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Flashcards in Block 3 More plz Deck (179):
1

sympathetic NS

mydriasis
a1 contracts pupillary dilator muscle
a1 contracts superior tarsal muscle
b2 relax ciliary muscle = increase long distance vision
b increase aq humor formation

2

parasympathetic NS

miosis
ptosis
muscarinic receptors:
M3 contract pupillary sphincter
M3 contract ciliary muscle = increase near vision
M3 increase drainage of aq humor

3

mydriatic agents

ATROPINE: muscarinic receptor antagonist > cycloplegia (paralysis of ciliary muscle)

PHENYLEPHRINE a1 agonist, reverts ptosis in Horner's syndrome
EPINEPHRINE a1 agonist, increases aq humor outflow, inhibits aq humor formation*

COCAINE blocks axoplasmic pump, inc NE
AMPHETAMINE release of NE

4

miotic agents

PILOCARPINE muscarinic agonist
ACETYLCHOLINE muscarinic agonist
NICOTINE activates para sympathetic nerves
PHYSOSTIGMINE anticholinesterase AChE

TERAZOSIN a1 antagonist

RESERPINE depletes NE

5

Tx for glaucoma

ECOTHIPHATE and PHYSOSTIGMINE anticholinesterases
PILOCARPINE muscarinic agonist
= increase outflow of aqueous humor

APROCLONIDINE a2 agonist
ACETAZOLAMIDE CA inhibitor
TIMOLOL b antagonist/blocker
= suppress aq humor formation

6

alpha agonists

phenylephrine a1
epinephrine a1
aproclonidine a2

7

muscarinic agonists

pilocarpine
acetylcholine

8

anticholinesterases

physostigmine
ecothiophate

9

botulism toxin

suppresses ACh release from neurons

10

optic nerve pathway

retinal ganglia > optic nerve > optic chiasm > optic tract > lateral geniculate nucleus > optic radiation > visual cortex (occipital lobe)

11

Meyer's Loop/sublenticular

upper visual field fibers --> temporal lobe --> visual cortex

12

retrolenticular

lower visual field fibers --> parietal lobe --> visual cortex

13

Area 17
and 18 and 19

visual cortex in occipital lobe

then 18 and 19 association cortex

14

CN I special neurons

BIPOLAR

15

bipolar neurons through

cribriform plate to olfactory bulb

16

receptors and 1* neuron process

1. activate receptor protein
2. activates G protein (G-olf)
3. inc cAMP
4. cAMP opens ligand gated Na+ channel > DEPOLARIZATION

17

2* olfactory neuron called

mitral neuron, in olfactory bulb, which goes to synapse a bunch of places

18

primary olfaction cortex

piriform "pear shaped" cortex

19

orbital frontal cortex

where taste and smell meet to produce "flavor"

20

gustation involves which CN

CN V (touch and temp), VII (taste), IX (taste touch temp), X

21

gustation receptor cells are not

primary neurons
they are RECEPTOR CELLS
(100 receptor cells per taste bud, each cell does one of five tastes, receptor cells turn over q10days)

22

gustation process/pathway

1. receptor is activate
2. G protein (sweet, omami, bitter) / Na channel or proton closes K channel (sour, salty)
3. 2nd mess (sweet, umami, bitter)
4. open channel for DEPOLARIZATION
5. open VG Ca++ or release intracellular Ca++
6. AP

23

gustation receptor cell types

sweet, sour, bitter, omami, salty

24

taste buds (tip to back of tongue)

fungiform, foliate, circumivallate

25

CN XI origin

C 1-5 of spinal cord

26

CN XI stroke on right
Sx

weak SCM same side (can't turn to opposite side)

27

CN IX glossopharyngeal supplies

tonsillar area and TM

28

retropharyngeal space

worry about infeciton

29

adenoidectomy

pharyngeal tonsils

30

cough afferent reflex

CN VII

31

cricothyroid muscle innervation

external branch of superior laryngeal nerve of vagus

32

piriform recess innervation

internal branch of superior laryngeal nerve of vagus

33

CN X vagus

cough swallow speech
PALATOGLOSSUS

34

4 gaze systems

1. saccadic movements (rapid, jerky movements, scan to find salience)
2. smooth pursuit (moving image centered on fovea)
3. VOR (steady fovea during head movement)
4. vergence (image on fovea when object is nearer or farther away)

35

MLF medial longitudinal fasciculus

nerves that supply pairs of eye muscles yoke together through this column of axons

36

UMN vs LMN anatomy

UMN: cortex to nucleus
LMN: nucleus to wherever (innervating or synapse)

37

anisocoria

pupils of different size

38

uveitis

iris
ciliary body
choroid

39

chorioretinitis

choroid
retinal layers

40

endophthalmitis

aqueous and vitreous humor
RECENT INTRAOCULAR SURGERY esp cataracts
normal flora: pseudomonas, staph, candida

Tx: fluoroquinolone or vance injected into eye

41

eye infections: route of infection

trauma
paranasal sinuses
IC
anatomical abnormalities (dysfxn tear states)
blood born
sexually transmitted

42

tear include

sIgA and lysozome
lubrication

sIgA (secretory IgA = dimer) protects IgA from being degraded

43

why not use corticosteroids during eye infections?

corticosteroids facilitate corneal penetration

44

Chlamydia trachomatis serotypes

INCLUSION conjunctivits serotypes D-K
TRACHOMA serotypes A-C *leading cause of blindness worldwide (due to multiple inf and non lasting immunity, scar cornea each time)

45

Chlamydia trachomatis Dx

direct fluorescent ab

46

Chlamydia trachomatic inf

*co-infection with N. gonorrhea
BASOPHILIC INCLUSION BODIES
elementary bodies (rigid membrane) enter epithelia cell > change into reticulate bodies > replicates binary fission > leaves as EB

47

Tx chlamydia

AZITHROMYCIN

48

adenovirus

ds DNA
non enveloped
lytic in epithelial cells
latent in lymphoid
highly contagious

*infects epithelia cells of RESPIRATORY TRACT, CONJUNCTIVA, ENTERIC ORGANS because antigen and ability to act on certain receptors > Sx

path: migration into (HOST CELL) microtubules > induce cell cycle > block apoptosis > block host mRNA transport and translation > disrupt cytokeratin network
(HOST ORG) antagonize interferon, TNF

49

how Dx adenovirus

ADENOPLUS test
detects hexon proteins (part of viral capsid)

50

chronic conjunctivitis associated with

blepharitis
staphylococcus

51

hordeolum

STYE
Tx:
erythromycin ointment
warm compress
massage open
keep clean

52

allergic rhinoconjunctivitis

IgE response
Tx: antihistamines, avoid steroids

53

viral conjuctivitis
neonatal
adult

HSV
adenovirus
Tx:
cold compress
topical vasoconstrictors

54

acute bacterial conjunctivitis
kids
adults

staph aureus+
strep pneumo+
h flu-

staph aureus+

Tx:
EMPIRIC (gram - and gram +)
TRIMETHOPRIM
POLYMYXIN OPHTHALMIC DROPS = POLYTRIM*

55

hyperacute bacterial conjunctivits

Neisseria gonorrheae
preauricular adenopathy
copious yellow/green PURULENT DISCHARGE

Tx:
CEFTRIAXONE

56

newborns receive prophylactic

erythromycin ointment
to prevent ophthalmia neonatorum

57

keratoconjunctivitis HSV

topical trifulridine and system acylovir

58

trifluridine

pyrimidine analog
*effective aginst acyclovir resistant virus bc can be phosphorylated BY HOST KINASES

TOXIC, TOPICAL ONLY

59

pseudomonas aeroginosa

gram -, rod, flagella
PYOCYANIN inhibits mto enz, disrupts ciliary beating
biofilms

adherence factors
secreted cytotoxins (destroy corneal epithelium)
host imm resp damages cornea > scarring, loss visual acuity

Tx:
POLYMYXCIN B

60

acanthamoeba

single cell, EUK
cysts and trophozoites in tissue

Tx: AZOLES

61

CMV retinitis

BRUSHFIRE

62

Toxoplasma

Dx: IgM serology
Tx: pyrimethamine and sulfadiazine

63

keratitis Sx

vision defects
photophobia
pain (cornea has lots nerve endings)
foreign body sensation

64

keratitis Tx

acyclovir and trifluridine VIRAL
moxifloxacin eyedrops

65

iritis (anterior uveitis)

notn infectious

66

chorioretinitis

IC or HIV: toxoplasma or CMV

67

conjunctivitis bilateral

allergic (usually)

68

conjunctivitis discharge type

viral, serous
Chlamydia, mucoid/mucopurulent
bacterial, mucopurulent

69

preauricular adenopathy

viral
chlamydia
neisseria gon

70

labyrinthitis

inner ear infection

71

associate recurrent OM (otitis media) with

conductive HL
meningitis
mastoiditis

72

commonly occur together, similar agents

bacterial conjunctivitis
otitis media
sinusitis

73

Moraxella catarrhalis

gram - diplococcus
OXIDASE +
FASTIDIOUS CHOCOLATE AGAR
95% produce BETA-LACTAMASES*
HOCKEY PUCK TEST

74

Haemophilus influence NTHi

gram -
LPS > rash
CHOCOLATE AGAR
NONENCAPSULATED
BETA-LACTAMASES*

75

Strep pneumo

gram + lancet shape diplococcus
many virulence
suscept: alcoholism, DM, chronic RD

76

strep pneumo virulence

resistance
capsule
choline-biding prot (bind carb on surface epithel)
neuramoinidases (cleave host mucins)
pneumolysis (pore forming toxin, disrupts host cilia > HL, causes apoptosis
iron acquisition A (compete with host for iron)

77

OM Tx

1. amox
2. augmentin (amok with clavulanate)
3. azithromycin
4. eartube insertion to drain fluid (8PM TM)

78

Otitis externa Tx

cleanse with acetic acid
topical abx:
NEOMYCIN +
POLYMXYIN -
HYDROCORTISONE itch

*avoid flushing unless TM intact

79

otitis media with effeusion

NOT AN INFECTION
fluid in eustachian tube > resolves on own

80

complications of OM

CHOLESTEATOMA cyst of epithelial cells > erode IE or bone or brain, eardrum sucked inward
CONDUCTIVE HL
MASTOIDITIS red, hot, swollen behind ear

81

otitis externa micro

staph +
pseudomonas -
aspergillus
candida

82

otitis externa Sx and issues

Sx: unilateral, inflam ear canal, pain, itch, purulent ear draiage

1. pustule with hair follicle
2. itches, red canal, pain
(can progress to)
3. invasion adj bone and cartilage --> CN PALSY/DEATH
(more common in elderly, poorly controlled DM, IC)

83

Olfactory projections

Olfactory bulb > olfactory tract >
1. olfactory tuburcle/amygdala > hypothalamus VISCERAL RXNS, HOMEOSTASIS, EMOTIONAL
2. piriform cortex pear > MD thalamus > orbitofrontal cortex CONSCIOUS PERCEPTION, FLAVOR
3. entorhinal cortex > hippocampus MEMORIES

84

Gustatory projections

CN VII, IX, X (1*) > solitary tract > SOLITARY NUCLEUS >
1. hypothalamus
2. amydala (emotions)
3. nucleus ambiguus (gag reflexes to stop intake of spoiled foods)
4. salivatory nucleus
5. hypoglossal nucleus
6. BILATERAL (2*) to VPM > (3*) gustatory cortex (insula) > orbitofrontal cortex (combination of taste and smell = flavor)

85

sense of taste tells:
salt
sweet
umami
sour
bitter

salt content
high-energy carbs
proteins
pH
toxic substances

86

Spinal accessory nerves is special because

it is the only cranial nerve to both enter and exit the skull

87

CN XII damage
when protrude the tongue...

deviates TOWARDS side of damaged NERVE
deviates AWAY side of lesioned CORTICOBULBAR TRACT

88

rate of blinking can be diagnostic because

descengin control from basal ganglia and cortex is regulated by DOPAMINERGIC CIRCUITS

89

epiphora
produced by
induced by

over-tearing
increased tear production
decreased outflow

CORNEAL STIMULATION reflex
strong emotional responses LIMBIC SYSTEM

90

Refraction definition

bending light
inverted and reversed

light when hits cornea gets bent > lens is adjustable for refraction

91

emmetropic

perfect vision: refracting normally, infinity in focus

92

refractive power measured in

diopters
(cornea + lens)

93

diplopia

oculomotor damage (or abducens or trochlear)

94

what is happening when lens is flat?

see long-distance (sympathetic)
ciliary muscle relaxed
zonules tight

95

what is happening when lens is FAT?

see close (parasympathetic)
ciliary muscle contracted (M3 Rec)
zonules relaxed

96

hyperopia

myopia

farsightedness
eyeball too short

nearsightedness
eyeball too long

97

presbyopia

decreased accommodative power with age

98

cataract

glycoslylation of LENS proteins

99

associate SYMPATHETIC EYE

superior cervical ganglion
NE and a1
superior tarsal (injury: ptosis)
pupillary DILATOR (injury: miosis)

100

associate PARASYMPATHETIC EYE

ciliary ganglion
ACh and M3
pupillary SPHINCTER/CONSTRICTOR (injury: mydriasis)

101

pupillary light reflex pathway

CN II > optic chiasm > optic tract > optic radiations > edinger westphal nucleus in midbrain > PREganglionic PARAsympathetic to ciliary ganglion > synapse at ciliary ganglion > POSTganglionic PARAsympathetic to pupillary sphincter > miosis

102

aqueous humor production in

absorbed in

posterior chamber

anterior chamber (canal of Schlemm)

103

increase outflow of aqueous humor by

MIOSIS: give AChE

104

b2 increases concentration of

cAMP > increase aq humor volume > increased intraocular pressure

Beta blockers decrease aqueous humor formation

105

inflow of aqueous humor

1. b2 sympathetics increase [cAMP]
2. CA incrases osmotic bleh so Cl- secretion

106

outflow of aqueous humor

1. paraysmpathetics > miosis (AChEs)
2. PGF2 > relaxation of ciliary muscle

107

glaucoma
open angle
closed angle

increased INTRAOCULAR PRESSURE
OPEN: common, slow progression, late symptoms
increased production, decreased outflow
normal angle

CLOSED: MEDICAL EMERGENCY
acute, suden onset
SEVERE PAIN, BLURRY, RED EYE
iris moves and blocks Schlemms canal

108

closed angle glaucoma progression >

edema and decreased transparency = "halo effect"
damages PRs
neural conduction of CNII affected

109

Muller cells (of eye)

specialized glial cells

110

Retina 3 nuclear layers

most inner: ganglion cell bodies (axons form optic nerve)
middle: INNER NUCLEAR LAYER bipolar cell bodies
outer: OUTER NUCLEAR LAYER PRs cell bodies

111

3 neurons that begin the process of visual perception

1* PRs
2* bipolar neurons
3* ganglion cells
ganglion axons go to form the optic nerve (CN II) > optic chiasm > optic tract > optic radiation > visual cortex

112

___% cones are in fovea

90%

113

blind spot

optic disk, where all ganglion cell axons leave to go to brain
no PRs

114

PRs adequate stimulus

LIGHT
350-750nM

115

PRs encode

frequency = color
intensity = brightness

116

scotopic vision

photopic vision

can see in dark, RODS

vision in bright lights, CONES

117

RODS

scopotic vision
more pigment
more sensitive to single photon
saturate sooner
RHODOPSIN
integrated: low spatial and temporal resolution
slower

118

CONES

photopic vision
less pigment
less sensitive to detecting photons
bright light
color vision per certain wavelengths
precise, high temporal and spatial resolution
faster

119

color vision wavelengths

blue: short wave
green: medium wave
red: long wave
*red doesn't overlap -> red vision from cones

120

types visual acuity

1. spatial ( two points in space, eye chart)
2. temporal (two events as separate, critical fusion freq: 50Hz)
3. spectral (two colors as different)

121

rhodopsin

light activated > change conformation > G protein > PDE > cGMP to GMP > CLOSE cAMP depending Na channels > HYPERPOLARIZATION

122

rhodopsin/rod vision special because

stimulus CLOSES channel, not open it
HYPERPOLARIZATION
2nd messenger: get AMPLIFICATION > increased sensitivity > CAN SEE IN DARK

123

Retinitis Pigmentosa and Retinopathy

neither involved in inflammation
both STOP PRs from working
NIGHT BLINDNESS FIRST

124

Vitamin A deficiency

NIGHT BLIND because rods don't work well

125

Macular degeneration (Fitz)

degeneration in RPE

126

rhodopsin cycle with RPE

light > rod > rhodopsin to opsin > all transretinal > all transretinol > TO RPE CELL > all transretinol > 11-cis-retinal > TO ROD > makes more rhodopsin

127

adaptation definition

dark adaptation

decreased response to sustained stimulus

RPE pumps retinal components into rods > more rhodopsin > more sensitive

128

upper visual fields project to

lower visual fields project to

lingual gyrus (of occipital)

cuneate gyrus (of occipital)

129

macular representation in area 17

peripheral field representation in area 17

macular = most caudal = towards back of head

peripheral = rostral 2/3 of area 17 = back of head towards eyes

130

dorsal stream (parietal and upper temporal visual association cortex)

ventral stream (inferior temporal visual association cortex)

"where"
(lying on back/dorsally in ocean, where am I?)

"what"
(lying on stomach/ventrally in ocean, what am I looking at?)

131

projections to superior colliculus

via optic radiation and brachium of superior colliculus
i. SCANNING movement
ii. ACCOMMODATION/ CONVERGENCE reflex

132

homonymous defects

right POST-CHIASMATIC defects
left homonymous hemianopsia
left upper homonymous quadrantanopsia
left homonymous hemianopsia with macular sparing

133

heteronymous defects

OPTIC CHIASM (can't see periphery)
bitemporal heteronmymous hemianopsia

134

hemianopsia

defective vision or blindness in one half of visual field

bitemporal heteronymous hemianopsia,
left homonymous (with and without macular sparing)

135

accommodation reflex

(initiated when gaze is shifted from distant object to near one and image becomes blurred)
OCULAR CONVERGENCE both MR contract
MIOSIS constrictor pupillae sharpen image
LENS THICKENING ciliary muscle contracts, increasing refractive power of lens

136

Horner's Sx

ptosis
miosis
vasodilation (flushing of face)
anhidrosis (absence of sweating)

137

Argyll Robertson pupil

pupil ACCOMMODATES to near objects but DOES NOT REACT TO LIGHT
(issues with pretectal area)

tabes dorsalis/tertiary syphilis, SLE, DM

138

strabismus

squint: failure of coordination of extra ocular eye muscle, resulting in deviation of affected eye and diplopia

139

amblyopia

lazy eye
decreased visual acuity in absence of anatomical defects in visual pathway

to avoid diplopia, vision in one eye is suppressed at level of the visual cortex

140

scotoma

island of visual loss within visual field

141

sphenoid sinus does not open into

middle nasal meatus

142

nasolacrimal duct communicates with

inferior nasal meatus

143

sensory neurons to roof of hard and soft palate

nasopalatine nerve of V

144

tympanosclerosis

calcium plaque in ME
perforation of TM

145

cholesteatoma

long standing retraction of TM into ME, negative pressure > skin cyst > cyst slowly erodes bone

Sx: facial paralysis, HL, dizziness, can erode brain cavity

146

hemotympanium

blood in middle ear
BAD

147

red eye, minor cold, clear eye drainage

adenovirus

148

visual field deficit, most common in HIV infected individuals

CMV

149

releases pnemolysin pore forming toxin

streptococcus pneumonea

150

green/yellow discharge from eyes

neisseria gonorrhea

151

ototoxic drugs

gentamicin, lasix, cisplatin, ASA/NSAIDS, antimalarials

152

presbycusis

most common cause of loss of hair cells, progressive

153

Otosclerosis

autosomal dominant
poor conduction
stapes needs fixing

154

BPPV

most common
"roll out of bed, turn and room starts spinning"
Dix Hallpike

155

Ostemoa

benign growth in ear canal
cold water exposure
nothing to do about it
looks like cholesteatoma

156

Meniere's

inner ear
spontaneous VERTIGO lapses
ENDOLYMPH LEAKING

157

Acute Otitis Media

2nd most common disease in children
Eustachian tube dysfunciton
s. pneumo
h. flu
moraxella

158

Allergic rhinitis

IgE mediated hypersensitivity of nasal mucosa to foreign substances
affects 20% US pop
DOESN'T HAPPEN BEFORE AGE 2, BUT BY 20YO
M>F

Sx: sneezing, rhinorrhea, nasal congestion, lacrimation

159

macular degeneration
dry
wet

DRY DRUSEN, can get wet

WET, BLOOD Subretinal hemorrhage, grayish = bad

160

wet macular degneration Tx

anti-VEGF

161

glaucoma

optic nerve cupping: ENLARGED OPTIC CUP
LOSS OF OPTIC NERVE FIBERS

162

diabetic retinopathy

can cause BLINDNESS
NONPROLIFERATIVE
microanurysms, blot hem, exudates, macular edema, cotton wool spotaj

PREPROLIFERATIVE
venous beading, intraretinal microvascular changes, ischemic areas (cotton wool spots)

PROLIFERATIVE
BOAT HEMORRHAGE

163

diabetic retinopathy Tx

anti-VEGF
proliferative; panretinal photocoagulation

164

hypertensive retinopathy

silver wiring
cotton wool spots

165

amaurosis fugax

sudden vision loss
no pain
vascular insufficiency
CARDIAC WORKUP

166

ophthalmic migraine

hallmark: SCINTILLATINGN SCOTOMA: aura, colorful/shimmery aura
20-30 minutes
Spasm of arteriol in occipital cortex

167

retinal arterial occlusion

CHERRY RED SPOTS
sudden vision loss one eye
painless
BREATHE CO2
TIMOLOL
ACETAZOLAMIDE IV

168

retinal vein occlusion

SQUASHED TOMATO

169

temporal arteritis

history is key
EXTREME TENDER SCALP
STEROIDS IMMEDIATELY

170

CN III palsy

"down and out"
mydriatic
ptosis
diplopia

171

CN IV palsy

common
one eye slightly higher than other
vertical diplopia (not horizontal)

172

CN VI palsy

one eye in "down and in"

173

alkali eye injury

irrigate forever

174

hyphema

DON'T MISS THIS
blood in anterior chamber

175

subconjunctival hemorrhage

blood on surface of sclera, under conjunctiva
harmless

176

sudden painless loss of vision

retinal detachment
retinal vein occlusion - squashed tomato
retinal artery occlusion - cherry red
vitreous hemorrhage

177

sudden painful loss of vision

corneal abrasion
uveitis
traumatic hyphema
acute glaucoma

178

sudden BILATERAL vision loss

painless: meds

painful: toxins, chemical exposure

179

gradual vision loss

macular degeneration
cataracts