Optoprep/ODquestions Flashcards
1
Q
What does virgin cytotoxic T cells divide into?
A
- effector T cells
- memory T cells
2
Q
What recognizes the MHC complex (antibody + MHC)?
A
cytotoxic T cells and virgin helper T cells
cytotoxic T cells divide into effector and memory T cells
3
Q
What’s the function of effector T cells?
A
promote mitosis of T and B cells to help combat pathogens
4
Q
What’s the function of helper T cells?
A
help direct the immune system to the appropriate cells
5
Q
What’s the function of killer T cells?
A
inject chemicals to cause death in the target cell
6
Q
What are the functions of B cells
A
upon activation by effector helper T cells and interleukins, begin mitosis and differentiate into memory B cells and effector B cells
new memory B cells are stored for future encounters
7
Q
What produces antibodies?
A
B cells - serve to inactive the offending agent
8
Q
What’s the vertex distance equation?
A
Fc = Fs/1-dFs
Fc = dioptric power of the corneal plane
Fs = dioptric power of the spec plane
d = vertex distance in m
9
Q
What’s weber’s Law?
A
K = delta I/I
K = Weber’s constant
I = difference in threshold
I = original stimulus intensity
10
Q
Goldmann 3 mirror
A
Trapezoid 73 degrees = eval retinal equatorial region
bullet mirror 59 degrees = assess ora serrata
square mirror 67 degrees = anterior equatorial retina and the ora serrata
11
Q
What’s the color of the following wavelengths?
Red
Orange
Yellow
Green
Blue
Violet
A
12
Q
What is the avg cell density of the endothelium
A
3000
13
Q
cellular density count below ____ cells/mm2 is associated with what risk?
A
1000
high risk for corneal endothelial decompensation
14
Q
Vitrosin
A
unique collagen that is capable of binding large amts of water (up to 200x its weight)
- contains hydroxyproline (specific to collagen)
- originates from the neruoectoderm
15
Q
Where are hemoglobin and albumin found?
A
proteins found in blood
16
Q
creatine
A
used as an energy source primarily by our muscles
17
Q
xanthophyll
A
yellow appearance in the macula
- combination of zeaxanthin and lutein
- decrease the formation of free radicals
- not made in our body which is why we advise pts with macular degeneration to take oral supplements (AREDS)
18
Q
What’s the avg IOP?
A
15 mmHg (+/- 2.57mmHg)
19
Q
normal fluctuation of IOP?
A
3-5mmHg
20
Q
Which glands produce oil?
A
MG and zeiss
21
Q
Which glands are apocrine (sweat) glands?
A
Moll
22
Q
Which glands produce the aqueous layer of the tear film?
A
Krause and Wolfring
23
Q
Describe a stage 3 macular hole
A
- FT macular hole (400um), smooth edge, small, surrounding, donut-shaped cuff of subretinal fluid
- yellow deposits at the base of the neuroretinal defect, along with perifoveal cystic changes
- operculum may be present but vitreofoveal separation has not occurred
24
Q
A deficiency of which vitamin can lead to prolonged dark adaptation?
A
Vit A
- active form of Vit A is retinol which is important for the formation of rhodopsin
- rods most active in situations with dim illumination
25
Less rhodopsin means?
fewer rods being able to respond in low levels of light
- need Vit A for formation of rhodopsin
26
Neutral density filter equation
OD = log(1/T)
OD = optical density
T = transmission faction of the filter
27
Which CN innervates the follow EOMs?
SR
IR
MR
SO
IO
LR6SO4, everything else is innervated by CN3
28
The oculomotor nerve has 2 divisions
What does the super and inferior divisions innervate?
Superior = SR and Levator
Inferior = IR, IO, MR
29
The equation for total transmission of light
multiply the percentages of all the lens materials in which light passes through
30
What is the strongest predictor for diabetic maculopathy and PDR?
duration of diabetes
31
What's optimal drop volume?
20uL
32
Rubeola
- measles
- seen in children btw the ages 5-15
- VERY contagious
- fever, bloodshot eyes, sore throat, coughing, maculopapular rash on the trunk, limbs, arms, face and neck
- koplik's spot (white spots inside the mouth or buccal area), conjunctivitis
- self-limiting and tx is palliative in nature
- use ocular lubricants, vasoconstrictor drops, sunglasses
- there's a vaccination for this
33
Parotiditis
infection or swelling of the salivary glands
- often seen in pts w/ mumps
- maculopapular rash
34
maculopapular rash
can be seen in a variety of viruses
35
What happens if a RBC is placed in 100% distilled water?
swells (cell contains higher concentration of solutes)
- distilled water is hypotonic to the cell
36
What if a RBC is placed in solution that contains higher concentration than the RBC?
cell shrinks and becomes crenated
37
What if the RBC and solution surrounding it has equal concentration?
isotonic (water will not leave or enter the cell)
38
Fluorescein angiography should be performed with caution when?
- Pt is taking B-blockers (in the case that the pt does have anaphylaxis, it is more difficult to manage if the pt is taking meds)
- Anaphylaxis
39
Visuoscopy is used to evaluate __
eccentric fixation
40
When is stereopsis present? when does it reach adult levels?
- present at 3-5 months
- adult-like levels at 5-7 years
41
non-granulomatous intraocular inflammation?
primarily what cells are present?
most common conditions that causes this?
WBC and protein
Idiopathic and ankylosing spondylitis (HLA-B27)
42
Most common cause of persistent decreased VA after a BRVO?
chronic macular edema
- neo, pre-retinal hemes or vit hemes, TRD can also develop
43
Sherrington's law
when a muscle is stimulated to contract, its antagonist is inhibited
"SHER ONE EYE"
44
What happens if you see a break while neutralizing a lens?
that means that the lens possess astigmatism
with break = line appears to break at the same direction of rotation
against break = should exhibit 90 degrees away from with break
45
programmed cell death
apoptosis
46
premature death of living cells/tissues
necrosis
47
autolysis
destruction of a cell by means of its own enzymes.
- aka self digestion
48
Phagocytosis
- ex. macrophage, neutrophils, dendritic cells
- engulfs a particle forming and internal vesicle known as a phagosome
49
Prosopagnosia
- lack of ability to recognize faces
50
Which part of the brain plays a role in facial recognition
IT cortex
51
Achromatopsia
inability to identify colors
52
color agnosia
a type of visual agnosia in which a person has difficulty associating colors with specific objects
53
Akinetopsia
which part of the brain is damaged?
cannot see mvmt in VF due to MT cortex (important for processing motion stimuli)
54
What medication is used to treat bronchospasm associated with COPD
Salmeterol (Serevent) = long acting beta agonist
should not be used in acute attacks!
55
Which medications are used for acute asthma attacks and COPD and emphysema?
Albuterol (Ventolin) and Pirbuterol (Maxair)
56
which medication is used for chronic asthma?
- montelukast (Singulair)
- used in chronic asthma prevention and maintenance
57
What is the 1st and 2nd most common cause of intermediate uveitis?
1. idiopathic
2. sarcoid
58
Is lime/plaster acid or alkali
alkali
59
Nucleobases
- pyrimidine
- cytosine
- thymine (DNA)
- uracil (RNA)
- guanine
- adenine
- all composed of purine or pyrimidine ring structures
60
cytidine and deoxyguanosine
- nucleosides which are composed of nucleobase joined with a sugar (ribose or deoxyribose)
61
Adenosine monophosphate
- nucleotide, an nucleoside linked with one or multiple phosphate
62
What is a nucleotide composed of?
nucelobase, sugar (ribose or deoxyribose), phosphate
- ex. ATP, NAD+, coenzyme A, cAMP
63
Short-term escape and long-term drift are usually associated with which medication?
timolol
- short term escape = occurs within the first few days
- long term drift = within months of initiating tx
64
oral antivirals should be initiated when after an onset of an acute HZ
72 hrs
65
Doses of antivirals meds?
Oral acyclovir: 800 mg 5x/day 7-10 days
Famciclovir: 500 mg TID
Valacyclovir: 500mg TID
66
HSV vs HZV
HSV = has terminal end bulbs, stain centrally, dendrites larger than zoster lesions, improves with topical antiviral
HZV = only stain w/ rose bengal, small lesions, may not improve with antiviral meds
67
overall diameter of the posterior surface of the cornea
11.7, spherical
68
anterior cornea vertical and horizonal measurements
vertical 10.6, horizontal 11.7
elliptical
69
spatial summation of the scotopic system
high sensitivity and poor resolution
70
Chloramphenicol side effects
- binds to 50S subunit
- chloramphenicol very lipid- soluble and easily crosses the BBB
- bone marrow depression, aplastic anemia, gray baby syndrome, optic neuropahty, teratogenesis, and enterocolitis
- useful for staphylococcal brain abscesses and certain types of meningitis
71
Tamoxifen
- tx breast cancer
- crystallin deposits on the plexiform and NFL around the paramacular region
- corneal deposits, CME, grey lesions in theRPE, retinal heme, optic disc edema
- ocular toxicity associated with high dose 120 mg daily
- standard daily dose is 20 mg
- should have a baseline and yearly dilated eye examination with OCT of the macula
72
What type of fungi is used to culture fungi?
sabouraud's agar
73
Metformin
- biguanide
- increase insulin sensitivity, molecular target is the AMP- dependent protein kinase (AMPPK)
- activates AMPPK to block break down of fatty acids and inhibit hepatic gluconeogenesis and glycogenolysis
74
Biguanides
Metformin (Glucophage, fortamet, glumetza, Riomet)
75
A cls that is rotated from its proper axis shows how much of the original power in the OR
10 degrees
15 degrees
3 degrees
A cls rotated 10 deg away from proper axis will result in a manifestation of astig that is 1/3 of its original power in the OR
- 10 degree = 1/3 the original power
- 15 degrees = 1/2 the original power
- 30 degrees = full amt of cyl power
76
Convert logMAR to snellen
20 x 10^(logmar)
77
Pretibila myedema is associated with which condition?
graves dz and hashimotos thyroiditis
- waxy, discolored, raised plaques of non-pitting edema of the skin
78
most common type of anterior scleritis
diffuse scleritis
79
What medication causes bulls eye maculopathy
chloroquine
80
Risk for toxicity is less with ___ for hydroxychloroquine
<5.0 mg/kg of body weight per day
81
Risk for toxicity is less than ___ chloroquine
<2.3 mg/kg body weight/day
82
What other ocular testing should you do for pt taking chloroquine
- color vision
- amsler grid
- OCT mac***
83
Where is oxytocin and vasopressin (ADH) stored? Where is it made?
stored in the posterior lobe of the pituitary gland, made by the hypothalamus
84
What part of the vitreous is cloquet's canal located?
primary vitreous
85
FDA classifies non-silicone hydrogel soft lens into 4 groups
Group 1: cls posess low water content, non-ionic
Group 2: high water content non-ionic
Group 3 low water content, ionic
Group 4 high water content, ionic
lens made from ionic compound tend to attract more protein, so a person who attracts more proteins should be fit in lenses in category 1
86
RGP lens guidelines
87
competitive inhibitor on a lineweaver-burk plot of an enzyme
increase slope
88
non-competitive inhibitor on a lineweaver-burk plot of an enzyme
decrease slope
89
digoxin
- cardiac glycoside, prescribed for hearth failure and arrhthmias
- xanthopsia (yellow/green tint to vision)
- blurry vision and halos around bright lights
90
What does the schirmer tear strip test for?
tear production, specifically the aqueous portion
91
decompression sickness aka "the bends" while diving is caused by what?
rapid mvmt of nitrogen from tissues into the blood stream
92
Pt with advanced glaucoma should perform which VF test?
10-2
93
which anti-muscarinic meds are contraindicated in narrow angle?
- treat asthma and COPD
- Ipratropium (atrovent) and tiotropium (spirvia)
94
treatment for CMV retinitis
ganciclovir (Cytovene) implant
- blurred vision, floater, scotoma ine one eye, mid peripheral heme "brushfire"
- AIDS
95
scopolamine patch
- induce mydriasis and reduce accommodation making it harder to read
96
Mooren's lightening streaks
brief vertical light flashes typically seen in temporal VF at night that are elicited by acceleration of the head (vitreotraction)
97
most allergic reaction to anesthetic are due to
ester group
amide group
ester
98
bile is important for
break down of fat
99
Ester vs amide anesthetics
amide has 2 "i" in the generic name of the drug
ester has 1 "i"
100
contrast sensitivity function of an 80 yo will shift the curve to the __
left
101
What topical medications can cause hypoesthesia w/ chronic use?
NSAID
B-blockers
anesthetics
CAIs
cls wear can also cause hypoesthesia
102
Meissner's corpuscle
found more superficially and detect low-frequency vibrations
103
end bulbs of krause
react to temps <20 deg C
104
ruffini endings
respond to constant pressure and touch as well as temps above 45 deg C
105
Pacinian corpuscles
located deeper in the dermis and sensitive to rapid presure changes related to vibration and touch
- also found in some internal organs that lie close to freely-movable joints
106
Chlorpromazine and thioridazine s/e
pigmentary changes/clumping in mid-periphery and posterior pole, focal/diffuse atrophy w/ chlorpromazine of the RPE and choriocapillaris
107
chloroquine and hydroxychloroquine
bulls eye maculopathy, pigment in the macula,
108
Canthaxanthin
crystallin retinopathy
109
which condition is assocaited with a chancre (painless ulcer)
syphilis found on the penis or vulva
110
inverse square law - amt of lumens falling on the surface decreases with square of the distance
E=I/d(squared)
E= illumination falling onto the surface
I = intensity of point source
d = distance between the surface and the light source
111
whats the minimum thickness of RGP?
0.12mm
112
Synergism
response elicited by combing drugs is greater than the response of the individual drug
113
Additive effect
response elicited by combing drugs equal to the combined response of an individual drug
114
Potentiation
drug which has no principal effect enhances the effect of a 2nd drug (ex. amoxicillin w/ clavulanate)
115
Antagonism
A drug inhibiting the effect of another drug
116
how often do we blink?
12-15 times a min
117
What eye drop is used to distinguish episcleritis vs scleritis?
phenylephrine, neosynephrine
118
how much ganglion cell axons are lost per year?
5,000
but more rapid with certain ocular dz like optic neuropathy.
119
Reye's syndrome
-linked with aspirin
- most destructive to the brain and liver
- always associated with previous viral infection
120
whats the equation for center thickness?
ct = 0.023 x cls power +0.20
as radius of curvature is thickened ct increases
121
What's the BP for the following?
Normal
elevated
stage 1 HTN
stage 2 HTN
Hypertensive crisis
122
ADH
- distal tubules become more permeable to water
- stored in the posterior pituitary
- decr amt of fluid to be excreted as urine
123
volume of the vitreous
4ml
124
CME affects which retinal layers?
INL and OPL
- break down of capillary beds causing leakage of fluid
124
what's the peak absorbency for the scotopic system/rhodopsin
507nm
125
increasing water of a soft (non-silicone) hydrogel cls will cause what?
increase dry eye symptoms
125
increasing water for silicone hydrogel will cause what?
decrease oxygen permeability
126
route of depolarization of the heart
SA node > AV node > Bundle of HIS > purkinje fibers
126
pacemaker of the heart
SA node
127
PMD vs KCN
- reduced BCVA w/ glasses is lost typically younger in pts with KCN compared to PMD
- protrusion of KCN occurs centrally or inf to the visual axis
- protrusion of PMD occurs above the area of thinning
- CT is reduced in KCN and normal in PMD
- fleischer's ring, apical corneal scarring, munson sign are you usually found in mod to severe stages of KCN
128
What secretes insulin?
beta cells of pancreas in response to elevated glucose
129
What are the target sites for insulin?
liver, adipose tissue, muscle cells
130
glucokinase and glycogen
activated by the liver which results in increase in uptake of glucose and synthesis of glycogen
131
what breaks down glycogen?
glycogen phosphorylase
132
lipoprotein
activated in adipose tissue to increase synthesis of triglycerides
133
which antibody can cross the placenta?
IgG
134
What antibody is first to respond during an immune response?
IgM
135
What is the basic unit used to measure retinal illumination?
trolands
T=LA
T = troland
L = luminance of the viewed surface
A = area of the pupil
136
what's the unit for illuminance?
lux
137
whats the unit for luminous power?
lumens
138
what unit is used to quantify luminance?
foot-lamberts
139
Dalen-fuchs nodules are associated with which condition?
vogt koyanagi- Harada syndrome
140
loop diuretic
furosemide
- inhibit electrolyte reabsorption at the loop of henle
141
hydrochlorothiazide
- thiazide diuretic
- inhibit Na+ and cl- reabsorption in the distal renal tubule
142
spironolactone
K+ sparing diuretic
- inhibit Na+ excretion while sparing K
143
acetazolamide
- CAI
- inhibits CAI
144
mannitol
osmotic diuretic
inhibits Na+ and water reabsorption
145
what's the minimum thickness for residual corneal bed?
250um
146
hypothyroidism
- elevated levels of THS, low T4
147
what do these marking mean on a frame?
Z87-2
+
V
S
Z87-2 = successfully met the requirements for high-impact and high mass velocity
+ = passed high impact test
V = safety lens is photochromic
S = special purpose (ex. didymium lens worn by glass-blowers)
148
during saccadic mvmts why does the background not appear blurred as its moves across the retina?
selective suppression of the magno pathway
149
magno pathway
where pathway
- responds to quickly moving objects and high temporal frequencies = both occur in the background during a saccade
150
Ependymal cells
found lining cavities of the CNS as well as walls of the ventricle in the brain
- these cells form the epithelium of the choroida plexus which secretes cerebrospinal fluid
151
oligodendrocytes
non-neuronal cells of CNS and serve to coat axons in myelin sheath, which greatly increases the speed of conduction
wraps alot of axons at the same time
schwann cells insulate one to one cellular axons of the PNS
152
Astrocytes
- most numerous and offer support and structure to the brain
- play large role in formation of BBB, inhibits toxic substances from entering the brain
- play an important role in removing NT from synaptic zone and removing excessive extracellular potassium
153
microglia
- type of macrophage that is capable of phagocytosis
154
Humans can distinguish discrepancy in the alignment of dots at what amt?
3-5 sec of arc
155
crystalline lens
- proteins arranged in anti-parallel beta sheets
- high water soluble protein
- crystallin is important for maintaining clairty
- oxidative damage causes formation of disulfide bonds bet methionine groups and cysteine side chains (both aa contain sulfur)
- glutathione is a powerful reductant produced by the body - protects from damage by free radicals and breaks disulfide bonds
156
Where does SO originate?
lesser wing, innervated by trochlear nerve
157
Propamidine (Brolene)
- mixed with neomycin
- antiprotozoal drug
- used for acanthamoeba
158
Natacyn
- used to tx candida and aspergillus infections
159
Nizoral
found in antidandruff shampoos and antifungal drugs to prevent fungal and skin infections esp for immunocompromised pt such as those with AIDS or undergoing chemo
160
Diflucan
tx fungal infections such as those caused by yeast
- also used to tx meningitis caused by fungi
161
best method for measuring VA for amblyopic pt
bailey lovie
162
basic amino acid contains
amine group
carboxylic acid group
alpha carbon
163
central oil droplet opacities are a type of congenital cataract associated with what condition?
galactosemia
164
christmas tree cataracts are associated with which condition?
myotonic dystrophy
165
sunflower cataracts are associated with which condition?
wilson's dz
166
lax criterion will present with __ sensitivity and ___ threshold
high sensitivity and low threshold
167
lax criterion
will report seeing a stimulus but unsure if they actually saw it
168
a strict criterion will show __ threshold and ___ sensitivity
high threshold and low sensitivity
169
strict criterion
will not respond seeing a stimulus unless they are sure they can see it
170
SMILE
- small incision lenticule extraction
- no excimer use like PRK or LASIK
- uses femtosecond laser to cut small incision to the cornea through which a small piece of corneal tissue is removed (called a lenticule)
171
periochoroidal space
space between the lamina fusca of the sclera and the choroid which is continuous with the space between the choroid and CB
172
acquired macular disease tend to produce what color defiency?
blue-yellow
173
optic nerve dz tend to produce which color deficiency?
red-green
174
MOA of rock inhibitor or rho-kinase
increase aqueous outflow through the TM
175
which plaque composition will cause the great risk for CRAO or BRAO?
calcific
- these plaques occur 2' to heart valves causing them to become brittle and break off
- very hard and do not change in shape or size causing ischemia
176
Hollenhorst plaque
- cholesterol and commonly disolve
- refractile, appear larger than the vessel
- commonly lodge at transiently at vessel bifurcations
177
fibrinoplately plaques
- composed of aggregations of fibrin and platelets
- fibrinoplatelet plaques may dissolve on their one
178
Talc emboli
- seen in pts who inject drugs IV
- may cause CRAO but do not pose great threat for an occlusion when compared to other plaque compositions
179
Walled eye bilateral internuclear opthalmoplegia (WEBINO)
occurs due to a lesion involving the paired MR subnuclei of the third nerve
180
Benedikt syndrome
- involves the fasciculus as the fibers pass through the red nucleus
- lesion in the tegmentum of midbrain and cerebellum or occulsion of cerebral artery
- caused by infarction, heme, tumor, TB
- pt will develop ipsilateral third nerve palsy w/ contralateral extrapyramidal signs (such as hemitremor)
181
Weber syndrome
involves fascicular fibers as they pass through the cerebral peduncle
- lesion of the posterior cerebral artery
- signs include ipsilateral third nerve palsy with contralateral hemiparesis
182
Nothnagel syndrome
- involves superior peduncle and fasciculus
- characterized by ipsilateral third nerve palsy as well as cerebellar ataxia
183
Claude syndrome
combo of both benedik and nothnagel
184
argyll robertson pupil
can accommodate but doesn't respond to light
185
Which conditions are associated with ipsilateral third nerve palsy?
Weber, Claude, Benedikt, Nothnagel
Webers the worst one!!
Benedikt = tremor ( lesion in the red nucleus)
Nothnagel = ataxia ( lesion in the sup cerebellar)
Weber = hemiplegia (corticospinal tract)
Claude = benedikt & nothnagel (RN and sup cerebellar lesion)
186
WEBINO
- wall eyed or exotropic bilateral internuclear ophthalmoplegia (EBINO)
- Unilateral (lateral lesion) or Bilateral (MLF lesion)
- Internuclear CN 6 - 3 (MLF communicates between 6 & 3)
- ophthalmoplegia (paralysis/weakness of the eye muscles
- LESION OF THE 6th nerve nucleus, MLF
- in a young person think about demyelinating dz
- in a older person could be stroke esp if its unilateral
- PSUEDO INO is most likely caused by myasthenia gravis
Ex. eyes will look straight in primary gaze, but if the pt looks left
- right eye will have weak adduction or slower (adduction lag)
- left eye will have dissociated horizontal abducting nystagmus (nystagmus prominent towards left side)
- MLF can cause bilateral lesion, or bilateral from a medial lesion
- lateral lesion = unilateral
DO MRI ON THE MLF
187
mvmt of sodium and K+ ions during one cycle of Na+/K+ ATPase pump
3 Na out
2 K+ in
188
Systolic BP primarily results from contraction of which part of the heart?
ventricle
- measures greatest amt of pressure on blood vessel walls
189
Diastole results from a contraction of which part of the heart?
heart relaxes and blood flows out of the aorta
- measures lowest amt of pressure on blood vessel walls
190
major proteins found in the tears
albumin
lysozymes (bacteriostatic), lactoferrin, IgA (destroy bacteria), IgG, sceretory component, glycoproteins (proper mucous function), antiporteinases (inhibit hydrolytic enzyme produced by bacteria), tissue plasminogen activator (active plasmin needed for wound healing), epidermal growth factor (wound healing)
191
Reis-bucklery dystrophy
dystrophy of bowmans layer and epithelial BM, replaced with fibrous tissue
192
map dot dystrophy/EBMD
thickening of BM and absence of hemidesmosomes of basal epithelial cells
193
Meesmans dystrophy
intraepithelia cyst
194
Macular dystrophy
abnormal aggregations of glycosaminoglycans and unusually close packing of collagen fibrils in the corneal lamellae
195
Granular dystrophy
abnormal hyaline dystrophy
196
Avellino dystrophy
abnormal depositon of both amyloid and hyaline
197
Gap junctions
open channels - allow quick transfer of ion or small molecules
found in heart or within the body where swift coordination is essential
198
Maculae adherens and zonula adherens
weld cells together prevent stretching
zonulae adherens form bands or collars that encircle cells
199
lipoproteins
transport lipids
Ex. chylomicrons are the largest lipoproteins and are used to transport dietary triglycerides from intestine to target tissues (addipose or liver)
200
VLDL
shuttle lipids (mostly triglycerides) from the liver to other tissues
201
LDL
moves cholesterol to various cells
202
HDL
smallest and contain the most amt of protein
- transport cholesterom from peripheral tissues to liver to be broke down and excreted in bile
- Good cholesterol
203
ER
main site for lipid synthesis
204
Classification of ectropion
involutional
Paralytic
mechanical
Cicatricial
Congenital
involution = aging mostly over age 60
Paralytic = inability of a pralytic orbicularis
muscle to oppose the force of gravity
mechanical = large lesion
congenital = birth
205
Describe this photo
Dark adaptation curve
- 1st 5 mins = cone regeneration (takes 10 mins)
- 10 mins = rod/cone break
- 2nd dip = rod regeneration (takes 35 mins for regeneration)
206
Define True Postives
Pts test POSITIVE and has the dz
207
Define true negative
Pts test NEGATIVE and does NOT have the dz
208
False positives
Pt who test positive but does NOT have the dz
209
False negative
Pt who test negative but DOES have the dz
210
What age is the following considered well developed?
Visual fixation:
Blink response to visual threat:
Accommodation:
Stereopsis:
VA at adult level:
VA at adult level:
Snellen acuity at adult level:
Visual fixation: birth
Blink response to visual threat: 2-5 months
Accommodation: 4 months
Stereopsis: 6 months
VA at adult level (VEP): 6-12 months
VA at adult level (via preferential looking): 3 years
Snellen acuity at adult level: 2-5 years
211
ACID
Hypersensitivity reaction
A - Allergic
C - cell mediated
I - immune complex deposition
D - delayed
212
What is IgE bound to
mast cells and basophils
213
What are some ex of type 1 hypersensitivity
anaphylaxis, angioedema, bronchospasm, urticaria, allergic conjunctivitis
214
What are some ex of type 2 hypersensitivity?
destruction of RBCs in hemolytic anemia, thrombocytopenia, neutropenia, ocular cicatricial pemphigoid, wegener's granulomatosis
215
Type 2 hypersensitivity
antigen or hapten closely associated with a cell binds to antibody, leading to cell or tissue injury
216
Type 3 hypersensitivity
Damage caused by deposition of antigen-antibody complexes in vessels or tissue. this deposition also causes complement activation and/or recruitment of neutrophils
217
What are ex of type 3 sensitivity?
serum sickness, SLE, SJS
218
Type 4 hypersensitivity
antigen exposure activates T cells, which then mediate tissue injury
219
Ex. of type 4
contact dermatitis, TB, transplant rejection
220
What's the avg thickness of the sclera posterior to the insertion of the recti muscle
0.3mm
221
What's the average thickness of the thickest portion of the sclera
1.0mm
222
What does this image show (green bracket)
recovery of light sensitivity of the cone
223
Which of the following recovers "sensitivity" faster?
cones
rods
cones
224
slab off
BUM
225
Reverse slab off
BDP
226
Dissimilar segments
bifocal in the more plus lens to provide BD prism
227
Brown syndrome
V pattern "Victor Brown"
- reduced elevation in the ADDuction of the involved eye
- widening of palpebral fissure on adduction
- restricted elevation on adduction with forced duction test
228
Furosemide MOA
loop diuretic inhibits NACl reabsorption at the ascending loop of henle
- also increases calcium excretion
229
Baileys Rule
- will tell you at what distance the pt has to hold things
F = 1/Equivalent viewing distance
230
an aneurysm greater than __ is concerning
2mm
231
When does microvascular mononeuropathy of CN 3,4,6 resolve by?
3 months
232
Which part of the eye mainly absorbs UVC?
Cornea
- excessive absorption can cause solar keratitis
233
UVA and UVB are primarily absorbed by which part of the eye?
lens
234
which drops can aid in dx of horner's syndome
cocaine and apraclonidine
- cocaine blocks the reuptake of NE (normal eye dilates)
- apraclonidine effect on alpha 2 receptor > alpha 1, constricts the normal eye
235
If Anisocoria is greater in the dark, what are you suspecting?
- Horner's syndrome
236
If anisocoria is greater in the light, what are you suspecting?
Adies tonic pupil
Third nerve palsy
Traumatic Iris damage
Pharmacological pupil dilation
237
What drops are you using to check if it's a pre or postganglionic horner's syndrome? What are you expecting after using the drops?
1% hydroxamphetamine
Dilation w/ drops = Preganglionic
"PREDIL"
NO dilation = Postganglionic "POST NOD"
238
What drops are you using to dx adies tonic pupil
0.125% pilo = CONSTRICTION = ADIES
** check for traumatic iris damage, may cause sluggish constriction**
239
What if you see an anisocoria w/ no pupil constriction w/ 0.125% w/ pilo?
- pharmacologic anisocoria
- Third nerve palsy
240
blurry vision due to a miotic is caused by which optical principle?
diffraction - similar to pinhole
241
How does pilocarpine lower IOP?
stimulating contraction by longitudinal muscle of the CB which opens the TM via increased tension of the scleral spur
242
What are the side effects of pilocarpine?
brow ache
induced myopia
increased risk of retinal tears and detachments, and epiphora
243
Deuteranopia, tritanopia, and protanopia
- stationary/non-progressive
- normal VA
- color deficient NOT color weak (deuteranmalous)
244
What's the most common type of congenital color deficiency?
Deuteranomalous - 5% of male population
- X-linked recessive pattern
- affect R/G hue discrimination
- can distinguish pure red from pure green (they are only "color weak"
245
Whats the primary pathway for energy production of the lens?
anaerobic glycolysis
246
monofixation syndrome
- children who have their esotropia corrected - most common fusion state is monofixation syndrome
247
Bailey-Lovie chart
log progression chart with equal letters and spacing on each line. each row is of equal difficulty
248
sloan chart
progression chart that has 10 letters of equal legibility
249
Lighthouse Distance VA
low vision pts
- modified ETDRS chart
- spaing btw letters and line gemoetrically consistent
- 5 letters for each line
- most commonly used at 10 ft
250
Feinbloom
14x12 booklet of numbers that goes in small steps (beneficial for low vision pt
- one problem is that numbers differ in size substantially
251
what axis is the polarizing filter placed? ** KNOW THIS**
90 degree/vertical to block horizontal glare
252
Which drugs can increase IOP?
LSD
Ketamine
253
Pulfrich phenomenon
illusion of an object moving perpendicular to a person's line of isght is actually moving toward them or away from them
- described in pts following a bout of optic neuritis
- swinging pendulum describes this phenomenon
- reduction in retinal illumination results in corresponding delay in signal transmission
- Ex. ND filter is placed over OD, pendulum appears swinging closer to OD (w/ filter) and swing away from left (unfiltered eye. This looks like the pendulum is swinging counterclockwise
254
What's an example of "motion-after effect" phenomenon
waterfall illusion
- involves staring at the waterfall then shift gaze to a stationary object, stationary object will float upwards a bit
- neurons responsible for downward mvmt becomes less sensitive after chronic stimulation of the downward waterfall. thus causing an upwarward mvmt on the stationary object
255
How long should a pt wait for YAG capsulotomy after a cataract sx? why?
3-6 months, decrease risk of PVD/RD
256
Mitosis are divided into what 5 phases in order
Prophase - nucleolus and nuclear membrane disentegrate, centrioles/asters are at opposite poles
metaphase - centromeres attached to spindle fibers and lined up at the equator
anaphase - chromosomes move to opposite poles, cell membrane pinches in the center
telophase - cell membrane completes constriction, nuclear membranes form around separated chromosomes
cytokinesis - mitosis completed, cytoplasm of parental cell into 2 daughter cells
257
What ocular dz are associated with corectopia?
colobomas, sector iris hypoplasia, ICE syndrome, axenfeld- Rieger syndrome and ectopia lentis
258
What is the pathway for AH outflow?
uveal > corneaoscleral > JXT > schlemm's > internal collector channel > external collector channels (main route for AH from schlemm's canal into the episcleral veins
259
Testing for syphilis
- RPR, FTA-ABS (confirmatory)
- VDRL (screening)
other test: darkfield microscopy, MHA-TP, TP-PA, TP-EIA,
260
Myotonic dystrophy
- muscle atrophy and wasting
- difficulty releasing their grip from door handle
- cardiac conduction defects
- early balding and infertility in men
261
gray line is also known as
muscle of riolan
"roll, tide, divide"
262
axons from contralateral ON synapse in which layers of the LGN?
1,4,6
263
axons from ipsilateral ON synapse in which layer of the LGN?
2,3,5
264
What can cause SJS
- sloughing & necrosis of epidermis
- sulfonamides >> penicillins > cephalosporins
- antipsychotics and anti-epileptics (dilantin
- antigoute meds
- analegesics (piroxicam)
265
What can penetrate intact corneal epithelium
CHANLS
- Corynebacterium
- Haemophilus Aegyptus
- Neisseria
- Listeria
- Shigella
266
HLA-B51 is associated with which condition?
Behcet
267
*** ALMOST ALL structures of the eyeball are derived from which cells?
neural crest cells
**Almost all structures of the eyeball are derived from neural crest cells except 10 structures. 5 from neuroectoderm and 5 from surface ectoderm**
remember melanocytes
268
Which 5 structures of the eye are from neuroectoderm
SOREE
SM of the iris: sphincter and dilator pupillae
Optic nerve
Retina
Epithelium of CB
Epithelium of iris
269
Which 5 structures of the eye derived from surface ectoderm
LEEEG
epithelium of the cornea
epithelium of the skin of the eyelid
epithelium of the conj
lens
glands of eyelid, lacrimal gland
270
What gives rise to the optic stalk?
Diencephalon
271
What gives rise to EOMS?
mesoderm ( gives rise to muscles of the eye)
other ex include skeletal muscles of the eyelid, orbicularis oculi, and levator
272
What are the 3 germinal layers? Which one does not contribute to ocular development?
Endoderm, ectoderm, mesoderm
Endoderm does not contribute to ocular development
273
What does the ectoderm and mesoderm form?
Ectoderm = surface ectoderm, neuroectoderm, neural crest cells
mesoderm = mesencyme
they all contribute to ocular development
274
Where does the blastoocyst implant?
endometrium
zygote > morula > blastocyst > embryo > fetus
275
What is the equation for illuminance?
Illuminance = candle power of source/light source to surface distance^2
276
What happens during contraction of the ventricles
mitral and triscupid close, atria relax, semilunar valves open
277
Duane syndrome
Type 1: abnormal abduction (most common)
Type 2: abnromal adduction
Type 3: abnormal adduction and abduction
often bilateral
278
Goldman 3 mirror
central lens = Hruby lens, 64D for viewing the posterior pole
bullet shaped mirror = examination of anterior structures (ora serrata), 59 deg
Square shaped mirror = anterior retina to equator (67 degrees)
trapezoidal mirror = equator to macula (73 degrees.)
279
PR release __ in the dark
glutamate = inhibitory, (depolarization)
280
PR ____ in the dark and ___ in the light
depolarize in the dark and hyperpolarize in the light
*produce graded potential*
281
What would a dark adaptation curve look like for a pt with RP?
the rod section of the curve shows a prolonged regeneration time. The rod portion of the curve will also display its plateau at a higher-than-normal threshold
282
Examples of monosaccharides
simplest form of sugar and building blocks of more complex carbohydrates such at starch and cellulose
- ex. glucose, galactose, ribose, fructose
283
pial blood vessels
blood vessels of the pia mater, supplies the parasympathetic pupillary fibers and surface of the oculomotor nerve
- aneurysms, trauma, uncal herniation can affect the blood supply of the pupil
284
vasa nervorum
supplies the internal fibers of the pupillary fibers and oculomotor nerve
ex. HTN, diabetes = SPARES the pupil
285
Neural tube defects
affect brain and spinal chord (ex. spina bifida and anencephaly)
286
lens placode
precursor to lens
287
incomplete closure of the optic fissure
alters the development of the optic cup can lead to coloboma of the retina, CB, or iris
288
label the structures
289
Where does aneurysm occur on the circle of willis?
pupil sparing aneurysms occurs between PCA and ICA
290
Magnocellular
- Massive, large diameter axons
- motion vision
- largest perceptive field
- rare in the fovea but numerous in the periphery
- sensitive to light in scotopic condtions
291
Parvocellular
- petite, small diameter axon
- small perceptive fields
- more concentrated in the macula
- 80% for all RGCs
- responsible for color and fine detail vision
292
Koniocellular
blue-yellow color and are preferentially activated by SWAP
293
At what gestation week do eyelids begin to fuse?
8 weeks
294
What's the unit of radiant power? Whats the unit for luminous power?
Radiant power = Watts
Luminous power = lumens
Radiant power is the physical energy per second produced by a light source
295
Photometry
how our visual system responds to electromagnetic radiation
296
What are the 3 layers of the sclera?
episclera
stroma
lamina fusca (choroid binds here)
297
What's the predominant collagen for the following?
Basement membranes
lens
bowmans
stroma
sclera
vitreous
stromal wound healing
Type 4 = Basement membrane, lens
Type 1 = bowmans bones stroma sclera
Type 2 = vitreous
type 3 = stromal wound healing
298
Willebrand's knee
- lesion causes a junctional scotoma
299
Classic ocular signs of VKC
- GPC
- shield ulcer
- Horner- trantas dots
300
NF-1
- lisch nodules on iris
- cafe-au-lait spots (hypopigmented macules on skin)
- mutation on genetic locus on chromosome 17
- optic nerve glioma
301
NF 2
AD
- mutation on chromosome 22
- bilateral vestibular schwannomas
302
Spherical order aberration
occurs when peripherally refracted light rays are focused in front of the retina and central rays are focused on the retina
- 4th order aberration
- causes halos around point light sources, causes night myopia, and decreased CS
- most visually significant higher order aberration
303
What are example of third order aberrations?
coma and trefoil
Coma
- coma sees a pt of light that resembles a comet (ex. w/ its tail)
- due to the eye at one edge of the pupil being focused more strongly than light rays entering the eye at the opposite edge of the pupil
- increase commonly occurs w/ decentered ablations, decentered corneal grafts, and keratoconus
Trefoil
- less visually significant compared to coma
304
Ex of lower order aberration
myopia, hyperopia, regular astig
myopia (positive defocus)
hyperopia (negative defocus)
305
Ex. of 4th order aberration
spherical aberration, secondary astigmatisms, tetrafoil
306
which glaucoma drops utilizes corneal estrase activation of topically applied ester prodrugs
latanoprost and travoprost
307
What's the difference between schirmer 1 and 2 test?
Schirmer 1
- does not use anesthetic
- measure basal and reflex tearing
Schirmer 2 test uses anesthetic and measures only basal reflex tearing
308
A normal baby begins making eye contact and react with facial expressions at what age?
6 weeks
309
when should infants be interested in lights?
2-3 months
310
cilioretinal artery is a branch from what?
posterior ciliary artery
311
ganglion cells exit the globe behind the lamina cribosa and is myelinated with what?
oligodendrocytes
312
Test of visual perception (TVPS; Gardner)
consist of 7 subtests
1. visual discrimination
2. visual memory
3. visual-spatial relationships
4. visual form constancy
5. sequential memory
6. Visual figure ground
7. visual closure
given to ages 4-18 (school ages)
313
Congenital nystgamus
CONGENITAL
Convergence and eye closure dampen nystagmus
Oscillopsia is usually absent
Null zone present
Gaze position does not change the direction of nystagmus
Equal amplitude and frequency of nystagmus in each eye
Near acuity is good b/c convergence dampens the nystgamus
Inversion of optokinetic nystagmus occurs
Turning the head or abnormal head posture allows eyes to enter a null zone leads to better VA
Absent nystagmus during sleep
Latent nystagmus occurs
314
Rod monochromatism inheritance pattern
AR
- lacks cones
- everything is seen as shades of gray
- abnormal cone ERG
315
Blue-cone monochromatism inheritance pattern
X-linked
- has only S cones (blue) cones NOT L and M cones (red and green)
316
Stereopsis reaches adult levels at what age?
6 months
317
Which of the following screens for R/G color deficiency and which one screens for B/Y color deficiency
1. Ishihara pseudoisochromatic plates
2. Hardy Rand Rittler (HRR) plates
3. Farnsworth Panel D-15
4. Farnsworth-Munsell 100 hue test
Ishihara = R/G
HRR, Farnsworth panel/munsell 100-hue = B/Y AND R/G
318
319
A lesion to the MLF is called?
internuclear ophthalmoplegia (INO) = slowed adducting saccadic velocity in one eye
common cause is MS
320
MLF
connects 6th nerve nucleus on one side of the pons with medial rectus subnucleus of CN III on the contralateral side of the midbrain
MLF is involved in horizontal gaze allowing abduction of one eye to be coordinated with adduction of contralateral eye
321
Where is the MLF lesion if the right eye does not adduct
right eye
lesion is ipsilateral to the eye that does NOT adduct
322
What's the 5 layers of bruch's membrane
Basal lamina of RPE
inner collagenous layer
elastic layer
outer collagenous layer
Basal lamina of the inner choriocapillaris layer
323
What is retinol important for?
formation of rhodopsin
324
What's located in the following layers?
OPL
NFL
INL
ELM
OPL = rods and cones synapse onto horizontal and bipolar cells
NFL = ganglion cell axons
INL = HBAM = Horizontal, bipolar, amacrine, mueller
ELM = inner segments of PR and their respective nuclei
325
Describe the wave
P = atrial depolarization
QRS = ventricular depolarization
T = ventricular repolarization
** atrial repolarization occurs at the same time as QRS waves **
326
What does DEM (Developmental eye motility) test for? What would the results look like for the following
Oculomotor dysfunction
Automaticity
Oculomotor dysfunction and automaticity
Test for eye movements and how pt process visual info and verbal task
Oculomotor dysfunction = abnormal horizontal, normal vertical
Automaticity = Abnormal vertical and horizontal
Oculomotor dysfunction and automaticity = increased vertical and even more increased time for horizontal
normal ratio but abnormal test = automaticity
abnormal ratio = both automaticity and oculomotor dysfunction
327
size of the foveola
1DD = 1.5mm = 0.50mm = 500um
328
monocular depth cues
Pictorial depth cues
- size
- linear perspective
- texture
- interposition
- clarity
- light/shadows
- motion parallax
329
Hirschberg test
shine a penlight directly at the pt and observe the corneal light reflexes of both eyes
1mm decentration = 22mm
330
Hydroxamphetamine MOA
NE release from presynaptic vesicles of the post-ganglionic nerve terminal (3rd order neuron)
used to localize damage in horner's (forces NE release on third order neuron)
dilates = 1st or 2nd horner's syndrome
does NOT dilate = 3rd order
331
Primary secondary and tertiary action of EOM muscles
332
Avg depth of the AC
3.0mm
333
What would you use to assess VA on a
1 year old infant
6 year old child
3 year old child
0-2: preferential looking, VEP
2-5 Allen cards, HOTV cards
5 yo = snellen
334
Original AREDS formulation vs the new formulation of AREDS
C,E, beta carotene, zinc oxide, and cupric oxide
25% reduction of risk for progression to advanced AMD over 5 years
beta carotene in heavy smokers can cause higher risk of lung cancer
AREDS 2: C,E, addition of lutein/zeaxanthin, removal of betacarotene, reduction of zinc
335
When does stereopsis first begin to develop? When does it reaches adult stage?
begins 3 months, reach adult levels at 6 months
336
pinhole causes what type of aberration?
diffraction
337
Know this - visual development
338
Superior optic radiations
Superior optic radiations = MEDIAL LGN = superior retina = inferior VF
- superior optic radiations pass posteriorly by the parietal lobe of the brain
- parietal lobe lesion = inferior VF defect = left homonymous inferior quadrantanopia
Inferior optic radiation = LATERAL LGN fibers = inferior retina = superior VF
- course to temporal lobe
PITS
Parietal = inferior VF
Temporal = superior VF
339
Brimonidine SE
dry mouth and follicular conjunctivitis (most common SE overall)
340
Where does the lens zonule originate? what are lens zonules mainly composed of?
basal laminae of NPE of pars plana and pars plicata, mainly composed of fibrillin
Marfans can cause a defect fibrillin formation = ectopia lentis = superotemporal lens dislocation
341
What systemic conditions are associated with ectopia lentis?
Marfans
homocystinuria
342
What is the iris derived from?
neuroectoderm (epithelium of iris) and neural crest (NCC)
343
What are the 5 layers of the iris?
ABL
stroma
muscular layer
anterior pigment epithelium
posterior pigment epithelium
344
marcus-jaw winking
eyelid rises up and down while chewing
involves abnormal connection between CN 3 and V
345
Which of the following passes through CTR?
A. superior ophthalmic vein
B. Trochlear nerve
C. Nasociliary nerve
D. Lacrimal nerve
C. Nasociliary nerve
346
simultaneous contrast
perceived brightness of a stimulus depends on its surrounding background
(ex. light appears brighter against a dark background)
347
Paracontrast
- forward masking, mask and target are spatially next to each other
348
metacontrast
- backward masking
349
simultaneous contrast
presence of one stimulus prevents you from perceiving a second simultaneous stimulus
350
Wilson dz copper deposit occurs on which layer?
descemets
351
What is this an image of?
Mach bands
- our visual system is insensitive to low spatial frequency stimuli
- phenomena is thought to be due to our visual system performing "fourier analysis" of visual stimuli
- our visual system is more sensitive to high spatial frequency stimuli (abrupt position btw 2 of these rectangles)
- lateral inhibition between neurons in the retina
352
ex. of 3rd and 4th order aberration
3rd = coma and trefoil
4th = secondary astig and 4th order aberration
353
what wavelength is rhodopsin most sensitive to?
507nm (green light)
353
Label the image
353
side effects of CAI
sulfa allergy, aplastic anemia, hypokalemia, bitter taste, paresthesias, and diuresis
alternative is methazholamide = contains sulfa but does not have the ring moiety
354
lens zonules attach where?
pars plicata
355
What muscles make up the annulus of zinn
SR, MR, IR, LR
356
Carotid cavernous fistula (CCF)
- abnormal connection between the carotid arterial system and the cavernous sinus
- HBP, proptosis, chemosis, venous loops in sclera (cork screw vessels), increased IOP (from increased episcleral venous pressure), engorgement of EOM, CN palsies (3,4,6,V1,V2) that pass within the cav sinus, swooshing sound
357
Developmental landmarks
walking
fixation on face, smiles at face
localizes sound, control head, distinguish between familiar and strangers
sit without support/protests separation from mother
stands, can say one or 2 words
walking 12 months
fixation on face, smiles at face 2-3 months
localizes sound, control head, distinguish between familiar and strangers 4-6 months
sit without support/protests separation from mother 7-9 months
stands, can say one or 2 words 12 months
358
Blood supply to these different parts of the ON
NFL
prelaminar layer
laminar layer
retrolaminar layer
NFL = CRA, cilioretinal artery
prelaminar layer = SPCA, branches of zinn-haller
laminar layer = SPCA
retrolaminar layer = pial vessels SCPA, CRA
359
Thickness of each corneal layer?
Epithelium
Bowmans
Stroma
Descemet's membrane
Endothelium
Epithelium 50
Bowmans 8-14
Stroma 500
Descemet's membrane 10-12
Endothelium 5
360
Congenital glaucoma triad
photophobia, tearing, blepharospasm
CYP1B1 gene
361
Amplitude of accommodation hofstetter's formula
18.5 - (0.3)age
362
W4D ***
2 red dots (top and bottom)
3 green dots (left, bottom, right dots)
4 dots
switching btw 3 and 4 dots
5 dots (2 red and 3 green)
red filter over OD
2 red dots (top and bottom) = left eye suppression
3 green dots (left, bottom, right dots) = right eye suppression
4 dots = 2 degree fusion
switching btw 3 and 4 dots = alternating supression
5 dots (2 red and 3 green) = diplopia
363
What innervates the iris sphincter muscles vs dilator muscles?
Iris sphincter is under parasympathetic control via SPCN which arise from the CG
Sympathetic fibers also pass through the CG, but do not synapse there and ultimately end up innervating the iris dilator muscle via LPCN
364
Define hypertelorism
increase the distance between the medial orbital walls
365
The primary visual cortex has dual blood supply
PCA and MCA (macula of contralateral VF)
macula sparing = stroke
knock out both PCA and MCA = tumor
366
Most common cause of unilateral AND bilateral proptosis
TED
367
TED
- most common cause of unilateral and bilateral proptosis
- eyelid retraction, diplopia dry eyes, inferior scleral show, SLK, compressive optic neuropathy
- IMSLO (IR most commonly involved
- EOM tendons are spared (unlike idiopathic orbital inflammation)
368
EOM tendons are spared in which condtion
TED NOT idiopathic orbital inflammation
369
Chronic corticoid steroid use
- moon face/buffalo hump (cushingoid appearance)
- weight gain
- Diabetes
- impaired immune system
- PSC
- ischemic heart disease and heart failure (lowers HDL, raise LDL)
- Gastritis
- Fluid retention
- Menstrual irregularities
- Osteoporosis
370
Venous drainage
choroid > choroidal veins > SOV > cav sinus
371
size of foveola
1.5mm
372
What structures pass through superior to the annulus of zinn
LFTs
Lacrimal nerve
Frontal nerve
Trochlear nerve
SOV
373
What structures pass within the annulus of zinn?
3N3 is 6 + CGs
- superior and inferior CN3
- Nasociliary branch of V1
- sympathetic roots of CG
- CN 6
374
What passes inferior to the annulus of zinn
inferior ophthalmic vein
375
Neural crest cells 1st, 2nd, and 3rd wave
1st = corneal endothelium
2nd= corneal stroma and sclera
3rd = iris and pupillary membane
376
What does the TM develop from?
mesoderm
377
Brown syndrome
- deficient elevation in adduction (cant look up when they adduct)
- (+) forced duction test
- most cases are congenital
- V-pattern since SO causes ABduction
- in severe cases pt would turn face AWAY from affected eye to reduce amt of dperession of the involved eye, elevate chin to reduce diplopia
- in acquired cases, there could be an issue with IO or SO muscle (trauma or orbital fracture, inflammation, RA, idiopathic)
378
Levels of visual impairment
Normal
Near normal
Moderate visual impairment
Severe visual impairment
Profound visual impairment
Near total-blindness
Total blindness
Normal: 20/25 or better
Near normal: 20/30 - 20/60
Moderate visual impairment: 20/70 - 20/160
Severe visual impairment: 20/200 - 20/400 ( or VF 20 degrees or less)
Profound visual impairment: 20/500 - 20/1000 ( or VF 10 degrees or less)
Near total-blindness: > 20/1000 (or VF 5 degrees or less)
Total blindness: no light perception
379
Vitamin A deficiency
- night blindness
- xerophthalmia (conj and corneal xerosis (dry), bitots spot, keratomalacia, retinopathy)
- severe corneal scarring
380
4 fat soluble vitamins
ADEK
381
9 water soluble vitamins
9 B, C
382
ciliary body epithelium produces aqueous humor at a rate of
2-3uL/min
