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Flashcards in Plastics Mnemonics Deck (20)
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0
Q

Structures within the superior orbital fissure but outside the area enclosed by the annulus of zinn

A

The structures within the superior orbital fissure but outside of the area enclosed by the annulus of Zinn are the lacrimal and frontal branches of CN V1, CN IV (trochlear), and the superior ophthalmic vein. This can be remembered by themnemonic “LFTs”(lacrimal, frontal, trochlear, and the superior ophthalmic vein).

This can be remembered by the mnemonic”Live Frankly To See Absolutely No Insult”- forLacrimal,Frontal,Trochlear,Superior Division of Oculomotor,Abducens,Nasociliary andInferior Division of Oculomotor nerve.

Note that this mnemonic has the divisions of the the ophthalmic branch of V1: lacrimal, frontal, and nasociliary. This mnemonic does not contain the superior ophthalmic vein or the sympathetics but no mnemonic is perfect.

1
Q

Medial orbital walls

A

Mnemonic:SMEL(sphenoid, maxilla, ethmoid, lacrimal) medial orbital wall bones are near the nose!

Another useful mnemonic couplet to remember how many bones are in each wall and which have a sphenoid component, “2, 2, 3, 4–All have sphenoid except the floor.” The superior and lateral walls are comprised of 2 bones, the floor by 3, and the medial wall has 4 bones.

2
Q

Branches of v1

A

three main divisions: V1(ophthalmic nerve), V2(maxillary nerve), and V3(mandibular nerve).

A mnemonic to remember the branches of V1isNFL:nasociliary,frontal,lacrimal.

3
Q

Epicanthus

A

Epicanthus inversus is associated with a medial eyelid skin fold that is more prominent in the lower eyelid. Epicanthus palpebralis is associated with a medial eyelid skin fold that is equally prominent in the upper and lower eyelid. Epicanthus supraciliaris is associated with a medial eyelid skin fold that is more prominent from the eyebrow to the lacrimal sac. Epicanthus tarsalis is associated with a medial eyelid skin fold that is more prominent in the upper eyelid.

This can be remembered with the mnemonic:
Epicanthus TIPS: Tarsalis (T= Top= upper eyelid), Inversus (I=Inferior=lower lid), Palpebralis(U=L), Supraciliaris: above the cilia (above the eyebrow).

4
Q

TED. Rx

A

Correct order of surgical intervention for thyroid disease is from IN to OUT of the eye: (OSL)

1) Orbit decompression
2) Strabismus (EOM)
3) Lids

Or DSL

5
Q

Structures within the annulus of zinn

A

A way to remember the structures within the annulus of Zinn: 3N3 is 6. the Superior and inferior divisions of CN3, nasociliary and the CN6.

7
Q

open globe

A

Mnemonic for suspected open globe:

CATS

CT
Antibiotics
Tetanus vaccine (if patient not up to date)
Shield

7
Q

Most abundant immunoglobulin in tears

A

IgA: A for abundant

IgA is secretory

8
Q

What drains into the superior/inferior/medial meatus?

A

although it is Middle Meatus, if you think of it as Medial Meatus:
MEDs get Max FAME (MEDial, Maxillary, Frontal/Anterior/Medial/Ethmoid.

suPErior meatus (Post Ethmoid)

The nasolacrimal duct drains just behind the inferior meatus. When performing silicone intubation of the nasolacrimal duct, you should look near the inferior meatus to find the end of the tube that has been threaded through the tear duct system

The frontal, anterior and medial ethmoidal, and maxillary sinuses drain into the middle meatus. The posterior ethmoidal sinus drains into the superior meatus.

10
Q

Lockwoods ligament and lateral orbital tubercle

A

The eye stands on a wooden floor.
Look! Wood!
(Lockwoods ligament = suspensory ligament of eyeball)

11
Q

exits of CN V

A

Standing Room only
V1 = SO fissure
V2 = foramen Rotundum
V3 = foramen Ovale

11
Q

V1 nerve branches

A

A mnemonic to remember the branches of V1 is NFL: nasociliary, frontal, lacrimal. Please see the answer image for an illustration of these important nerve branches.

The frontal nerve branches into the supratrochlear and supraorbital. The lacrimal nerve does not branch. The nasociliary nerve gives off the ethmoidal nerves, the long ciliary nerve, the communicating branch to the ciliary ganglion, and the infratrochlear nerve.

The long ciliary nerves supply the iris, cornea, and ciliary muscle. Prior to entering the globe, the nasociliary branch gives off branches (i.e. the ethmoidal nerves) that go through the anterior and posterior ethmoidal foramen to supply innervation to the ethmoid sinus, the lateral wall of the nose, and the tip of the nose’s skin.

In herpes zoster ophthalmicus, involvement of the tip of the nose may indicate that there is involvement of the nasociliary branch of V1 (i.e. “Hutchinson’s sign”). Since the cornea is innervated by the nasociliary branch, this indicates a higher (though not absolute) risk of corneal involvement.

12
Q

V1 nerve branches

A

A mnemonic to remember the branches of V1 is NFL: nasociliary, frontal, lacrimal.

The frontal nerve branches into the supratrochlear and supraorbital. The lacrimal nerve does not branch. The nasociliary nerve gives off the ethmoidal nerves, the long ciliary nerve, the communicating branch to the ciliary ganglion, and the infratrochlear nerve.

The long ciliary nerves supply the iris, cornea, and ciliary muscle. Prior to entering the globe, the nasociliary branch gives off branches (i.e. the ethmoidal nerves) that go through the anterior and posterior ethmoidal foramen to supply innervation to the ethmoid sinus, the lateral wall of the nose, and the tip of the nose’s skin.

In herpes zoster ophthalmicus, involvement of the tip of the nose may indicate that there is involvement of the nasociliary branch of V1 (i.e. “Hutchinson’s sign”). Since the cornea is innervated by the nasociliary branch, this indicates a higher (though not absolute) risk of corneal involvement.

13
Q

Location of accessory glands

A
accessory glands (Krause and Wolfring) = produce aqueous component of tears.
Lacrimal gland = reflex tears.  
Wolfring = wolf guarding the border (of the tarsus --> nonmarginal tarsal border)
Krause = found in the "crotch" of the eyelids (fornix)
14
Q

NLDO?

A

Valve of HASner HAS the problem

15
Q

enlargement of lacrimal sac

A

Mnemonic “AMBI”: above = mass; below = inflammation

Suspicion should arise if one sees enlargement of lacrimal sac superior to the medial canthal tendon or if there is blood reflux with canalicular irrigation.

16
Q

BCC location

A

Lesions of the lower eyelid are the most common location (50-60% of cases), medial canthus (25-30%), upper eyelid (15%), and lateral canthus (5%).

This also follows the same pattern as thyroid: I>M>S>L (mnemonic: I aM So Large) i = inferior (lower lid) m = medial canthus s = superior (upper lid) l = lat canthus (courtesy of Dr Brett Shapiro).

17
Q

Whitnall’s tubercle (aka lateral orbital tubercle)

A

Whitnall’s tubercle: usually the location for reattachment during the lateral tarsal strip or other lateral canthal procedures

Whitnall's tubercle CLAW
C: Canthal tendon
L: Lateral rectus (check ligament) & Lockwood ligaments*
A: Aponeurosis -levator-and ligament
W: Whitnall's ligament

*Lockwood’s ligament: suspensory ligament of the lower lid

19
Q

structures outside SO fissure

A

The annulus of Zinn is a circle overlying the superior orbital fissure and divides it into two. The area of the superior orbital fissure that is enclosed by the annulus of Zinn (called the oculomotor foramen) transmits CN III, CN VI, and the nasociliary branch of CN V1.

The structures within the superior orbital fissure, but outside of the area enclosed by the annulus of Zinn are the lacrimal and frontal branches of CN V1, CN IV (trochlear), and the superior ophthalmic vein. This can be remembered by the mnemonic LFTs (Lacrimal, Frontal, Trochlear). You just have to remember the superior ophthalmic vein (the mnemonic is not perfect).

Another mnemonic for this latter fact is: “LeFT Out”

20
Q

Ab to granulomatosis with polyangiitis

A

cANCA, or cytoplasmic antineutrophil cytoplasmic antibody, is the autoantibody associated with GPA.

cANCA being associated with GPA can be remembered by the fact that GPA is often treated with cyclophosphamide. cANCA is highly specific and relatively highly sensitive for the diagnosis of GPA.

GP is a systemic small- & medium- vessel vasculitis that commonly affects the sinus, lungs, and kidneys. It can have orbital manifestations as well as episcleritis, scleritis, and uveitis.

Wegener’s has been replaced by the rheumatology folks because of Dr. Wegener’s ties to Nazi Germany!