First Aid pg 480-484 Neuro

Question 1

What primarily renal drug affects aq humor? how?

Answer 1

carbonic anhydrase inhibitors, dec formation

Question 2

Which drugs dec the production of aq humor?

Answer 2

BB (timolol, other non sel BB), alpha agonists, carbonic anhydrase inhibitors

Question 3

Which drugs inc out flow of aq humor?

Answer 3

Prostaglandin F2 alpha (+)’r - latanoprost, travoprost

Cholinomimetics - pilocarpine, carbachol

Question 4

Where is the light focused, in terms of retina, in the case of hyperopia and myopia?

Answer 4

In hyperopia, light focused behind retina, and in myopia light is focused in front of the retina

Question 5

Why does presbyopia happen?

Answer 5

dec lens elasticity, dec collagen IV

Question 6

How does DB lead to lens opacification?

Answer 6

Inc gluc in the lens –> sorbitol via aldose reductase, and also to fructose. Both fructose and sorbitol will stimulate water influx –> osmotic cell injury, lens becomes opaque

Question 7

Which drug can lead to cataracts?

Answer 7

Long term corticosteroid use

Question 8

Which enzyme def leads to cataracts?

Answer 8

galactokinase, galactose 1 phosphate uridyltransferase

Question 9

Which of the trisomies can lead to cataracts?

Answer 9

all of them

Question 10

What AD disease of chromosome 22 can lead to juvenile cataracts? What other tumors come with?

Answer 10

NF2 - comes with bilat acoustic schwannomas, meningiomas, ependymomas

Question 11

What AD disease of chr 15 lead to cataracts and also have a frontal fold closure issue?

Answer 11

Marfan syndrome

Question 12

What disease leads to nephritis, hearing problems, and cataracts later in life? What molecule is affected?

Answer 12

Alport syndrome, collagen IV

Question 13

Optic disc atrophy with cupping?

Answer 13

Glaucoma

Question 14

Open angle glaucoma is more common in which patient population?

Answer 14

African American

Question 15

Cause of secondary closed angle glaucoma?

Answer 15

Hypoxia from retinal disease, like DB or vein occlusion - induces vasoproliferation in iris that contracts angle

Question 16

Why not give epi in acute closure glaucoma?

Answer 16

Mydriasis makes it worse

Question 17

halos, rock hard eye, frontal headache

Answer 17

Glaucoma - acute closure

Question 18

Most common cause of conjunctivitis?

Answer 18

viral is most common, esp adenovirus

Question 19

Extra ocular symptom of viral conjunctivitis?

Answer 19

swollen preauricular node

Question 20

Diseases associated with uveitis?

Answer 20

systemic inflammatory disorders - sarcoidosis, rhematoid arthritis, juvenile idiopathic arthritis, PAIR (HLA-B27) arthritides

Question 21

What causes metamorphopsia and loss of central vision?

Answer 21

Age related macular degeneration - distortion and scotomas

Question 22

Two types of DB retinopathy and describe them

Answer 22

Non proliferative - damaged capillaries leak blood –> lipids and fluid seep into retina –> hemorrhages and macular edema

Proliferative - chronic hypoxia result in new blood vessel formation with then traction on the retina

Question 23

Tx for Non-prolif DB retinopathy?

Answer 23

blood sugar control, surgery

Question 24

Tx for Proliferative DB retinopathy?

Answer 24

Peripheral retinal photocoag, surgery, anti-VEGF (Bevacizumab)

Question 25

What causes retinal v occlusion?

Answer 25

compression from nearby arterial atherosclerosis

Question 26

What are the signs of retinal v occlusion?

Answer 26

Retinal hemorrhage, venous engorgement, edema in affected areas

Question 27

Which two layers of the retina separate in retinal detachment?

Answer 27

Seperation of the rods and cones layers (neurosensory layer) from the outer pigmented epithelium

Question 28

How does retinal detachment look on fundoscopy ?

Answer 28

crinkling of retinal tissue and changes in vessel direction

Question 29

Why the vision loss in retinal detachment?

Answer 29

Due to degeneration of photoreceptors

Question 30

Retinal breaks are more common in patients with a history of what?

Answer 30

high myopia or history of head trauma

Question 31

First symptoms that indicate retinal detachment?

Answer 31

"flashes" and "floaters" (from posterior vitreous detachment) and monocular loss of vision - like a "curtain drawn down"

Question 32

secondary causes of retinal detachment?

Answer 32

retinal breaks, DB traction, inflammatory effusions

Question 33

Retina cloudy with attenuated vessels and “cherry-red” spot at fovea

Answer 33

Central retinal artery occlusion

Question 34

Diseases with cherry red spots

Answer 34

Tay Sachs, Neimann Picks

Question 35

Painless, progressive vision loss beginning with night blindness (rodsaffected first). (Inherited)

Answer 35

Retinitis Pigmentosa

Question 36

Bone spicule–shaped deposits around macula

Answer 36

Retinitis Pigmentosa

Question 37

Infections associated with retinitis?

Answer 37

CMV (HHV5) (HIV/immunocompromised), Toxoplasmosis (congenital), HSV, VZV

Question 38

Retinal edema and necrosis leading to a scar?

Answer 38

Retinitis

Question 39

Treatment for congenital chorioretinitis?

Answer 39

Sulfadiazine + pyrimethamine

Question 40

Treatment for CMV retinitis?

Answer 40

Foscarnet, Cidofovir - if gancilovir fails

Question 41

Enlarged blind spot and | elevated optic disc with blurred margins

Answer 41

Papilledema

Question 42

Pathway of Miosis

Answer 42

ƒƒ 1st neuron: Edinger-Westphal nucleus to ciliary ganglion via CN III ƒƒ 2nd neuron: short ciliary nerves to pupillary sphincter muscles

Question 43

Pathway of Mydriasis

Answer 43

ƒƒ 1st neuron: hypothalamus to ciliospinal center of Budge (C8–T2) ƒƒ 2nd neuron: exit at T1 to superior cervical ganglion (travels along cervical sympathetic chain near lung apex, subclavian vessels) ƒƒ 3rd neuron: plexus along internal carotid, through cavernous sinus; enters orbit as long ciliary nerve to pupillary dilator muscles. Sympathetic fibers also innervate smooth muscle of eyelids (minor retractors) and sweat glands of forehead and face.

Question 44

Disease with Marcus Gunn Pupil

Answer 44

MS

Question 45

What is a Marcus Gunn pupil?

Answer 45

DEC bilateral pupillary constriction when light is shone in affected eye relative to unaffected eye

Question 46

How does one test for Marcus Gunn pupil?

Answer 46

Swinging flashlight test

Question 47

Symptoms of SNS denervation of face?

Answer 47

``` ƒƒ Ptosis (slight drooping of eyelid: superior tarsal muscle) ƒƒ Anhidrosis (absence of sweating) and flushing of affected side of face ƒƒ Miosis (pupil constriction) ```

Question 48

Horner's seen with which diseases?

Answer 48

Any lesion of spinal cord above T1 --> Pancoast tumor, Brown Sequard, Late stage syringomyelia, Also seen with cluster headaches, Lung cancer, PICA injury, Cavernous sinus syndrome,

Question 49

Chronic closure glaucoma - sx?

Answer 49

Mostly asymptomatic, but over time can lead to CN II issues, especially loss of periph vision

Question 50

Bacteria causing conjunctivitis?

Answer 50

H. influ, Chlamydia(follicular type), N gon

Question 51

Causes of Neonatal conjunctivitis?

Answer 51

N. gonorrhea, HSV-1, Measles ( the 3Cs coryza, conjunct., cough) Reactive arthritis.(Reiter syndrome)

Question 52

Cause of retinal occlusion?

Answer 52

Atrial fib