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Neuro EyesEars

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ekadar's version from 2015-11-22 08:43

Section

Question Answer
physiology of accomodationfocus on near objects -> ciliary muscles tighten -> zonular fibers relax -> lens becomes more convex
uveitis is inflammation ofuveal coat (iris, ciliary body, chorioid)
uveitis associated withsarcoid, RA, juvenile idiopathic arthritis, TB, HLA-B27 associated conditions
retinitis isretinal edema and necrosis leading to scar
retinitis is associated withimmunosuppression
viruses associated with retinitisCMV, HSV, HZV
central retinal artery occlusion causesacute, painless, monocular vision loss; retinal whitening with cherry-red spot
presbyopiadecreased ability to change focus during accommodation due to sclerosis and decreased elasticity. normal aging. necessitates reading glasses
what can fix myopia (near sighted)presbyopia cant see things that are far away
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Question Answer
collects aqueous humortrabecular meshwork, then canal of schlemm
produces aqueous humorciliary epithelium
ciliary epithelium receptorbeta
pupillary sphincter receptorM3
pupillary dilator receptoralpha-1
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Question Answer
open/wide angle glaucoma symptomspainless; peripheral then central vision loss, usually with increased IOP, optic disc atrophy with cupping
open/wide angle glaucoma associated withbeing old, being black, high IOP
secondary causes of open/wide angle glaucomauveitis, trauma, corticosteroids, vasoproliferative retinopathy
obstruction in open/wide angle glaucomaobstructed outflow at trabecular meshwork
obstruction in closed/narrow angle glaucomalens against iris obstructs normal aqueous flow through pupil; fluid buildup behind iris pushes peripheral iris against cornea, impeding flow through trabecular meshwork
symptoms of chronic closed/narrow angle closureoften asymptomatic, with damage to optic nerve and peripheral vision
symptoms of acute closed/narrow angle glaucomavery painful, sudden vision loss, halos around eye, rock-hard eye, frontal headache, rock hard eye
contraindicated in acute closed/narrow angle glaucomaepinephrine (mydriatic effect)
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Section

Question Answer
CN III damageeye looks down and out; ptosis, pupillary dilation, loss of accomodation. Usually PCOMM aneurysm
CN IV damageeye moves upward, particularly with contralateral gaze and ipsilateral head tilt (problems going down stairs)
CN VI damagemedially directed eye that cannot abduct
testing extraocular muscle function, clockwise starting at upper nasalIO, MR, SO, IR, LR, SR
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Question Answer
miosisparasympathetic
mydriasissympathetic
Marcus Gunn pupilafferent pupillary defect due to optic nerve damage. When light shines in affected eye both eyes do not constrict. Swing light to normal eye and botch constrict. Swing light back to affected and both dilate.
HORNERSRemember PAM (ptosis, anhydriosis, miosis) is horny. sympathetic denervation of face
argyll robertson pupilsPupils that accomodate (constrict in near reflex), but don't react (constrict in light reflex)
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Section

Question Answer
pathway of pupillary light reflexlight enters retina -> signal via CN II to pretectal nuclei -> activate bilateral Edinger-Westphal nuclei -> pupils contract bilaterally
marcus gunn pupilafferent pupillary defect; less bilateral pupillary constriction when light is shone in affected eye
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Question Answer
CNIII dysfunctiondown and out
CNIV functionsuperior oblique (down and in)
CNIV dysfunctioneye moves upward
CNVI functionabduction
CNVI dysfunctionmedially directed eye cannot abduct
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Question Answer
retinal detachmentseparation of neurosensory layer from outermost pigmented epithelium -> degeneration of photoreceptors and vision loss
secondary causes of retinal detachmentretinal breaks, diabetic traction, inflammatory effusions
breaks are more common in patients withhigh myopia (light focused in front of retina)
breaks are often preceded byposterior vitreous detachment (flashes and floaters)
retinoblastomaloss of red reflex. seen white reflex
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Question Answer
symptoms of age related macular degenerationdistortion (metamorphopsia) and eventual loss of central vision (scotomas)
dry macular degeneration caused bydeposition of yellowish extracellular material beneath retinal pigment epithelium (drusen); gradual loss of vision
prevent progression of dry macular degeneration withmultivitamin and antioxidant supplements
wet macular degeneration due toabnormal blood vessel growth; rapid loss of vision
treatment of wet macular degenerationanti-VEGF injections, laser
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Question Answer
right or left anopiaoptic nerve
bitemporal hemianopiaoptic chiasm from pituitary adenoma or craniopharyngiomas
left or right homonymous hemianopiaoptic tract, or lesion to both meyers loop and dorsal optic radiation) (MCA)
upper quadrantic anopiameyer's loop in temporal lobe (MCA)
lower quadrant anopiadorsal optic radiation in parietal lobe; MCA
hemianopia with macular sparingPCA infarct in occiput
central scotomamacular degeneration
meyer's loopinferior retina; loops around inferior horn of lateral ventricle
dorsal optic radiationsuperior retina; shortest path via internal capsule
right nasal hemianopiainternal carotid artery
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Section

Question Answer
medial longitudinal fasciculus allows talk betweenCN VI and CN III nuclei
MLF is highly myelinatedlesions seen in patients with demyelination
abducting eye getsnystagmus
if right MLF lesion and looking leftright eye has impaired adduction (because right medial rectus is messed up) w/leftward gaze and left eye has nystagmus w abduction
if right MLF lesion and looking rightcan look right normally because problem is the right eye's medial rectus
vestibular testingCOWS (quick phase of nystagmus cold opposite warm the same)
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Ear

Question Answer
low frequency soundbest detected at the apex of the cochlea near the helicotrema
high frequency soundbest detected at base of cochlea near oval and round windows
hyperacusisparalysis of stapedius muscle which is innervated by stapedius nerve, part of facial nerve
choleastomaconducive hearing loss
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