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Opthalmology > Neurophthalmology > Flashcards

Neurophthalmology Flashcards

1
Q

Length of optic nerve

A

3.5-5.5 cm

5cm

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2
Q

Parts of the optic nerve

A

Intraocular (shortest-1mm)
Intraorbital (longest-30mm)
Intracanalicular
Intracranial

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3
Q

What runs in the optic foramen

A

Optic nerve and ophthalmic artery

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4
Q

What passes through the superior orbital fissure

A

L-lacrimal
F-frontal
T-trochlear
(CN 4)

In annulus of Zinn (origin of 4 recti)
Superior division of CN 3
Nasociliary nerve 
Abducens nerve (CN 6)
Inferior division of CN3
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5
Q

Muscles of eye supplied by

A 
LR6
SO4
Rest 3
LPS,SR- superior division of CN3
MR,IR,IO-inferior division of CN3
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6
Q

Lesion of optic nerve

A

Ipsilateral blindness

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7
Q

Lesion at chi Asma

A

Bitemporal hemianopia

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8
Q

Left sided optic tract lesion

A

Right homonymous hemianopia

Shows wernicke’s hemianopic pupil

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9
Q

What is wernicke’s hemianopic pupil

A

Person sitting in dark room
Torch shown in one direction
Normal reaction

Shown on opposite direction
No reaction

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10
Q

Optic radiation lesions in temporal lobe causes

A

Temporal lobe (inferior fibres-loop around temporal horn-Meyer’s loop)

Pie in the sky/superior quadrantopia

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11
Q

Optic radiation lesion in parietal lobe

A

Parietal lobe (inferior fibres-baum’s loop)

Pie in floor
Inferior quadrantopia

opposite side

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12
Q

What is junctional scoring of traqair

A

Caused in pituitary adenoma
(Lesion of junction of ON and chiasma)

Central scotoma and *superotemporal quadrantopia

*(Inferior nasal fibres of opposite side-willibrand’s knee)

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13
Q

Posterior junctional syndrome

A

Involves macular fibres

Hetronymous macular

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14
Q

Lesion of posterior cerebral artery in visual cortex causes (ocular)

A

Macular sparing hemianopia

Key hole vision (if both gone)

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15
Q

Middle cerebral artery block in visual cortex causes what ocular lesion

A

Macular homonymous hemianopia
(But not complete as some posterior cerebral artery fibres supply the macula)

MCA block usually occurs due to trauma of tip of visual cortex

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16
Q

What is the primary visual cortex area number and secondary visual cortex area number

A 
Area 17 (primary)
Area 18,19 (secondary)
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17
Q

How many layers of area 17 and thickest layer

A

6 layers

Thickest layer 4 - (contains a,b,calpha and cbeta)

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18
Q

Maximum fibres of optic radiation terminate at which layer of visual cortex (area 17)

A

Layer 4

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19
Q

Layers of lateral geniculate body and what layers have contralateral and ipsilateral supply

A

1,2,3,4,5
1,2-magnocellular layer
3,4,5,6-parvocellular layer

1,4,6-contralateral supply
2,3,5-ipsilateral supply

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20
Q

Visual cortex Lesions

Congruous or incongruous

A

Congruous

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21
Q

What is psycho sensory reflex

A

Dilatation due to anxiety
Iris sphincter-parasympathetic supply
Dilator pupillae-sympathetic supply

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22
Q

Pupillary light reflex pathway (from where to where)

A

Retina to pretectal nucleus

Then to edinger Westphal nucleus

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23
Q

What structure in the light reflex pathway explains consensual light reflex

A

Edibger westphal nucleus

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24
Q

Efferent pathway of pupillary reflex

A 
CN 3
Inferior division of third nerve 
Nerve to inferior oblique 
Shitt ciliary nerve 
Iris sphincter
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25
Abnormal pupillary reactions
RAPD eg Marcus Gunn pupil Optic neuritis/RBN TAPD-optic atrophy Pupillary reactions absent ARP-Argyll Robertson pupil Cause-neurosyphilis Light bear disassociation present Due to lesion of pretectal nucleus Holmes adie tonic pupil Know this xD
26
Holmes-adie tonic pupil features and etiology
Almost absent light reflex Sluggish accommodation reflex Tendon reflex sluggish Etiology-lesion in ciliary ganglion Denervates hypersensitivity to parasympathetic fibres
27
Anatomical classification of optic neuritis
Papillon is Retrobulbar neuritis Neuroretinitis
28
Main feature of papillon is
Blurry disc margins
29
Main feature of RBN
RAPD pain on elevation of eye FUNDUS NORMAL
30
Neuroretinitis main features
Blurred disc margins | Macular star
31
Why pain in eye in RBN
Superior recurs fibres attached to myelin sheath of optic nerve SR pulls on the nerve
32
Etiological classification of optic neuritis
``` Inflammatory Degenerative Autoimmune Ischemic Hereditary ```
33
Causes of degenerative optic neuritis
Multiple sclerosis | Toxic amblyopia
34
Drugs causing toxic amblyopia (optic neuritis)
``` Tobacco Ethambutol/isoniazid Chloroquine Ethyl alcohol Methyl alcohol Digoxin ```
35
Field defect in tobacco amblyopia
Centrocaecal scotoma
36
Why is methyl alcohol poisoning more dangerous than ethyl alcohol
Methyl alcohol directly damages the ganglion cell | Acute damage
37
How does ethyl alcohol cause chronic damage to eyes | Treatment
Causes vit B12 deficiency which causes optic neuritis | Treatment- hydroxycobalamine injections
38
What all does chloroquine cause (ocular probe)
PSC Optic neuritis Bulls eye maculopathy Vortex keratopathy/cornea verticellata (deposition of drug in a whorl like manner)
39
Ciliary artery supply to Iceland tissue
Anterior-muscular branches Posterior- Long-2 Short-10-20
40
Blockage of what causes AION
Blockage of posterior ciliary artery
41
Etiology of arteritic AION
Giant cell arteritis
42
Common symptoms of both arteritic and non-arteritic AION And disctinct ones
Both-RAPD,VFD-altitudinal,low VA Arteritic-painful,amaurosis fugax Non-arteritic-painless,dyschromatopsia
43
Risk factors for non-arteritic AION
Hypertension | Small size optic disc
44
Common signs and differences between arteritic and non-arteritic AION
Blurred disc margins present(papillitis),flame shaped haemorrhages Arteritic-pallor of disc Non-arteritic-no pallor (hyperaemic disc present)
45
Treatment of AION
steroids
46
What is leber’s hereditary optic neuropathy
Genetic disease involving mutation of maternal mitochondrial DNA Causes B/L ON involvement
47
Papilloedema what
Oedema around the disc
48
Clinical features of papilloedema
``` VA normal PR normal Colour normal Brightness normal VFD PRESENT(enlargement of blind spot) ```
49
Examination findings in papilloedema
``` Venous dilatation (first sign) Blurring of disc margin ```
50
Etiology | Intraocular causes for papilloedema
(Any cause for hypotonia) Trauma Surgery Chronic uveitis (ciliary shutdown)
51
Etiology- intraorbital cause of papilloedema
(Any increases pressure in the orbit) Tumour Inflammation Thyroid disease
52
Etiology-intracranial causes for papilloedema
``` (Any increase in ICT) Tumour Encephalitis Abscess Benign intracranial HTN ```
53
Benign intracranial HTN aka
Pseudo tumour cerebri
54
Etiology of pseudotumour cerebri
Obesity Hypervitaminosis Tetracycline OCPs
55
Systemic cause of papilloedema
Malignant HTN | Severe anemia
56
Classification of optic atrophy and optic disc features
Primary - chalky white,clear margin Secondary - dirty white,blurred disc Consecutive - pale waxy disc Glaucomatous -cupping of disc
57
Causes in the particular classification of optic atrophy
Primary- (brain) Multiple sclerosis,neurosyphilis Secondary - (optic nerve) Papillitis,papilloedema Consecutive-(retina) Retinitis pigmentosa ,diffuse chorioretinitis Glaucomatous-glaucoma
58
Horners syndrome
Lesion of sympathetic chain
59
Clinical features of horners syndrome
``` Miosis Ptosis (mullers) Enophthalmos Anhydrosis Loss of ciliospinal reflex (pinching of nape of neck causes dilatation of pupil) ```
60
What is characteristic of congenital horners syndrome
Hererochromia iridis
61
Causes of horners syndrome
Central - brain stem disease,spinal cord tumour Preganglionic-pan coast tumour,carotid aortic aneurysms Post ganglionic-atherosclerosis of ICA,neuropharyngeal tumour,cavernous sinus pathology
62
Nuclei in the midbrain (eyes)
EW SR,IO,IR,MR LPS CN 4
63
2 nuclei from the Brian supply the opposite sides | Which one
SO (CN4) | SR
64
What is the crossing of 4th nerve nucleus and what does its lesion cause
Anterior medullary velum | Both SO palsy
65
What happens to eye in midbrain lesion
B/L ptosis C/L SR palsy Rest same side palsy (IO,IR,MR)
66
What are yoke muscles
Contralateral synergist Eg. for right LR Left MR is yolk muscles
67
PPRF lesion
Ipsilateral Horizontal gaze palsy Know the diagram or else you won’t understand
68
FEF lesion
Contralateral horizontal gaze palsy
69
MLF lesion
Internuclear ophthalmoplegia Know what happens (check diagram)
70
PPRF lesion aka (2)
Frontal lobe lesion of that side | Supranuclear lesion
71
Doll’s reflex
Oculocephalic reflex Supranuclear lesion present- but no muscle palsy Nuclear lesion absent
72
1 and a half syndrome
Same side lesion of PPRF and MLF
73
Nystagmus not in this
Have you done it!! 😲
74
Components of vertical gaze syndrome
Interstitial nucleus of Cajal Rostral interstitial MLF Posterior commissure
75
Weber syndrome
3rd nerve palsy and contralateral hemiplegia
76
Benedicts syndrome
3rd nerve palsy and contralateral hemitremors | Red nucleus affected
77
Millard gubler syndrome
6th nerve palsy and contralateral hemiplegia
78
Foster Kennedy syndrome
I/L optic atrophy | C/L papilloedema
79
Pseudo foster Kennedy syndrome
Non arteritic AION One eye-blurring of disc margin Other eye- optic atrophy
80
Where are the first second and third order neutrons of optic nerve
First-bipolar cells of retina Second- ganglion cell layer of optic nerve Third-LGB

Opthalmology (10 decks)

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