Neuro - FA Patho Eye/Ear p520 -531

Question 1

Most common cause of conjunctivitis?

Answer 1

viral is most common, esp adenovirus

Question 2

Extra ocular symptom of viral conjunctivitis?

Answer 2

swollen preauricular node

Question 3

What is astigmatism?

Answer 3

Abnormal curvature of cornea –> different refractive power at different axes. Correct with cylindrical lens.

Question 4

Why does presbyopia happen?

Answer 4

dec lens elasticity, changes in lens curvature, dec strength of ciliary m

Question 5

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

Answer 5

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

Question 6

Presbyopia leads to an issue with ?

Answer 6

accommodation

Question 7

Bacteria causing conjunctivitis?

Answer 7

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

Question 8

Causes of Neonatal conjunctivitis?

Answer 8

N. gonorrhea, HSV-1, Chlamydia - neonatal

Children - Measles ( the 3Cs coryza, conjunct., cough) Reactive arthritis.(Reiter syndrome)

Question 9

What happens in cataracts

Answer 9

Painless, often bilateral, opacification of lens , often resulting in glare and dec vision, especially at night

Question 10

long use of what drugs can lead to cataracts

Answer 10

excess alcohol use, or prolong corticosteroid use

Question 11

Congenital risk factors of cataracts

Answer 11

classic galactosemia, galactokinase deficiency, trisomies (13, 18, 21), ToRCHeS infections (eg, rubella), Marfan syndrome, Alport syndrome, myotonic dystrophy, neurofibromatosis 2.

Question 12

Optic disc atrophy with cupping?

Answer 12

Glaucoma

Question 13

How does Diabetes lead to lens opacification?

Answer 13

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 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

halos, rock hard eye, frontal headache are symptoms of what

Answer 16

Glaucoma - acute closure

Question 17

Chronic closure glaucoma - symptoms?

Answer 17

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

Question 18

which ND is associated with early onset glaucoma?

Answer 18

Sturge Weber

Question 19

explain the pathophysio behind early onset glaucoma in sturge weber

Answer 19

ipsilateral leptomeningeal angioma & episcleral hemangioma –> inc IOP –> early onset glaucoma

Question 20

2ndary causes of open angle glaucoma

Answer 20

blocked trabecular meshwork from WBCs (eg, uveitis), RBCs (eg, vitreous hemorrhage), retinal elements (eg, retinal detachment).

Question 21

Diseases associated with uveitis?

Answer 21

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

Question 22

Collection of pus in the anterior chamber is seen in ?

Answer 22

uveitis

Question 23

What causes metamorphopsia and loss of central vision?

Answer 23

Age related macular degeneration - distortion and scotomas

Question 24

In dry macular degeneration, what collects in the eye?

Answer 24

—Deposition of yellowish extracellular material (“Drusen”) in between Bruch membrane and retinal pigment epithelium

Question 25

What makes wet macular degeneration wet - how to tx?

Answer 25

n due to bleeding 2° to choroidal neovascularization. Treat with anti-VEGF (vascular endothelial growth factor) injections (eg, bevacizumab, ranibizumab).

Question 26

What is seen in this picture? what are the arrows pointing to?

Answer 26

DB retinopathy retinal hemorrhages

Question 27

What is this a picture of? What are the arrows pointing to?

Answer 27

HTN retinopathy macular star = red arrow (exudate) cotton wool spots = blue arrow

Question 28

What is this a picture of?

Answer 28

Retinal v occlusion arrows point to engorged veins and hemorrhage

Question 29

Two types of DB retinopathy and describe them

Answer 29

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 30

Arrows in this photo point to?

Answer 30

crinkling of retinal tissue seen in retinal detachment

Question 31

What causes retinal vein occlusion?

Answer 31

compression from nearby arterial atherosclerosis

Question 32

What are the signs of retinal vein occlusion?

Answer 32

Retinal hemorrhage, venous engorgement, edema in affected areas

Question 33

Which two layers of the retina separate in retinal detachment?

Answer 33

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

Question 34

Why the vision loss in retinal detachment?

Answer 34

Due to degeneration of photoreceptors

Question 35

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

Answer 35

high myopia or history of head trauma

Question 36

First symptoms that indicate retinal detachment?

Answer 36

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

Question 37

secondary causes of retinal detachment?

Answer 37

retinal breaks, DB traction, inflammatory effusions

Question 38

This sign is seen in what disease that isn't congenital?

Answer 38

Central retinal a occlusion Cherry red spot also seen in Neiman Pick and Tay Sachs

Question 39

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

Answer 39

Retinitis Pigmentosa

Question 40

Bone spicule–shaped deposits around macula

Answer 40

Retinitis Pigmentosa

Question 41

Enlarged blind spot and elevated optic disc with blurred margins, is due to?

Answer 41

Papilledema, Inc ICP

Question 42

Loss of red reflex in children due to?

Answer 42

in children include retinoblastoma, congenital cataract, toxocariasis.

Question 43

What is a Marcus Gunn pupil?

Answer 43

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

Question 44

How does one test for Marcus Gunn pupil?

Answer 44

Swinging flashlight test

Question 45

Causes of Horner syndrome by neuron?

Answer 45

ƒ 1st neuron: pontine hemorrhage, lateral medullary syndrome, spinal cord lesion above T1 (eg, Brown-Séquard syndrome, late-stage syringomyelia) ƒ 2nd neuron: stellate ganglion compression by Pancoast tumor ƒ 3rd neuron: carotid dissection (painful)

Question 46

To test the left superior oblique and inf oblique musc, which direction should pt look?

Answer 46

Obliques go Opposite (left SO and IO tested with patient looking right)

Question 47

Causes of CN III damage?

Answer 47

* Ischemia --\> pupil sparing (motor fibers affected more than parasympathetic fibers) * ƒ Uncal herniation --\> coma * ƒ PCom aneurysm * ƒ Cavernous sinus thrombosis * ƒ Midbrain stroke

Question 48

Sx of CN III motor damage

Answer 48

ptosis, “down-and-out” gaze.

Question 49

If PANS is also affected along with motor inn in CN III, what added sx do you see

Answer 49

diminished or absent pupillary light reflex, “blown pupil” ( along with ptosis and down and out gaze)

Question 50

What disease lead to motor or PANS affected CN III

Answer 50

If just motor - usually vascular disease, if PANS, those fibers are on periphery and affected by compression (PComm, uncal herniation)

Question 51

Sx of CN VI damage

Answer 51

Pupil is higher in the affected eye, head tilt

Question 52

Sx of CN VI damage

Answer 52

Affected eye unable to abduct and is displaced medially

Question 53

Infections associated with retinitis?

Answer 53

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

Question 54

Retinal edema and necrosis leading to a scar?

Answer 54

Retinitis

Question 55

Cause of retinal occlusion?

Answer 55

Atrial fibrillation

Question 56

Meyer loop is responsible for what part of retina? and what vision loss?

Answer 56

inferior --\> Pie in the sky ( upper quadrantic anopia)

Question 57

Meyer loop 1. which lobe 2. what vision defect 3. what blood supply

Answer 57

1. temporal 2. upper quadrantic anopia 3. MCA

Question 58

you lesion the optic tract, what visual defect?

Answer 58

Homnoymous hemianopia \*\*\*\* optic tract is in frontal lobe is supplied by MCA

Question 59

What else can cause Homnoymous hemianopia?

Answer 59

LGB complete lesion

Question 60

Meyer loop loops around?

Answer 60

Inferior horn of lateral ventricle

Question 61

Sx of cavernous sinus syndrome

Answer 61

—presents with variable ophthalmoplegia, dec corneal sensation, Horner syndrome and occasional decreased maxillary sensation.

Question 62

Cavernous sinus syndrome caused by?

Answer 62

2° to pituitary tumor mass effect, carotid-cavernous fistula, or cavernous sinus thrombosis related to infection.

Question 63

Why do you see optic neuritis in MS?

Answer 63

CN II is only nerve myelinated by oligodendrocytes

Question 64

What eye gets nystagmus in R-MLF lesion in L gaze?

Answer 64

L Explanation: Abducting eye gets nystagmus (CN VI overfires to stimulate CN III)

Question 65

When you say this patient has R INO, it means what?

Answer 65

R eye paralyzed

Question 66

Bilateral INO seen in

Answer 66

MS, stroke

Question 67

what neurocutaneous dz is associated with optic gliomas?

Answer 67

NF type 1

Question 68

clinical symptom of lesions in frontal eye fields?

Answer 68

eyes look toward lesion

Question 69

what area is associated with extraocular movement during REM sleep?

Answer 69

paramedian pontine reticular formation

Question 70

what are the component of the outer ear

Answer 70

Pinna, auditory canal and eardrum

Question 71

what conducts and amplify sound from ear drums to inner ear

Answer 71

ossicles