimune: As citocinas de resposta aguda que estão elevadas nos pacientes com KCS são: ___,___, ____ e ____.

Answer 35

**IL-1 alfa, IL-1 beta, TNF alfa, IL-6**

Question 36

O sistema imune não reconhece microorganismos infecciosos ou dano tecidual, ele reconhece moléculas que não estão no tecido saudàvel: nesse sentido, qual a relação da inflamação inerente ao glaucoma e o sistema imune? | GELATT: ocular immunology, 264

Answer 36

Question 37

Quanto à resposta immune ocular do tipo inata: quais os peptídeos antimicrobianos presentes no filme lacrimal?

Answer 37

**Lisozima, alfa lisina, lactoferrina, ceruloplasmina, transferrina**

Question 38

Imunologia ocular: dos fatores que determinam o tipo de resposta imunológica, tem-se o bloqueio de moléculas importantes para a ativação do sistema imune. Essa é a estratégia medicamentosa tem como exemplo os inibidores de calcinerina. Dois medicamentos muito usados na rotina da oftalmologia veterinária são...

Answer 38

**Ciclosporina e Tacrolimus**

Question 39

A) Indique um diagnóstico provável B) Cite outros tipos que possam acometer conjuntiva.

Answer 39

**Hemangiossarcoma conjuntival e corneal** **melanoma, cce, mastocitoma, papilomas, linfossarcoma, histiocitoma, tvt**

Question 40

A) What's the diagnosis? B) Ddx?

Answer 40

A) **Evertion of the cartilage of the nictitating membrane** B) **Prolapse of the gland, orbital flat prolapse**

Question 41

A) What's the likely diagnosis? B) DDx C) Likely pathogenesis

Answer 41

A)**Prolapse of the gland of the nictitating membrane** B)**eversion of the cartilage** C)**weakness in the connective tissue attachment between the NM ventrum and the periorbital tissues**

Question 42

What are the most common primary tumors of the third eyelid?

Answer 42

**adenocarcinoma, papillomas, malignant melanomas**

Question 43

A) Describe the image B) Likely diagnosis C) DDx

Answer 43

A)**Hyperemia, red, proliferative, protruding mass** B)**Hemangioma of the nictitating membrane** C)**Hemangiossarcoma, angiokeratomas**

Question 44

Considering the picture and the following features: thickening, depigmentation, follicle formation. What's the likely diagnosis?

Answer 44

**plasma cell infiltration of the nictitating membrane ** / **plasmona**

Question 45

About conjunctival grafts: False or true. Justify! A) They preserve corneal and ocular integrity, replace corneal tissue, and supply vascularization. B) Conjunctival defects smaller than 1 cm in diameter can either be allowed to heal by second intention or can be closed with 5-0 to 7-0 pilyglactin 910 sutures. C) They grafts created needs to be (~1-2 mm) smaller than the necessary to cover the wound. D) Sutures must be placed in corneal healthy epithelium to prevent dehiscence of the graft. E) Island graft can be created from the palpebral conjunctiva of the upper eyelid and used it in cases of Bacterial infection, also ideally used in already vascularized corneas.

Answer 45

A)**True** B)**True** C)**False. Larger** D)**False. In healthy corneal stroma** E)**False. Should not be used in cases of Bacterial infection**

Question 46

The blood supply of the NM is supplied by the _______.

Answer 46

**Malar artery**

Question 47

Na córnea do equino, encontramos os dois tipos de condroitina (sulfato de condroitina 4 e 6), porém uma está em maior quantidade do que a outra. A) quem está em maior quantidade? B) qual tipo consegue reter mais água?

Answer 47

**Sulfato de condroitina 4** **Sulfato de condroitina 6**

Question 48

Quais as proteínas/ moléculas presentes no processo de reepitelização da córnea?

Answer 48

**Hsp70 = induz migração e proliferação celular** **SLUG= facilita migração** **IL-11= inflamação e imunidade** **Striatin protein= adesão celular** **SLRPs= produz, organiza e remodela colágeno e elastina**

Question 49

Excessive degradation of normal healthy tissue is prevented by natural proteinase inhibitors in the tear film and cornea. Which are...

Answer 49

**alfa1- proteinade inhibitor** **alfa2-macroglobulin** **tissue inhibitors of metalloproteinases (TIMPs)**

Question 50

A) What are the two general types of chemical burns to the cornea? B) What are the clinical signs? C) What is the difference between them? D) Cite acidic chemicals and alkali chemicals

Answer 50

**acidic and alkali** **unexplained acute blepharospasm and severe corneal opacity, loss of corneal epithelium, pain, rapid dissolution of corneal stroma, anterior uveitis** **Alkali = tends to be more severe / Chemical= tends to be deeper** **Acidic= sulfuric acid, sulfurous acid, hydrochloric acid... Alkali= ammonium hydroxide, potassium hydroxide, sodium hydroxide, calcium hydroxide, magnesium hydroxide**

Question 51

What are the two forms of neurogenic keratitis?

Answer 51

A)**neutrotrophic = lack of sensory innervation (trigeminal nerve)** and **neuroparalytic = lack of motor innervation (facial)**

Question 52

Define corneal abscess and identify Ddx.

Answer 52

**accumulation of inflammatory cell debris in the superficial or deep stroma** **Ddx = corneal epithelial inclusion cyst**

Question 54

Considering this image and the features: corneal lesion adjacent to the limbus, regional corneal edema, leukocyte infiltrates, vascularization, raised corneal nodules. A) What's the likely diagnosis? B) Ddx?

Answer 54

**Parasitic keratitis secondary to leishmaniasis** **Protozoal keratitis: amoeba, toxoplasma gondii

Question 55

O que compõe a inervação da conjuntiva?

Answer 55

**N. Ciliar longo** **N. Zigomático-facial temporal** **Infratroclear** **Frontal**

Question 57

Superificial punctate keratitis: clinical presentation and treatment

Answer 57

**multiple, punctate/circular Grey, superficial corneal opacities that may ir may not be ulcerated** **topical cyclosporine or corticosteroids combined with a topical antibiotic when ulcerations are present**

Question 59

About crystalline corneal opacities in the dog: False or True. Justify. A) There are three main clinical groups: corneal dystrophies, lipid keratopathy, corneal degeneration B) Corneal distrophies are primary, bilateral and inherited in general C) Hypothyroidism and Cushing's disease can lead to corneal distrophies D) Degeneration happens without inflammatory process and with chronicity E) Rule out corneal infiltration from systemic disease: chemistry panels (cholesterol, high-density lipiprotein, low-density lipoprotein, fasting blood glucose, triglycerides, calcium -ionizado-, phosphorus) + thryroid and adrenal function F) Topical anti-inflammatory medications are an option for medical treatment

Answer 59

**A) True** **B) True** **C) False. It can lead to lipid keratopathy** **D) False. It's secondary to localized ocular inflammatory process** **E) True** **F) False. Topical anti-inflammatory medications may exacerbate the lesion**

Question 60

Breed-predisposed corneal dystrophy:

Answer 60

**beagle, Liberian Husky, Shetland sheepdog, Cavalier K C S, Boston, Boxer, Chihuahua, Dachshund, Miniature Schnauzer, Poodle**

Question 61

Crystalline corneal opacities in the dog: False or true. Justify. A) Corneal degeneration is commonly bilateral and associated with keratitis, uveitis. B) Cholesterol is a component of opacity in the three main clinical groups C) Fatty acids are present in both corneal distrophy and lipid keratopathy D) Phospholipids, fatty acids, calcium are the components of opacity all opacities but not when episcleritid, sclerosis, chronic lipid keratopathy and chronic corneal distrophy occurs.

Answer 61

A)**False. Unilateral** B)**True** C)**True** D)**False. Actually, only when those are the associated conditions**

Question 62

A) Clinical signs B) Likely diagnosis C) Likely causes D) Therapy

Answer 62

A)**gray-white, superficial crystalline corneal opacity, axial/paraxial, oriented in the horizontal interpalpebral fissure** B)**Band Keratopathy** C)**dystrophic calcification secondary to corneal inflammation, sistemic hypercalcemia, hyperadrenocorticism, diabetes mellitus, hepatopathy** D)**superficial keratoctomy * or EDTA**

Question 63

Considering the following image: A) Describe the clinical signs B) Likely diagnosis C) Common breeds D) Ddx

Answer 63

**diffuse corneal opacity, blue-white appearance, lack of corneal vascularization or conjunctival hyperemia** **Corneal Endothelial Dystrophy** **Boston terrier, Chihuahua, Dachshunds **Uveitis, Glaucoma**

Question 64

A)Intracorneal stromal hemorrhage or corneal Hemangiossarcoma? B)Systemic diseases that can lead to this condition?

Answer 64

**Intracorneal stromal hemorrhage.** **DM, Hyperadrenocorticism, Hypothyroidism, systemic hypertension**