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Physiology Flashcards

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1
Q

CSF

A

Cerebrospinal Fluid

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2
Q

CSF: Composed mainly of what?

A

Water

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3
Q

CSF: Produced from where?

A

Secretory epithelium of the chorioid plexus

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4
Q

CSF: In the CNS what is the volume of CSF present?

A

150ml

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5
Q

CSF: Function

A

Supplies water, amino acids and ions whilst removing metabolites

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6
Q

CSF: 3 functions

A

Mechanical Protection - shock-absorbing medium that protects brain tissue so that the brain floats within the cranial cavity

Homeostatic Function - pH of the CSF affects pulmonary ventilation and cerebral blood flow to transport hormones

Circulation - medium for minor exchange of nutrients and waste products between the blood and brain tissue

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7
Q

Embryology of the Brain and Ventricular System: At 3 weeks what has developed?

A

The neural canal gives rise to the adult brain and ventricles and the spinal cord central canal

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8
Q

Embryology of the Brain and Ventricular System: The chorioid plexus develops from what?

A

Cells in the walls of the ventricles

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9
Q

Embryology of the Brain and Ventricular System: How is the chorioid fissure formed?

A

Developing arteries invaginate the roof of the ventricle

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10
Q

Embryology of the Brain and Ventricular System: How is the chorioid plexus formed?

A

Involuted ependymal cells along the vessels enlarge into the villi

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11
Q

Embryology of the Brain and Ventricular System: Chorioid plexus in the adult brain is found within what?

A

3rd, 4th and lateral ventricles

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12
Q

Chorioid Plexus

A

Network of capillaries in the walls of the ventricles

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13
Q

CSF Production: Secretion involves the transport of what to where?

A

Ions - Sodium, Chloride and Bicarbonate
Across the epithelium from the blood to the CSF

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14
Q

CSF Production: Secretion is dependent on what?

A

Sodium transport across the cells into the CSF

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15
Q

CSF Production: Electrical gradient with Sodium allows the synchronised transport of what?

A

Cl-

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16
Q

CSF Production: CSF has a lower what (3) than blood plasma?

A

K+
Glucose
Protein

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17
Q

CSF Production: CSF has a higher what (2) than blood plasma?

A

Sodium
Chloride

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18
Q

The Ventricular System: What are the ventricles names?

A

Lateral ventricles
Third Ventricle
Fourth Ventricle

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19
Q

The Ventricular System: CSF Flow - Intraventricular Foramen of Monroe

A

Allows flow from the lateral ventricles to the third ventricle

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20
Q

The Ventricular System: CSF Flow - Cerebral Aqueduct of Sylvius

A

Allows flow from the Third Ventricle to the Fourth Ventricle

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21
Q

The Ventricular System: CSF Flow - Foramen of Magendie

A

Median aperture that allows flow from the Fourth Ventricle to the Subarachnoid Space

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22
Q

The Ventricular System: CSF Flow - Foramina of Luschka

A

Lateral aperture that allows flow from the Fourth Ventricle to the Subarachnoid Space

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23
Q

CSF Circulation: The CSF is originally formed where?

A

Chorioid Plexus of each lateral ventricle

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24
Q

CSF Circulation: Flows from the lateral ventricles to the third ventricle how?

A

Through two narrow openings in the interventricular foramina

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25
CSF Circulation: Where is CSF added in third ventricle?
Roof
26
CSF Circulation: CSF flows from the third ventricle to where and how?
Into the fourth ventricle through the cerebral aqueduct of the midbrain
27
CSF Circulation: CSF enters the subarachnoid space how?
Through 3 openings in the roof of the fourth ventricle - single median aperture and paired lateral apertures
28
CSF Circulation: After the subarachnoid space the CSF circulates into what?
Central canal of the spinal cord
29
CSF Circulation: Where does CSF flow through the subarachnoid space and ventricular system?
Between the Pia and Dura Mater
30
CSF Circulation: CSF returns to venous blood via what?
Arachnoid granulations into the superior sagittal sinus
31
CSF Circulation: Interstitial fluid of the brain is composed mostly of what?
Circulating CSF
32
CSF Circulation: Interstitial fluid of the brain drains to the CSF via what?
Perivascular space
33
Blood Brain Barrier: Structure
Highly selective barrier between the systemic circulation and the brains extracellular fluid formed by endothelial cells
34
Blood Brain Barrier: BBB consists of what three structures?
Capillary endothelium Basal membrane Perivascular astrocytes
35
Blood Brain Barrier: Tight junctions between the brain endothelial cells function
Prevent paracellular movement of undesirable molecules
36
Blood Brain Barrier: What cells prevent the crossing of CSF into the blood?
End foot of the astrocytes
37
Blood Brain Barrier: What parts of the brain do not have a BBB?
Circumventricular organs Pineal gland
38
Blood Brain Barrier: Main function
Protect the brain from harmful neurotoxins and helps prevent infection from spreading to the brain
39
Pathologies of the Ventricles, Chorioid Plexus and CSF: Examples of Tumours (3)
Colloid Cyst Ependymomas Choroid Plexus Tumours
40
Pathologies of the Ventricles, Chorioid Plexus and CSF: Colloid Cysts are often found where?
At the interventricular foramen
41
Pathologies of the Ventricles, Chorioid Plexus and CSF: Ependymomas arise from where?
Ependymal cells lining the ventricles
42
Ventricular Haemorrhage
Accumulation of blood within the ventricles
43
Ventricular Haemorrhage: Epidural Haematoma
Arterial bleed between the skull and dura mater
44
Ventricular Haemorrhage: Subdural Haematoma
Venous bleed between the dura mater and arachnoid
45
Hydrocephalus
Accumulation of the CSF in the ventricular system or around the brain causing ventricular enlargement and increased CSF pressure
46
Hydrocephalus: Aetiologies (2)
Obstruction of drainage Overproduction of CSF
47
Idiopathic Intracranial Hypertension and Pseudotumour Cerebri: What type of condition is this?
Enigmatic
48
Idiopathic Intracranial Hypertension and Pseudotumour Cerebri: Clinical Presentation (2)
Headache Visual disturbances
49
Idiopathic Intracranial Hypertension and Pseudotumour Cerebri: Why do visual disturbances develop?
Papilloedema
50
Papilloedema
Optic disc swelling due to increased intracranial pressure transmitted to the subarachnoid space surrounding the optic nerve
51
Papilloedema: Clinical Presentation (4)
Enlarged blind spot Blurring of vision Visual obscurations Loss of vision
52
Aqueous Humor
Specialised fluid that bathes the structures within the eye
53
Aqueous Humor: Function
Provides oxygen and metabolites
54
Aqueous Humor: Ascorbate has what function?
Powerful antioxidant
55
Aqueous Humor: What is the function of bicarbonate in this?
Buffers the H+ produced in the cornea and lens by anaerobic glycolysis
56
Aqueous Humor: Produced in an ... dependent process?
Energy
57
Aqueous Humor: Produced from what?
Epithelial layer of the ciliary body
58
Aqueous Humor: Secreted into where from the ciliary body?
Posterior chamber of the eye then flows to the anterior chamber
59
Aqueous Humor: Drained into what and how?
Into the scleral venous sinus via a trabecular meshwork and the canal of Schlemm
60
Aqueous Humor: Where is the canal of Schlemm located?
In the angle between the iris and cornea iridocorneal angle
61
Aqueous Humor: Small amount diffuses through what to where?
Vitreous to be absorbed across the retinal pigment epithelium
62
Aqueous Humor: Ionic Composition - Function of Carbonic Anhydrase
Hydration of Carbon Dioxide to form Bicarbonate and H+
63
Aqueous Humor: Ionic Composition - What happens to Bicarbonate and H+?
Transported across the basolateral membranes of pigmented epithelial cells into the interstitial fluid in exchange for Chloride and Sodium
64
Aqueous Humor: Ionic Composition - Cl- and Na+ Ions that enter cells undergo what?
Diffusion via gap junctions between pigmented and non-pigmented cells
65
Aqueous Humor: Ionic Composition - Cl- and Na+ are transported out of non-pigmented cells into aqueous humor how?
Na+/K+/2Cl- Transporters
66
Aqueous Humor: Ionic Composition - K+ ions leaving the cell are recycled how?
Na+/K+ pump and Cl- channels
67
Aqueous Humor: How does water move?
AQP1 aquaporins of non-pigmented cells and via the paracellular cell pathway
68
Glaucoma: Occurs due to what?
Increased intra-ocular pressure due to imbalance between the rates of secretion and removal of aqueous humor
69
Glaucoma: How can we treat this?
Carbonic Anhydrase Inhibitors
70
Glaucoma: How do Carbonic Anhydrase Inhibitors work?
Reduce the production of aqueous humor to reduce ocular pressure
71
Glaucoma: Examples of Carbonic Anhydrase Inhibitors (2)
Dorzolamide Acetazolomide
72
Ciliary Epithelium: The ciliary body and posterior surface of the iris is covered by what?
Two juxtaposed layers of epithelial cells: 1. Forward continuation of the pigment epithelium of the retina 2. Inner non-pigmented epithelial layer
73
Microbiology: Bacterial Conjunctivitis - Causative organisms in neonates (3)
Staphylococcus aureus Neisseria gonorrhoea Chlamydia trachomatis
74
Microbiology: Bacterial Conjunctivitis - Causative Organisms in patients that are not neonates (3)
Staphylococcus aureus Streptococcus pneumoniae Haemophilus influenzae
75
Microbiology: Bacterial Conjunctivitis - Management options (3)
Topical Antibiotics - Chloramphenicol, Fusidic Acid and Gentamicin
76
Microbiology: Bacterial Conjunctivitis - Chloramphenicol does not manage what bacteria?
Pseudomonas aeruginosa
77
Microbiology: Bacterial Conjunctivitis - Chloramphenicol is avoided in what cases? (2)
Allergy Aplastic anaemia
78
Microbiology: Bacterial Conjunctivitis - Chloramphenicol Effective against what bacteria? (3)
Streptococcus Staphylococcus Haemophilus influenza
79
Microbiology: Bacterial Conjunctivitis - Chloramphenicol has a risk of what side effect?
Gray Baby if the dose is too high
80
Microbiology: Bacterial Conjunctivitis - Chloramphenicol why does this present with Gray Baby?
Neonata cannot process the drug as the liver is immature and can cause hypotension
81
Microbiology: Bacterial Conjunctivitis - Fusidic Acid treats what bacteria?
Staphylococcus aureus
82
Microbiology: Bacterial Conjunctivitis - Gentamicin treats what bacteria?
Coliforms Pseudomonas aeruginosa
83
Microbiology: Viral Conjunctivitis - Causative organisms (3)
Adenovirus Herpes simplex Herpes zoster
84
Microbiology: Viral Conjunctivitis - Management
Ganciclovir
85
Microbiology: Viral Conjunctivitis - Ganciclovir Mechanism of Action
Inhibits viral DNA synthesis as base analogue mimics Guanine
86
Microbiology: Viral Conjunctivitis - Ganciclovir application
Used for dendritic ulcers of the cornea
87
Microbiology: Chlamydial Conjunctivitis - Management
Topical Oxytetracycline
88
Microbiology: Chlamydial Conjunctivitis - Suspect in what cases?
Bilateral conjunctivitis in young children
89
Microbiology: Chlamydial Conjunctivitis - May have what complication?
Subtarsal scarring
90
Microbial Keratitis: Bacterial Keratitis - Why is admission required?
For hourly drops
91
Microbial Keratitis: Bacterial Keratitis - Usually associated with what? (2)
Corneal pathology Contact lens wearing
92
Microbial Keratitis: Bacterial Keratitis - Management options (2)
4-Quinolone e.g Ofloxacin Gentamicin + Cefuroxime
93
Microbial Keratitis: Bacterial Keratitis - 4-Quinolones does not treat what bacteria?
Streptococcus pneumoniae
94
Microbial Keratitis: Herpetic Keratitis - If recurrent can result in what?
Reduced corneal sensation
95
Microbial Keratitis: Herpetic Keratitis - Management
Topical Antiviral Ganciclovir
96
Microbial Keratitis: Herpetic Keratitis - Risk of Ganciclovir management
Can cause corneal melt and perforation of the cornea
97
Microbial Keratitis: Adenoviral Keratitis - Usually follows what? (2)
URTI Conjunctivitis
98
Microbial Keratitis: Adenoviral Keratitis - Management
May require steroids to speed up recovery if chronic
99
Microbial Keratitis: Fungal Keratitis - Seen in what patients? (2)
Those who work outside Ocular surface disease
100
Microbial Keratitis: Fungal Keratitis - Management
Topical Anti-fungals - Natamycin or Amphotericin
101
Keratitis: Causative amoebic organism
Acanthomoeba
102
Keratitis: Management if Acanthomoeba causative organism (3)
Polyhexamethylene Biguanide Propamide Brolene Chlorhexadine
103
Pre-Septal Cellulitis: Often associated with what structures?
Paranasal snuses
104
Pre-Septal Cellulitis: Diagnostic test
CT scan to identify orbital abscesses
105
Pre-Septal Cellulitis: Clinical Presentation (4)
Painful Proptosis - bulging of one or both eyes Pyrexial Sight Threatening
106
Orbital Cellulitis: Direct extension from what?
The sinus or focal orbital infection
107
Orbital Cellulitis: When is a scan required?
Any suggestion of restriction of the muscles or optic nerve dysfunction
108
Orbital Cellulitis: Management
Broad spectrum antibiotics - if an abscess is present this requires drainage
109
Endophthalmitis
Infection of the inside of the eye
110
Endophthalmitis: Clinical Presentation (3)
Painful Decreasing vision Incredibly red eye
111
Endophthalmitis: Management
Intraviteal - Amikacin or Ceftazidime or Vancomycin Topical antibiotics
112
Endophthalmitis: Most common Causative Organism
Staphylococcus epidermidis
113
Chorioretinitis: When does Cytomegalovirus Retinitis present?
During AIDS
114
Chorioretinitis: Viral aetiologies (2)
Herpes Simplex Virus Herpes Zoster Virus
115
Chorioretinitis: Fungal aetiologies
Candida
116
Chorioretinitis: Parasitic aetiologies (2)
Toxoplasma gondii Toxocara canis
117
HSK-HSV Chorioetinitis: Alternate Name
Acute Retinal Necrosis
118
Chorioetinitis: Endogenous Type is caused by what?
Candida and Aspergillus
119
Chorioetinitis: Endogenous Type - Associated with what? (2)
Bacterial endocarditis Indwelling catheters
120
Chorioetinitis: Endogenous Type - How is this diagnosed?
Imaging shows Roth spots with disseminated embolic bacterial abscesses
121
Chorioetinitis: Toxoplasmosis - Causative organism
Toxoplasmosis gondii
122
Chorioetinitis: Toxoplasmosis - Aetiologies (2)
Contaminated soil Undercooked meat
123
Chorioetinitis: Toxoplasmosis - Clinical presentation
Mild Flu-like illness followed by cyst formation in the latent phase
124
Chorioetinitis: Toxoplasmosis - Management when sight threatening (2)
Clindamycin Azithromycin
125
Chorioetinitis: Toxocara Canis - Description of the organism
Parasitic nemotode that affects cats and dogs
126
Chorioetinitis: Toxocara Canis - Unable to do what in humans?
Replicate
127
Chorioetinitis: Toxocara Canis - How does this cause irreversible vision loss?
Forms granulomas
128
Chorioetinitis: Toxocara Canis - Diagnostic test
ELISA test on the serum
129
Antibiotics: Chloramphenicol - Mechanism of action
Inhibits Peptidyl Transferase Enzyme
130
Antibiotics: Chloramphenicol - Bacteriocidal action on what bacteria? (2)
Streptococcus Haemophilus influenzae
131
Antibiotics: Chloramphenicol - Bacteriostatic action on what bacteria?
Staphylococcus
132
Antibiotics: Chloramphenicol - Side effects (3)
Allergy Irreversible Aplastic Anaemia Gray baby syndrome
133
Antibiotics: Inhibition of Cell Wall Synthesis - Two Types
Penicillins Cephalosporins
134
Antibiotics: Inhibition of Cell Wall Synthesis - Used for what bacteria in Dacrocystitis? (2)
Streptococcus pyogenes Staphylococcus aureus
135
Antibiotics: Inhibition of Nucleic Acid Synthesis - Example of type of drug
Quinolones - Ofloxacin
136
Vision: The pattern of the object must fall onto what?
The vision receptors - rods and cones
137
Vision: The pattern of the object must fall onto the vision receptors to enable what?
Accomodation
138
The Visual Field: How is binocular visual field generated?
Monocular visual fields (+/- 45 degrees) are overlapped
139
The Visual Field: The retina is divided in half relative to what?
The fovea
140
The Visual Field: Two halves of the visual field retina
Nasal hemiretina Temporal hemiretina
141
The Visual Field: What happens to the nerve fibres of the nasal hemiretina?
Crosses at the optic chiasma
142
Visual Field: Visual Field Mapping involves what structures? (4)
Retina Lateral Geniculate Nucleus Superior Colliculus Cortex
143
Visual Field: Why is the central field over-represented?
As the magnification factor is not constant
144
Visual Field: Primary Visual Cortex - In this the eye-specific inputs are segregated where?
Layer 4
145
Visual Field: Primary Visual Cortex - At the primary visual area vision is largely segregated into what?
Ocular dominance columns
146
Visual Field: Primary Visual Cortex - Each column in the primary visual area is dominated by what?
Input from one of the two eyes
147
Visual Field: Primary Visual Cortex - Cells outside of layer 4 receive input from where?
Both eyes
148
Visual Perception: Ambylopia can be caused by what from infancy?
Strabismus - wandering eye
149
Hebb's Postulate
When the axon of cell A is near enough to excite cell B and is repeatedly fired, growth and metabolic changes cause increased efficiency in cell A
150
Retina: Direct Pathway Stages (3)
1. Photoreceptors 2. Bipolar Cells 3. Ganglion Cells
151
Retina: Function of horizontal cells
Receive input from photoreceptors and project to other photoreceptors and bipolar cells
152
Retina: Function of amacrine cells
Receive input from bipolar cells and project to ganglion cells, bipolar cells and other amacrine cells
153
Photoreceptors: Two types
Rods Cones
154
Photoreceptors: Function
Converts electromagnetic radiation to neural signals via transduction
155
Photoreceptors: Four regions
Outer segment Inner segment Cell body Synaptic terminal
156
Photoreceptors: Phototransduction - The resting membrane potential is ...
Depolarised
157
Photoreceptors: Phototransduction - Resting Membrane Potential (mV)
-20 mV
158
Photoreceptors: Phototransduction - On light exposure what happens to Vm?
Hyperpolarises
159
Photoreceptors: Phototransduction - In the dark what happens to Vm?
It is positive
160
Photoreceptors: Phototransduction - Why is Vm positive when its dark?
cGMP-gated Na+ channel is open
161
Photoreceptors: Modulation of the Dark Current - In the Dark the Outer segment Sodium Potential is what?
Equal to the potassium potential - therefore Vm is between ENa and EK
162
Photoreceptors: Modulation of the Dark Current - In the Light the Outer Segment Sodium Potential is what?
Reduced - as the channels close on the outer segment so ENa
163
Photoreceptors: Modulation of the Dark Current - In the light the Outer Segment is ...
Hyperpolarised
164
Photoreceptors: Visual Pigment Molecules - What is present on Rods?
Rhodopsin
165
Photoreceptors: Visual Pigment Molecules - Rhodopsin is composed of what?
Retinal - Vitamin A derivative Opsin - G-protein coupled receptor
166
Photoreceptors: Visual Pigment Molecules - Rhodopsin is present where?
In the membrane folds of the discs of the outer segment
167
Photoreceptors: Visual Pigment Molecules - Light enables what reaction in Rhodopsin?
11-cis-Retinal to All-Trans-Retinal (active form)
168
Phototransduction: Molecular mechanism (4 stages)
1. All-trans-Retinal activates Transducin 2. Molecular cascades causes reduced cGMP 3. Closure of cGMP-gated Na+ Channels 4. Lowered Na entry results in hyperpolarisation
169
Phototransduction: Dark Current Channel - What state is it in in the dark?
Open
170
Phototransduction: Dark Current Channel - What state is it in in the light?
Opened by cGMP
171
Phototransduction: Dark Current Channel - Permeable to what?
Sodium
172
Phototransduction: Dark Current Channel - Enables steady release of what?
Glutamate
173
Phototransduction: Dark Current Channel - Relationship between Glutamate and Light
Glutamate decreases with light
174
Visual Acuity
Ability to distinguish two nearby points
175
Visual Acuity: Determined by what two factors?
Photoreceptor spacing Refractive power
176
Visual Acuity: Rod function
Enable vision in dim light
177
Visual Acuity: Cone function
Enable vision in day light
178
Visual Acuity: Why does the rod system decrease acuity?
More convergence
179
Colour Vision: Cannot see what light ranges?
Infrared UV range
180
Rods: Does it detect colour?
No its achromatic
181
Rods: Convergence is (high/low)
High
182
Rods: Level of light sensitivity
High
183
Rods: Level of visual acuity
Low
184
Cones: Does it detect colour?
Yes - chromatic
185
Cones: High density where?
Fovea
186
Cones: Level of convergence
Low
187
Cones: Level of light sensitivity
Low
188
Cones: Level of visual acuity
High
189
Immunology: Basic Immune responses for the eye (3)
Blink reflex Physical and chemical properties of the eye surface Limit exposure and size of the eye
190
Immunology: Blink Reflex - Function
Tears enable flushing of the eye
191
Immunology: Blink Reflex - Mucous layer acts as a what?
Anti-adhesive
192
Immunology: Chemical Protection - 7 components of the tears
Lysozyme Lactoferrin and Transferrin Lipids Angiogenin Secretory IgA Complement system IL-6 -8 and MIP
193
Immunology: Chemical Protection - Function of Lysozyme
Protective against Gram Negative bacteria and Fungi
194
Immunology: Chemical Protection - Function of Lactoferrin and Transferrin
Protective against Gram positive bacteria
195
Immunology: Chemical Protection - Function of tear lipids
Anti-bacterial to cell membranes
196
Immunology: Chemical Protection - Function of Angiogenin
Anti-microbial effect within the tear film
197
Immunology: Chemical Protection - Function of IL-6 -8 and MIP
Anti-microbial products that recruit leukocytes
198
Immunology: Immune Cells - Function of Neutrophils
Attracted by chemotaxis to the site to release Free radicals and enzymes
199
Immunology: Immune Cells - Function of Macrophages
Phagocytosis of damaged cells to aid the activation of adaptive immune system
200
Immunology: Immune Cells - Function of Conjunctival Mast Cells
Vasoactive mediators
201
Immunology: What is the main Antigen Presenting Cell of the External Eye?
Langerhans Cells
202
Immunology: Langerhans Cells are rich in what molecules?
Class II MHC
203
Immunology: Langerhans Cells - Abundant in what location?
Corneo-scleral limbus
204
Immunology: Langerhans Cells - Absent from what location?
Central third of the cornea
205
Immunology: Conjunctiva - The only part of the eye with what?
Lymphatic drainage
206
Immunology: Conjunctiva - What is present within this area in conjunctival zones?
Diffuse lymphoid populations
207
Immunology: Conjunctiva - What Lymphocytes are present?
CD4+ T cells CD8+ T cells IgA-secreting plasma cells
208
Immunology: Conjunctiva - What cells acts as APCs here?
Dendritic cells
209
Immunology: Conjunctiva - What is present in the MALT?
Macrophages Langerhans Cells Mast cells Neutrophils and Eosinophils - if recruited
210
Immunology: Cornea and Sclera - What is the structure here?
Tough collagen coat
211
Immunology: Cornea and Sclera - Is there a blood supply?
No
212
Immunology: Cornea and Sclera - Langerhans cells are only present where?
Peripheral cornea
213
Immunology: Lacrimal Gland - Has more of what compared to the conjunctiva?
Plasma cells and CD8+ T cells
214
Immunology: Lacrimal Drainage System - What is present here?
Diffuse lymphoid tissue and follicles in MALT
215
Immune Privilege: Advantage
Tolerate the introduction of antigens without eliciting an inflammatory immune response
216
Immune Privilege: Examples of sites with Immune Privilege (4)
Brain or CNS Testes Placenta and Foetus Eyes
217
Immune Privilege: Sites in the Eye that are Immune Privileged (5)
Cornea Anterior chamber Lens Vitreous chamber Sub-retinal space
218
Immune Privilege: ACAID
Anterior Chamber Associated Immune Deviation
219
Hypersensitivity Reactions: Occular Example of Type I
Acute Allergic Conjunctivitis
220
Hypersensitivity Reactions: Occular Example of Type II
Ocular Cicatricial Pemphigoid
221
Hypersensitivity Reactions: Occular example of Type III
Autoimmune corneal melting
222
Hypersensitivity Reactions: Occular example of Type IV
Corneal Graft Rejection - vascularisation of the host cornea reaching the donor tissue results in graft rejection
223
Corneal Transplants: Factors that help maintain immune privilege - Why is the net antigenic load is reduced?
Reduced and impaired expression of MHC Class I and II
224
Corneal Transplants: Factors that help maintain immune privilege - The cornea lacks what two structures?
Blood Lymph vessels
225
Corneal Transplants: Factors that help maintain immune privilege - Central cornea is deficient of what?
Langerhans Cells
226
Corneal Transplants: Factors that help maintain immune privilege - Secretion of what?
Immunosuppressive properties
227
Meninges
Protective coverings of the brain and spinal cord
228
Meninges: Dura Mater - Sensory supply
CN V
229
Meninges: Dura Mater - Function
Encloses the dural venous sinuses
230
Meninges: Sub-Arachnoid Space - What is present here? (2)
Circulating CSF Blood vessels
231
Meninges: Pia Mater - Function
Adheres to the brain, nerves and vessels
232
Sub-Arachnoid Space: Location
Between the arachnoid and pia mater
233
Sub-Arachnoid Space: Contains what?
CSF
234
Sub-Arachnoid Space: CSF can be accessed where?
Lumbar puncture at L3/4 or L4/5 intervertebral disc
235
Sub-Arachnoid Space: Ends where?
S2
236
Raised Intra-Ocular Pressure: Increase in pressure within the cranial cavity due to what? (2)
Increased pressure in fluid surrounding the brain Increase in pressure within the pressure
237
Raised Intra-Ocular Pressure: 3 components of the cranial cavity
Brain Blood Volume CSF
238
Raised Intra-Ocular Pressure: Monro-Kellie Hypothesis
Increasing the volume of one of the three components increases the volume of the other two must increase to maintain the equilibrium
239
The Optic Nerve: Raised Intra-cranial pressure is transmitted along what?
The sub-arachnoid space in the optic nerve sheath
240
The Optic Nerve: Compression of the optic nerve may also compress what? (2)
Central artery Vein of the retina
241
The Optic Nerve: Compression of the optic nerve can lead to?
Papilloedema - leads to bulging or swollen optic discs when caused by raised ICP
242
The Optic Nerve: Symptoms of the Optic Nerve Compression (5)
Transient visual obscurations Transient flickering Blurring of vision Constriction of the visual field Decreased colour perceptio
243
The Oculomotor Nerve: Raised ICP can compress the oculomotor nerve when?
If the medial temporal lobe herniates through the tentorial notch
244
The Oculomotor Nerve: Compression causes what? (2)
Paralysis of somatic motor innervation to the 4 extra-ocular muscles and eye lid Paralysis of parasympathetic innervation of the sphincter of the pupil
245
The Oculomotor Nerve: Clinical Presentation of compression (4)
Loss or slowing of pupillary light reflex Dilated pupil Ptosis Eye turned inferolaterally - due to unopposed actions of lateral rectus and superior oblique
246
The Trochlear Nerve: Emerges from where?
Midbrain
247
The Trochlear Nerve: Supplies what meninges?
Dura mater
248
The Trochlear Nerve: Compression can result in what?
Paralysis of the superior oblique muscle
249
The Trochlear Nerve: Clinical Presentation
Diplopia when looking down - inferior oblique is unopposed so cannot move inferomedially
250
The Abducens Nerve: Susceptible to what type of damage?
Stretching
251
The Abducens Nerve: Complication of stretching
Paralysis of lateral rectus muscle
252
The Abducens Nerve: Clinical presentation of stretching
Eye cannot move laterally in the horizontal plane - medial deviation of the eye
253
Dural Septae
Folds of the dura mater that creates a septa in the cranial cavity
254
Dural Septae: Divides the cranial cavity into what four sections?
Falx Cerebri Tentorium Cerebelli Falx Cerebelli Diaphragma Sellae
255
Mechanisms of Ocular Trauma (3)
Blunt trauma Penetrating trauma Burns - chemical, physical or thermal
256
Blunt Trauma: Blow Out Fractures - Mechanism
Fracture to one of the walls of the orbit but the orbital rim remains intact
257
Blunt Trauma: Blow Out Fractures - What type are most common?
Inferior blowout fractures
258
Blunt Trauma: Blow Out Fractures - In an inferior blowout fracture what happens?
Orbital fat prolapses into the maxillary sinus that may be joined by prolapse of the inferior rectus muscle
259
Blunt Trauma: Blow Out Fractures - How may inferior blow out affect vision?
Diplopia
260
Hyphaemia
Blood in the anterior chamber
261
Hyphaemia is a sign of what?
Intra-ocular trauma
262
Sub-conjunctival Haemorrhage: Mechanism
One of the small blood vessels within the conjunctiva ruptures to release blood into the space between the sclera and conjunctiva
263
Sub-conjunctival Haemorrhage: Management
Self resolving within 2 weeks
264
Penetrating Trauma
Injury that penetrates the cornea or the sclera
265
Penetrating Trauma: Types of injury caused by small objects? (5)
Sub-tarsal Conjunctival Corneal Intra-ocular Intra-orbital
266
Penetrating Trauma: What do intra-ocular injuries require?
X-ray for potential intra-ocular foreign bodies
267
Penetrating Trauma: Signs of a Penetrating Foreign Body (4)
Irregular pupil Shallow anterior chamber Localised cataract Gross inflammation
268
Sympathetic Opthalmia
Penetrating injury to one eye that results in the exposure of intra-ocular antigens for auto-immune reactions in both eyes
269
Sympathetic Opthalmia: Complication
Bilateral blindness
270
Burns: Alkali - Pathological changes (2)
Cicatrising changes to the conjunctiva and cornea Can change the pH of the entire eye
271
Burns: Alkali - Is penetration easy?
Yes
272
Burns: Acid - Is penetration easy?
No
273
Burns: Acid - Impact on proteins
Causes coagulation
274
Burns: Complications (4)
Limbal ischaemia Corneal scarring Corneal vascularisation End stage scarring
275
Average diameter of the optic nerve
1.5 mm
276
The Optic Nerve: What are the 3 C's?
Contour Colour Cup
277
The Optic Nerve: What happens to the disc in Disc Drusen?
Disc margin appears blurred
278
The Optic Nerve: Colour
Orange with a pale centre
279
The Optic Nerve: Aetiologies of changes in colour (5)
Glaucoma Optic neuritis Arteric ischaemic optic neuropathy Non-arteritic ischaemic optic neuropathy Compressive lesion
280
The Optic Nerve: Disc - why is it pale?
Devoid of neuroretinal tissue
281
The Optic Nerve: Normal Cup:Disc ration?
0.3
282
The Optic Nerve: What does an increase in cup:disc ratio suggest?
Decrease in the quantity of healthy neuroretinal tissue
283
Visual Pathologies: Homonymous
Same part of the field in each eye
284
Visual Pathologies: Hemianopic
Half of the field is affected
285
Visual Pathologies: Quadrantanopic
Quarter of the field is affected
286
Visual Pathologies: Most common cause of Quadrantanopic pathology
Occipital lobe stroke
287
Visual Pathologies: Inferior quadrantic defect due to what?
Parietal lobe defect
288
Visual Pathologies: Superior quadrantic defect due to what?
Temporal lobe defect
289
What is given after a foreign body is removed from the eye?
Chloramphenicol ointment
290
Systemic Disease: Myotonic Dystrophy
Difficulty in releasing grip
291
Systemic Disease: Myotonic Dystrophy - Genetics
Autosomal dominant mutation of the dystrophica myotonica protein kinase gene
292
Systemic Disease: Myotonic Dystrophy - Common ocular presentations (3)
Early onset cataracts Ptosis Hypermetropia
293
Systemic Disease: Myotonic Dystrophy - Uncommon Ocular Presentations (4)
Mild ophthalmoplegia Pupillary light-near dissociation Pigmentary retinopathy Optic atrophy
294
Systemic Disease: Neurofibromatosis Type I - Ocular presentation (2)
Optic glioma - causes an afferent pupillary defect with globe proptosis Two or more Lisch Nodules - bilateral yellow or brown shaped nodules
295
Systemic Disease: Thyroid Eye Disease - Pathophysiology
Inflammation. ofthe eye muscles and orbital fat causes fluid retention and swelling of the eye
296
Systemic Disease: Thyroid Eye Disease - Appearance (4)
Peri-orbital swelling Prominent eyes - lid retraction with proptosis Kocher Sign - frightened appearance of eyes Conjunctival injection
297
Systemic Disease: Thyroid Eye Disease - Symptoms of soft tissue involvement (3)
Grittiness Photophobia Lacrimation
298
Systemic Disease: Thyroid Eye Disease - Signs of soft tissue involvement (3)
Hyperaemia Chemosis Periorbital swelling
299
Systemic Disease: Thyroid Eye Disease - Proptosis complications
Keratopathy causing corneal ulceration
300
Systemic Disease: Thyroid Eye Disease - Optic Neuropathy complications (2)
Reduced colour vision Vision with RAPD
301
Systemic Disease: Dermatomyositis - Ocular presentation (3)
Bilateral lilac eyelid discolouration - heliotropic rash Swelling of the eyelids and periorbital skin Dry eyes and scleritis
302
Systemic Disease: Marfan Syndrome - Genetics
Autosomal dominant mutation of the fibrillin-1 gene
303
Systemic Disease: Marfan Syndrome - Ocular presentation
Dislocated Lens - ectopia lentis
304
Systemic Disease: Rheumatoid Arthritis - Corneal findings (2)
Scleromalacia perforans Peripheral ulcerative keratitis
305
Systemic Disease: What diseases present with Mutton-Fat Keratic Precipitates (Granulomatous Anterior Uveitis) (3)
Sarcoidosis TB Syphillis
306
Systemic Disease: Infective Causes of Uveitis (6)
TB Herpes Zoster Toxoplasmosis Candidiasis Syphillis Lyme Disease
307
Systemic Disease: Non-infective causes of Uveitis (4)
HLA-B27 Juvenile Arthritis Sarcoidosis Behcet's Disease
308
Systemic Disease: Causes of Vortex Keratopathy (4)
Amiodarone Hydroxychloroquine Chloropromazine Fabry Disease
309
Systemic Disease: Causes of Bulls Eye Maculopathy (2)
Hydroxychloroquine Chloroquine
310
Systemic Disease: Causes of Symbelpharon (3)
SJS - Sulfa drugs and penicillin Ocular cicatricial pemphigoid Chemical injury
311
Systemic Disease: Impact on the eye with Steroid use
Raised intraocular pressure
312
The Retina: How many layers?
9
313
The Retina: Diabetic Retinopathy - 3 Types
Non-proliferative Diabetic Retinopathy Proliferative Diabetic Retinopathy Diabetic Macular Oedema
314
The Retina: Non-Proliferative Diabetic Retinopathy - 5 signs on examination
Micro-aneurysms Hard exudates Intra-retinal haemorrhages Cotton wool spot Venous beading
315
The Retina: Proliferative Diabetic Retinopathy - 2 signs on examination
Neovascularisation Vitreous haemorrhage and traction
316
The Retina: Proliferative Diabetic Retinopathy - Clinical Presentation (2)
Floaters Severe visual loss
317
The Retina: Proliferative Diabetic Retinopathy - Management
Immediate ophthalmologic consultation
318
The Retina: Diabetic Retinopathy - Management for CSME (Clinically-significant Macular Oedema)
Focal macular laser
319
The Retina: Diabetic Retinopathy - Management for Proliferative Diabetic Retinopathy
Panretinal Photocoagulation
320
The Retina: Diabetic Retinopathy - Management for Vitreous Haemorrhage or Retinal Detachment
Vitrectomy
321
The Retina: Diabetic Retinopathy - Management for Diabetic Macular Oedema
Anti-VEGF
322
who do i love
kirsten <3
323
Normal Axial Length
>26 mm
324
Normal Spherical Equivalent
<8.00 D
325
Posterior Vitreous Detachment: 3 classifications
Break Hole Tear
326
Posterior Vitreous Detachment: Break
Full-thickness defect in the Sensory Retina
327
Posterior Vitreous Detachment: Hole occurs due to what?
Chronic Retinal Atrophy
328
Posterior Vitreous Detachment: Tear occurs due to what?
Dynamic vitreoretinal traction
329
Retinal Detachment
Separation of the sensory retina from the RPE by sub-retinal fluid
330
Retinal Detachment: Rhgmatogenous occurs due to what?
Retinal break
331
Retinal Detachment: Two components of retinal break formation
Acute posterior vitreous detachment Predisposing peripheral retinal degeneration
332
Fresh Rhegmatogenous Retinal Detachment: Presentation (5)
Convex deep mobile elevation that extends to the ora serrata Slightly opaque retina Dark blood vessels Loss of choroidal pattern Retinal breaks
333
Exudative Retinal Detachment
Damage to the RPE by subretinal disease that allows the passage of fluid from the coroid into the subretinal space
334
Exudative Retinal Detachment: Aetiologies - Intraocular Inflammation (2)
Harada disease Posterior scleritis
335
Exudative Retinal Detachment: Aetiologies - Systemic (2)
Toxoaemia of Pregnancy Hypoproteinaemia
336
Exudative Retinal Detachment: Aetiologies - Iatrogenic (2)
RD surgery Excess retinal photocoagulation
337
Exudative Retinal Detachment: Signs (3)
Convex with smooth elevation Mobile and deep with shifting fluid Subretinal pigment after flattening
338
Central Retinal Artery Occlusion: Impact
Severe vision loss
339
Central Retinal Artery Occlusion: Leading cause of death in these patients?
Cardiovascular disease
340
Central Serous Chorioretinopathy: Typical Patient
Healthy 30-50 year old male
341
Central Serous Chorioretinopathy: Most common angiographic finding
Small focal hyperfluorescent RPE leak with a smokestack
342
Epiretinal Membrane: Mainly associated with what disease?
PVD
343
Epiretinal Membrane: Two stages
Subretinal fluid Cystic
344
Epiretinal Membrane: Features (3)
Metamorphopsia Decreased acuity Retinal striae
345
Vitreomacular Traction: Features (4)
Metamorphopsia Decreased vision Partial posterior vitreous detachment Vitreous traction on the macula with subretinal fluid accumulation
346
Macular Hole: Ia Staging
Foveolar detachment
347
Macular Hole: II Staging
Full thickness defect less than 400 micrometers
348
Macular Hole: III Staging
Full thickness defect more than 400 micrometers with no PVD
349
Macular Hole: IV Staging
III with PVD
350
Cystoid Macular Oedema
Fluid collection in the outer plexiform
351
Emmetropia
No refractive error - the light is focused on to the retina
352
Ametropia
Refractive error is present - the light is focused behind or in front of the retina
353
Anisometropia
Significant difference between the right and left ametropia
354
Myopia
Light is focused in front of the retina
355
Myopia: Impact on distance targets?
Blurred
356
Myopia: Impact on close targets?
None
357
Myopia: What lenses are required?
Negative - image magnification required
358
Hypermetropia
Light is focused behind the retina
359
Hypermetropia: Impact on distant vision?
Nothing
360
Hypermetropia: Impact on near vision?
Blurred
361
Hypermetropia: Lenses
Positive - image magnification required
362
Astigmatism
Eye has unequal refractive powers at different meridia to cause a distorted vision
363
Astigmatism: Lenses required
Cylindrical lenses
364
Presbyopia
Reduction in the ability of the eye to accomodate for close-work with age
365
Presbyopia: Requires what lens?
Supplementary converging or positive lens to focus on light from a near object onto the retina
366
Vision
Smallest letter on a chart that a patient can read without the aid of spectacles or contact lenses
367
Visual acuity
Smallest letter on the chart a patient can read with the best spectacle or contact lens correction
368
Pinhole Acuity
The smallest letter visible when viewing through a pinhole
369
The appearance of the retina with an arterial occlusion
Pale
370
The appearance of the retina with a vein occlusion
Dark red/purple
371
ARMD
Age-related macular degeneration
372
Causes of Sudden Visual Loss (6)
Vascular occlusion - retinal artery, vein or optic nerve head circulation Haemorrhage Vitreous haemorrhage Retinal detachment Age Related Macular Degeneration - Wet Type Closed angle glaucoma
373
Aetiologies of Gradual Vision Loss (5)
Cataract Age Related Macular Degeneration - Dry Type Refractive error Glaucoma Diabetic Retinopathy
374
VIth Nerve Palsy: Four main causes
Microvascular Raised intracranial pressure Tumour Congenital
375
VIth Nerve Palsy: Pathophysiology
False localising sign and as the pressure increases the brain descends to push the sixth nerve over the edge of the petrous bone
376
VIth Nerve Palsy: Clinical Presentation (3)
Papilloedema Lateral Rectus Palsy - the impacted eye cannot abduct as medial rectus Double vision
377
IVth Nerve Palsy: Aetiologies (4)
Congenital Decompensated Microvascular Tumour Bilateral - due to closed head trauma
378
IVth Nerve Palsy: Clinical Presentation (3)
Superior Oblique Muscle Plasy - causes intorsion and depression whilst in adduction of the eye and abduction is weak Vertical double vision Head Tilt due to incyclo-torsion to compensate vision (tilted to impacted eye)
379
IVth Nerve Palsy: Clinical Presentation due to blunt head trauma (3)
Torsion Chin is depressed Asthenopia
380
IIIrd Nerve Palsy: Two branches of the nerve
Superior Inferior
381
IIIrd Nerve Palsy: Aetiologies (5)
Microvascular Tumour Aneurysm - causes a blown pupil Multiple Sclerosis Congenital
382
IIIrd Nerve Palsy: Impacts what muscles? (6)
Medial rectus Inferior rectus Superior rectus Inferior oblique Sphincter pupillae Levator palpebrae superioris
383
IIIrd Nerve Palsy: Clinical Presentation (2)
Ocular depression and lateral eye movement Blown pupil - dilation
384
IIIrd Nerve Palsy: Most common artery impacted by aneurysm?
Posterior communicating artery to press the superficial parasympathetic around the nerve
385
Macular sparing
Visual field loss thay preserves vision in the centre of the visual field
386
IIIrd Nerve Palsy: When does macular sensing appear?
Damage to one hemisphere of their visual cortex
387
Optic Nerve Defects: Aetiologies (3)
Ischaemic Optic Neuropathy Optic neuritis Tumours - Meninioma, Glioma or Hemiangioma
388
Optic Nerve Defects: Pathophysiology
Complete or abide the horizontal
389
Optic Neuritis
Progressive visual loss with pain behind the eye on movement
390
Optic Nerve Defects: Clinical Presentation (3)
Colour desaturation Central Scotoma Gradual recovery within weeks or months
391
Optic Nerve Defects: Signs on Examination (2)
Optic atrophy Optic nerve haemangioma

Ophthamology (4 decks)

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