NBEO Part 1 > Cumulative 2 > Flashcards

Cumulative 2 Flashcards

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1
Q

Ocular complications of prolonged topical steroid use? (Name at least 4)

A

1) posterior subcapsular cataract
2) elevation of IOP
3) reduced resistance to bacterial, fungal and viral infections
4) delayed wound healing
5) mydriasis
6) ptosis development

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2
Q

What is Digoxin used to treat?

A

A-fib & Congestive heart failure

Atrial fibrillation and in severe symptomatic systolic heart failure

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3
Q

Ocular side effects of high doses of oral digoxin

A

Xanthopsia (yellowing of vision) ***most common
Cyanopsia (blue vision)
Chloropsia (green vision)
Light flashes
Scintillating or moving light or spots
Blurred, hazy, misty or snowy vision
Difficulty reading

Digoxin: tx congestive heart failure

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4
Q

True or False
Pilocarpine is a sympathomimetic drug

A

FALSE
** pilocarpine is a parasympathomimetic drug, it is a direct cholinergic agonist

Increases aqueous outflow via CORNEOSCLERAL route

Causes headaches, brow aches and can cause retinal detachment

Super low dose used to dx Adie’s tonic pupil, super sensitive will cause pupil constriction

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5
Q

Drug class of phenylephrine

A

Adrenergic agonist (aka sympathomimetic)
* stimulates alpha-1 adrenergic receptors
* commonly used during an eye exam because causes mydriasis without cycloplegia

1% phenylephrine for localizing 3rd order lesion of Horner’s syndrome
2.5% phenylephrine for dilation
10% phenylephrine for breaking posterior synechiae (ABSOLUTE CONTRAINDICATION FOR TCA)

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6
Q

Which NSAID is FDA approved for treatment of seasonal allergic conjunctivitis?

A

Ketorolac (Acular)
* decrease conjunctival and post-cataract inflammation, prevent and treat CME and control discomfort associated with seasonal allergic conjunctivitis

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7
Q

What is Topamax® primarily used for?

A

Treatment of seizures

Topamax® may also be used for migraines, depression, bipolar disorder, and weight loss.

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8
Q

What adverse effect can Topamax® cause related to vision?

A

Uveal effusions

This leads to swelling of the ciliary body and narrowing of the angle.

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9
Q

What condition can result from the use of Topamax® due to uveal effusions?

A

Angle-closure glaucoma

This condition can occur alongside myopia.

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10
Q

What should patients do if they experience blurred vision while taking Topamax®?

A

Immediately discontinue the medication

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11
Q

How long after starting Topamax® can signs and symptoms occur?

A

3-14 days

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12
Q

Fill in the blank: Topamax® is also used to promote _______.

A

weight loss

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13
Q

What are the possible psychological conditions that Topamax® can help manage?

A

Depression, bipolar disorder

These are considered off-label uses.

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14
Q

MOA of sulfonamides

A

Folic acid synthesis inhibitor

Interferes with synthesis of folic acid by inhibiting enzyme that is necessary for incorporating PABA into dihydrofolic acid, inhibiting folic acid formation leads to bacteria not synthesizing amino acids and DNA

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15
Q

Which oral antibiotic has the ability to protect the cornea from thinning due to inhibition of collagenase?

A

Doxycycline
* collagenase breaks down collagen
* useful for corneal ulcers, chemical burns, disorders related to collagen vascular thinning

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16
Q

Which antibiotic can cause punctate epithelial erosions delayed re-epithelialization and corneal ulceration?

A

Gentamicin

(*Tobragent 30!!! Inhibits protein synthesis via 30 S bacterial ribosomes)

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17
Q

What is potentiation?

A

A drug which has no principal effect but enhances the effect of a second drug

Example: amoxicillin with clavulanate

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18
Q

What does antagonism refer to in pharmacology?

A

A drug inhibits the effect of another drug

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19
Q

Define synergism in the context of drug interactions.

A

The response elicited by combining drugs is greater than the responses of the individual drugs

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20
Q

What is meant by additive effect?

A

The response elicited by combining drugs is equal to the combined responses of the individual drugs

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21
Q

What can occur when amiodarone is taken concurrently with warfarin?

A

*prolonged bleeding

Amiodarone will enhance warfarin’s MOA, which can result in dramatically increased clotting times and prolonged bleeding
*need to Rx half dose warfarin if need to use both meds
* recall warfarin is an anti-coagulant for stroke, blood clots, heart attacks
* amiodarone is class III anti-arrhythmic that blocks potassium channels

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22
Q

What is the daily maximum safe dose of oral hydroxychloroquine?

A

5 mg/kg of actual body weight

Example: patient weighs 175 lbs would be at threshold dose when taking 400mg daily

1) convert pounds to kg
175/2.2 =79.545

2) multiply kg by 5
79.545 x 5 =397.725 ~400mg daily

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23
Q

What is the recommended dosage of trifluridine (Viroptic®) for adults and children aged 6 or older?

A

Q2H up to 9 gtts per day

Instill 1 drop into the affected eye(s) every 2 hours during waking hours, up to a maximum of 9 drops per day.

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24
Q

How long should trifluridine be administered until the corneal ulcer has re-epithelialized?

A

Continue until the corneal ulcer has completely re-epithelialized.

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25
What is the dosage of trifluridine after re-epithelialization?
1 drop every 4 hours while awake for a minimum of 5 drops per day for an additional 7 days.
26
What should be done if no signs of improvement occur after day 7 of trifluridine therapy?
Another treatment should be considered.
27
What is the maximum duration for continuous administration of trifluridine?
Continuous administration should not exceed 21 days.
28
Why should continuous administration of trifluridine be avoided for periods exceeding 21 days?
Due to potential ocular toxicity.
29
Fill in the blank: The maximum daily dosage of trifluridine is ______ (drops)
9 drops
30
True or False: Trifluridine can be safely administered for more than 21 days without concern for ocular toxicity.
False
31
Marcus-Gunn jaw winking is a result from aberrant connections between which cranial nerves?
Cranial nerve III and V
32
What is Marcus-Gunn jaw winking?
A phenomenon that occurs due to an abnormal connection between cranial nerve V and cranial nerve III. *aberrant regeneration * eyelid moves involuntarily when jaw is moved
33
Which cranial nerves are involved in Marcus-Gunn jaw winking?
Cranial nerve V (trigeminal nerve) and cranial nerve III (oculomotor nerve).
34
What is the cause of Marcus-Gunn jaw winking?
Aberrant connection of branches from the motor root of the trigeminal nerve to the levator muscle instead of the pterygoid muscle.
35
What effect does Marcus-Gunn jaw winking have on the upper eyelid?
It allows for an elevation effect of the upper eyelid when jaw movements are initiated.
36
What percentage of patients with congenital ptosis may experience Marcus-Gunn jaw winking?
Up to 5%.
37
How does the severity of Marcus-Gunn jaw winking change with age?
It tends to lessen in severity with age.
38
Should Marcus-Gunn jaw winking be confused with aberrant regeneration of cranial nerve VII?
No, it is an isolated neurologic finding.
39
Does Marcus-Gunn jaw winking require further work-up?
No, it does not require further work-up.
40
How is Marcus-Gunn jaw winking typically managed?
It is monitored indefinitely unless there is cosmetic concern or surgical intervention is desired.
41
Fill in the blank: Marcus-Gunn jaw winking occurs due to an abnormal connection between cranial nerve V and cranial nerve _______.
III
42
Dermatochilasis
Excess upper eyelid skin * baggy eyelids and pseudoptosis * eyelid skin laxity and loss of muscle tone
43
Which cell types are found in Bowman’s?
None, it’s acellular * 12 microns thick and serves as a smooth support membrane for the corneal epithelial cells * layer does not contain cells but is made up of collagen fibrils arranged in random way
44
What can Vitamin A deficiency lead to?
Loss of goblet cells, resulting in dryness of the conjunctiva and eventual keratinization in severe cases. ## Footnote Goblet cells are important for maintaining moisture in the conjunctiva.
45
What are Bitot spots?
Triangular patches that represent keratinized conjunctival epithelium with a foamy appearance, typically occurring in the interpalpebral zone. ## Footnote Bitot spots are often associated with Vitamin A deficiency.
46
What are Tranta's dots?
Discrete white spots found at the apices of limbal papillae associated with vernal keratoconjunctivitis. ## Footnote These dots indicate an allergic response in the conjunctiva.
47
What are Roth's spots?
Retinal hemorrhages with whitish centers, commonly observed in conditions such as bacterial endocarditis, leukemia, diabetes, and pernicious anemia. ## Footnote Roth's spots are indicative of systemic diseases affecting the vascular system.
48
What are Herbert's pits?
Depressed, round, thin areas that result from resolved limbal follicles in trachoma disease. ## Footnote Herbert's pits are a sign of chronic inflammation in the conjunctiva.
49
What are concretions?
Small, chalky, whitish-yellow deposits typically found in the inferior tarsal and fornical conjunctiva, often associated with meibomian gland disease. ## Footnote Concretions can lead to discomfort and irritation in the eyes.
50
What is detection acuity?
The ability to determine whether a target is present or absent in an empty field ## Footnote The minimum threshold for humans is one second of arc.
51
What is the minimum threshold for humans in detection acuity?
One second of arc ## Footnote This is the minimum angle at which a target can be detected.
52
Define vernier acuity.
The capacity to detect lateral misalignment of two objects that are separated by space ## Footnote The minimum threshold for humans is 3 seconds of arc.
53
What is the minimum threshold for humans in vernier acuity?
3 seconds of arc ## Footnote This indicates the smallest angle at which lateral misalignment can be detected.
54
What is Snellen acuity an example of?
Both recognition and resolution acuity ## Footnote Recognition involves identifying a target, while resolution is necessary for that recognition.
55
Define resolution acuity.
The capacity to discern two or more targets that are spatially separated ## Footnote The human threshold for resolution acuity is approximately 30 seconds of arc.
56
What is the minimum threshold for humans in resolution acuity?
Approximately 30 seconds of arc ## Footnote This represents the smallest angle at which separate targets can be distinguished.
57
Fill in the blank: The minimum threshold for human detection acuity is _______.
one second of arc
58
True or False: Vernier acuity is defined as the ability to recognize a target such as a letter or number.
False ## Footnote Vernier acuity relates to detecting lateral misalignment, not recognition.
59
Lateral wall of the orbit is made up of?
Greater wing of sphenoid bone and Zygomatic bone ** “the Great Z”
60
Orbital roof is made up of?
Lesser wing of sphenoid bone and orbital plate of frontal bone * “Front Less”
61
Orbital Floor is made up of?
Orbital plate of maxillary bone, orbital process of pterygopalatine bone and zygomatic bone ** “My Pal gets his Z’s on the Floor”
62
Medial wall of the orbit is made up of?
Body Sphenoid bone Maxillary bone Ethmoid bone Lacrimal bone “Your body SMELs”
63
What are the two types of secondary structures in proteins?
Alpha helices and beta sheets ## Footnote Secondary structures form from the folding of amino acid chains.
64
What holds primary structures of proteins together?
Peptide bonds ## Footnote Primary structures are the initial sequences of amino acids.
65
How are secondary structures formed?
By folding chains of amino acids into a helix or sheet ## Footnote The R side chains in helices face away from the center.
66
What are the two patterns of beta sheets?
Parallel and anti-parallel ## Footnote In parallel sheets, all N terminals are at the same end; in anti-parallel, N and C terminals alternate.
67
What stabilizes secondary structures?
Hydrogen bonds between peptide bond groups ## Footnote These bonds help maintain the structure of helices and sheets.
68
What does tertiary structure refer to in proteins?
The final overall three-dimensional shape ## Footnote Tertiary structure results from the bonding between side chains.
69
What are the types of bonding that occur in tertiary structure? (Of proteins, name 2)
* Hydrogen bonds * Hydrophobic interactions * Disulfide bonds * Salt bridges ## Footnote These interactions contribute to the protein's folding and stability.
70
What forms disulfide bonds in proteins?
Oxidation of sulfhydryl groups of cysteine ## Footnote Disulfide bonds are strong, covalent interactions.
71
What are the two classifications of quaternary proteins?
Globular and fibrous ## Footnote Quaternary proteins are oligomeric, formed by multiple peptide units.
72
Describe globular proteins.
Compact, water-soluble, and ball-shaped ## Footnote Most globular proteins function as enzymes.
73
Describe fibrous proteins.
Elongated, strong, and not water-soluble ## Footnote Fibrous proteins like collagen serve structural roles.
74
What are white dot syndromes also known as?
Primary idiopathic inflammatory choriocapillaropathies ## Footnote These are ocular inflammatory conditions characterized by white dots on the fundus.
75
What are the most common visual symptoms of white dot syndromes?
* Blurred vision * Visual field loss ## Footnote These symptoms are typically observed in patients with white dot syndromes.
76
What is the exact etiology of white dot syndromes?
Unknown ## Footnote Some believe there may be connections with infections, genetic predispositions, and autoimmune associations.
77
Name three classically recognized white dot syndromes.
* Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) * Birdshot retinochoroidopathy * Multiple evanescent white dot syndrome (MEWDS) ## Footnote Additional recognized syndromes include serpiginous choroiditis, punctate inner choroidopathy (PIC), and multifocal choroiditis with panuveitis (MCP).
78
What is polypoidal choroidal vasculopathy characterized by?
A dilated network of choroidal blood vessels with multiple terminal aneurysmal protuberances ## Footnote This condition is idiopathic and distinct from white dot syndromes.
79
True or False: Polypoidal choroidal vasculopathy is considered a white dot syndrome.
False ## Footnote Polypoidal choroidal vasculopathy is not classified as a white dot syndrome.
80
Fill in the blank: White dot syndromes are characterized by the presence of _______ on the fundus.
white dots ## Footnote This is a defining feature of these ocular inflammatory conditions.
81
What are the possible associations believed to be linked with white dot syndromes?
* Bacterial infections * Viral infections * Genetic predispositions * Autoimmune associations ## Footnote These associations are hypothesized but not definitively established.
82
Name 4 white dot syndromes
1) APMPPE (acute posterior multifocal placoid pigment epitheliopathy 2) birdshot retinochoroidopathy 3) MEWDS (multiple evanescent white dot syndrome 4) serpigenous choroiditis 5) PIC (punctate inner choroidopathy) 6) MCP (multifocal choroiditis with panuveitis)
83
Meniscus lenses power of the front and back surface are?
Positive front surface Minus back surface *ophthalmic lenses are meniscus shape to reduce abberations that can reduce quality of vision
84
True or False In plus meniscus lens, the back surface is stronger than the front surface
FALSE * front surface is stronger than the back in plus meniscus lenses
85
True or False Minus meniscus lenses front surface is stronger than the back surface
FALSE *back surface is stronger than the front
86
A keplerian telescope possesses an eyepiece with a corresponding power of +15.00 and an objective lens with a power of +5.00. What is the tube length of the telescope?
87
What type of glands are meibomian glands?
Sebaceous glands * embedded in the tarsal plates of the eyelids that provide outer lipid portion of tear film * pores open along the lid margin posterior to the cilia * approximately 30-40 glands in upper lid and 20-30 in the lower lid
88
What is a monocyte?
Immature macrophage located in the blood
89
What are the two major classes of leukocytes?
Granulocytes and agranulocytes ## Footnote These classes differ in the presence of cytoplasmic granules.
90
Which leukocytes fall under the category of granulocytes?
Neutrophils, basophils, and eosinophils ## Footnote Granulocytes have a lobed nucleus and visible cytoplasmic granules.
91
What distinguishes agranulocytes from granulocytes?
Agranulocytes do not possess cytoplasmic granules ## Footnote This class includes monocytes and lymphocytes.
92
What types of cells are included in the agranulocyte class?
Monocytes and lymphocytes ## Footnote These cells play different roles in the immune system.
93
What are monocytes and their role in the immune response?
Immature macrophages that move to infection sites and differentiate into macrophages and dendritic cells ## Footnote They destroy microbes and debris via phagocytosis.
94
What types of lymphocytes are involved in specific immune responses?
T cells and B cells ## Footnote They play crucial roles in adaptive immunity.
95
What do basophils release to affect the inflammatory response?
Histamine and other substances ## Footnote This release helps to prolong the inflammatory response.
96
What are the two structural groups that local anesthetics can be divided into?
Esters and amides
97
List examples of ester-based anesthetics (name 3)
* Procaine * Benzocaine * Tetracaine * Cocaine * Proparacaine * Chloroprocaine
98
List examples of amide-based anesthetics.
* Lidocaine * Bupivacaine * Mepivacaine * Ropivacaine Amide = has two “i” in the name
99
How can you determine if a local anesthetic is an ester or amide based on its name?
If it contains 2 letters 'i', it is an amide if it contains only 1 letter 'i', it is an ester
100
True or False: Most allergic reactions to local anesthetics are due to the amide group.
False
101
What is the common cause of allergic reactions to ester anesthetics?
Para-aminobenzoic acid
102
Fill in the blank: The metabolite responsible for allergic reactions to ester anesthetics is _______.
para-aminobenzoic acid
103
True or False Proparacaine is an ester anesthetic
True *if generic name of drug contains only one “I” then it is an ester
104
How do herpes simplex dendrites stain with fluorescein?
Stain centrally with fluorescein ## Footnote Herpes simplex dendrites do not stain centrally with rose Bengal.
105
What is a characteristic feature of herpes simplex dendrites?
Exhibit terminal end bulbs
106
How do the sizes of herpes simplex dendrites compare to zoster lesions?
Dendrites are usually larger than zoster lesions
107
What is the effect of topical antivirals on herpes simplex dendrites?
Improves with topical antivirals
108
How do herpes zoster pseudodendrites stain with fluorescein?
Do not stain with fluorescein
109
How do herpes zoster pseudodendrites stain with rose Bengal?
Stain well with rose Bengal
110
What is a distinguishing feature of herpes zoster pseudodendrites compared to herpes simplex dendrites?
Do not exhibit terminal end bulbs
111
How do the sizes of herpes zoster pseudodendrites compare to herpes simplex dendrites?
Lesions are typically smaller than herpes simplex dendrites
112
What is the effect of topical antiviral medication on herpes zoster pseudodendrites?
May not improve with topical antiviral medication
113
Herpes simplex dendrites vs herpes zoster pseudo-dendrites
114
Tx for RCE
Hyperosmotic drops (Muro 128) * draw out excess water, helping further strengthen and establish adhesion between basement membrane and overlying epithelium
115
At approximately what age are patients expected to reach VA of 20/20 when testing using visual evoked potentials? (VEP)
6 months
116
What does AC/A ratio mean?
Amount of change to convergence resulting from a change in accommodation * high AC/A, a one diopter increase in accommodation will cause a greater increase in convergence (more eso, Less exo) * low AC/A, as the target gets closer, the resultant phoria will become more exo or less eso High AC/A: more than 6/1 normal AC/A 6/1 - 4/1 Low: less than 4/1
117
Intraocular drug injected directly into anteiror chamber of eye
Intracameral injection
118
Tx for CMV retinitis
Ganciclovir implant (Cytovene) * CMV has mid-peripheral hemes in a “brush fire” pattern *TORCH congenital condition (C for cytomegalovirus) * most common opportunistic infection of HIV/AIDS
119
What is the excitation and emission peak of fluorescein? (In nm)
Excitation peak is 490nm (blue range) Emission peak is 530nm (green range) * fluorescence: molecules stimulated by light of shorter wavelength will become excited to a higher energy level and emit light of a longer wavelength
120
First pass metabolism
Drug metabolized by liver prior to being disposed into general circulation thru body * oral and rectal drugs will travel to liver first
121
True or False Buccal and sublingual drugs need to be metabolized by liver first
FALSE * avoid first pass and deliver drug to body rapidly
122
Intrathecal injection
Drug is administered via injection into the spinal canal (subarachnoid space), allowing delivery to desired organ via cerebrospinal fluid without first being metabolized by liver
123
Both alleles for a trait are expressed
Co-dominance Example: type AB blood
124
Pleiotropy
Allele can display several different phenotypic results Ex: sickle cell anemia
125
Principle of inheritance that states alleles that code for differnt traits like eye color and hair color are sorted into sex cells independently from each other
Independent assortment * established by Gregor Mendel
126
Signs of Horner’s syndrome
PAM! Ptosis Anhydrousis (ipsilateral) Miosis Lower IOP (1-2mmHg) Lower lid elevation in affected eye Iris heterochromia (congenital Horner’s)
127
Ocular dominance histogram of neurons Category 1 cells
Exclusively monocular * receive input from contralateral eye
128
Ocular dominance histogram of neurons Category 7 cells
Exclusively monocular, receive input from ipsilateral eye
129
Ocular dominance histogram of neurons Category 2 & 3
Binocular, receive disproportionate amount of input from contralateral eye
130
Ocular dominance histogram of neurons Category 5&6
Binocular, display dominance for input from ipsilateral eye
131
Ocular dominance histogram of neurons Category 4 cells
Receive input from both right and left eye equally
132
What type of discharge is seen in gonococcal infections?
Purulent
133
What type of discharge is seen in chronic allergic conjunctivitis and dry eye syndrome?
Mucoid
134
What type of discharge is seen in acute allergic conjunctivitis or active viral infections?
Watery or serous discharge
135
Patients diagnosed with gonorrheal infections must be referred for genitourinary evaluation due to high association with?
Co-infection of chlamydia
136
Optotype 17.46 mm high at a distance of 20 feet, what is the visual acuity?
20/40 Explanation: Height of snellen 20/20 optotype that subtends an angle of 5 minutes of arc at twenty feet is 8.73mm 8.73mm(x) = 17.46 x= 2, therefore the optotype is 2x bigger than 20/20 To figure out visual acuity multiply 2 by snellen fraction 20x 2= 40 Therefore the VA is 20/40
137
Which type of leukemia presents in children and has the best prognosis following proper treatment?
ALL: acute lymphocytic leukemia ** remember ALL kids survive
138
A protanope has a neutral point of 492 nm. Light with a wavelength of 502 nm will most likely be perceived as what color?
Yellow * protanopes lack erythrolabe, neutral point 492nm * wavelengths above the neutral point are perceived as various hues of yellow * wavelengths below the neutral point are seen as blues that increase in saturation towards the shorter wavelengths
139
CHAI-T
CHLOROQUINE HYDROXYCHLOROQUINE AMIODARONE (anti-arrhythmia) INDOMETHACIN (NSAIDs for inflammation) TAMOXIFEN (Tx breast cancer) Drugs that can cause Whorl keratopathy aka corneal verticillata aka vortex keratopathy * whorl-like corneal epithelial desposits in the corneal epithelium * fine grey/brown opacities in inferior corneal epithelial layer that swirl outward from a point just below pupil, sparing the limbus * pts asymptomatic, some may see halos
140
Trochlear nerve characteristics
1) very slender, runs a very long course as it leaves its nucleus and travels to eye 2) crossed nerve (decussates) innervates contralateral superior oblique muscle 3) only cranial nerve to exit the brain from the dorsal side
141
Which cranial nerve is the only nerve to emerge from the dorsal aspect of the brain?
CN IV
142
What is acute corneal hydrops?
A condition caused by ruptures in Descemet's membrane allowing aqueous influx into the corneal stroma
143
What symptoms are associated with acute corneal hydrops?
* Loss of corneal clarity * Ocular discomfort * Redness * Foreign body sensation * Watering of the eyes
144
What does a slit-lamp examination reveal in cases of acute corneal hydrops?
Significant central or inferior corneal edema with associated hyperemia of the conjunctiva
145
Does acute corneal hydrops occur unilaterally or bilaterally?
Typically affects one eye at a time; the contralateral eye exhibits signs of keratoconus without hydrops
146
Is acute corneal hydrops a self-limiting condition?
Yes, it is self-limiting and usually resolves in 8 to 10 weeks
147
What process occurs in the cornea during the healing of acute corneal hydrops?
Corneal endothelial cells migrate across the area of rupture in Descemet's membrane to re-establish stromal deturgescence
148
What therapeutic treatments may be used for acute corneal hydrops?
* Sodium chloride drops * Ointment * Broad-spectrum antibiotic
149
What is a common complication after the resolution of hydrops?
Corneal scar formation
150
What treatment may be considered to minimize scarring after acute corneal hydrops?
Topical steroids
151
Fill in the blank: Acute corneal hydrops is caused by ruptures in _______ membrane.
Descemet's
152
What is the role of tyrosine kinase in relation to the insulin receptor?
Tyrosine kinase is attached to the insulin receptor on the inside of the cell and becomes activated upon insulin binding.
153
What is the result of tyrosine kinase activation?
Phosphorylation of the glucose transport protein, which then relocates to the cellular membrane to facilitate glucose import.
154
What is adenylyl cyclase and its importance?
Adenylyl cyclase is an enzyme important for cellular communication, found in the adenylyl cyclase pathway.
155
What initiates the signaling cascade in the CAMP-dependent pathway?
A G protein-coupled receptor.
156
What does hexokinase do?
Hexokinase catalyzes the first step of glycolysis by converting glucose to glucose-6-phosphate.
157
What is pepsin and its function?
Pepsin is an enzyme released by the stomach to aid in the digestion of proteins.
158
Fill in the blank: Tyrosine kinase becomes activated once _______ is bound to the insulin receptor.
[insulin]
159
True or False: Hexokinase is involved in the conversion of glucose to glucose-6-phosphate.
True
160
Fill in the blank: The signaling cascade initiated by adenylyl cyclase is known as the _______ pathway.
[CAMP-dependent]
161
Which area of retinal photoreceptors contain many mitochondria responsible for overall metabolism of the cell?
Ellipsoid region (part of inner segment)
162
Inner segment of photoreceptors
2 regions 1) myoid region (vesicles derived from Golgi apparatus and endoplasmic reticulum) 2) ellipsoid region (30-50 mitochondria)
163
Enteral drug administration
Via esophagus, stomach, small intestine and large intestine (GI tract) . I.e: oral and rectal administration
164
Parenteral drug administration
Everything else that does NOT include GI tract Intravenous Subcutaneous Intravitreal Nasal Intramuscular Inhalation Percutaneous (absorption thru intact skin)
165
What are the two main organisms that cause hyperacute bacterial conjunctivitis?
N. gonorrhoeae and N. meningitidis ## Footnote N. gonorrhoeae can be contracted during birth and from infected adults, while N. meningitidis is rare in this condition.
166
How is N. gonorrhoeae contracted in neonates?
From the infected mother during passage through the birth canal ## Footnote This can lead to hyperacute bacterial conjunctivitis in newborns.
167
What can be a sign of child abuse in adolescents regarding hyperacute conjunctivitis?
Contracting N. gonorrhoeae from an infected adult ## Footnote This highlights the importance of considering the source of infection.
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Why is hyperacute bacterial conjunctivitis considered serious?
Neisseria species can invade an intact cornea ## Footnote This invasion can lead to severe complications.
169
What must be reported to the CDC regarding hyperacute bacterial conjunctivitis?
Contraction of the infection ## Footnote Reporting is crucial for public health tracking.
170
List three tell-tale signs of hyperacute bacterial conjunctivitis.
* Ballooning of the lids * Copious amounts of discharge * Swollen pre-auricular nodes ## Footnote These signs help differentiate it from other eye conditions.
171
What precautions should be taken when examining patients with hyperacute bacterial conjunctivitis?
Wear gloves and avoid contact with your own eyes ## Footnote Consider wearing goggles to prevent self-inoculation.
172
What type of treatment is required for hyperacute bacterial conjunctivitis?
Both oral and topical antibiotics ## Footnote Timely treatment is critical to prevent complications.
173
What is the requirement for patients with hyperacute bacterial conjunctivitis?
Culture and sensitivity of the bacteria ## Footnote This helps guide appropriate antibiotic therapy.
174
What is contact dermatitis, and how does it present?
A type IV allergic reaction presenting with scaly, rough skin that may be swollen ## Footnote There is typically no discharge or swollen pre-auricular nodes.
175
What are common allergens that can cause contact dermatitis on the eyelids?
* Cosmetics * Nickel * Topical medications such as neomycin ## Footnote Awareness of these allergens can help in prevention.
176
What is epidemic keratoconjunctivitis (EKC) characterized by?
Tender pre-auricular nodes and watery discharge ## Footnote EKC is viral in origin and usually does not present with copious discharge.
177
What demographic typically presents with vernal conjunctivitis?
Young males with a history of atopy ## Footnote This condition is associated with allergic responses.
178
What are common symptoms of vernal conjunctivitis?
* Swollen eyelids * Thick, ropy discharge * No affected pre-auricular nodes ## Footnote These symptoms help in distinguishing it from other types of conjunctivitis.
179
An object located further than the far point of a myopic eye will result in the formation of an image located?
Behind the lens and in front of the retina * object located at far point will produce an image at the retinal plane * object further than far point will produce an image located in front of retinal surface, whether myopia is due to increased axial length, or increased refractive power of ocular components (cornea, lens)
180
VA is 8/200, what is JND and what would you show the patient during trial framing?
181
What is a normal cornea's shape?
A prolate shape, steeper in the center and flattens towards the periphery ## Footnote This shape is typical for a healthy cornea.
182
What is an oblate cornea?
A cornea that is flattened in the center and steepens towards the periphery ## Footnote This shape is less common and can be caused by various factors.
183
What effect does LASIK surgery have on corneal curvature?
Flattens the central corneal curvature to correct myopic refractive error ## Footnote This results in a more oblate corneal shape.
184
What is the effect of radial keratotomy on corneal shape?
Results in an oblate corneal shape by flattening the central corneal curvature ## Footnote This is achieved through radial cuts in the cornea.
185
How do orthokeratology contact lenses affect corneal shape?
Create a more oblate corneal shape due to reverse geometry that causes central corneal flattening ## Footnote These lenses are designed to reshape the cornea temporarily.
186
What effect does keratoconus have on corneal curvature?
Causes steepening of the central corneal curvature ## Footnote This condition leads to a conical shape of the cornea.
187
What is the effect of LASIK for hyperopia on corneal curvature?
Causes further steepening of the central corneal curvature ## Footnote This is the opposite effect of LASIK for myopia.
188
What is the target of Adrenocorticotropic hormone (ACTH)?
Adrenal glands ## Footnote ACTH promotes the secretion of glucocorticoids, mineralocorticoids, and androgens.
189
What does Follicle stimulating hormone (FSH) promote?
Growth of the reproductive system ## Footnote FSH targets the gonads.
190
What is the target of Luteinizing hormone (LH)?
Gonads ## Footnote LH promotes sex hormone production.
191
Which hormone stimulates the secretion of thyroid hormones?
Thyroid stimulating hormone (TSH) ## Footnote TSH targets the thyroid gland.
192
What does Prolactin stimulate?
Milk production ## Footnote Prolactin targets the mammary gland.
193
What are the targets of Growth hormone?
Liver and adipose tissue ## Footnote Growth hormone promotes growth indirectly and controls protein, lipid, and carbohydrate metabolism.
194
What is an easy mnemonic to remember the hormones secreted by the anterior pituitary?
FLATPeG ## Footnote Each letter represents a hormone: FSH, LH, ACTH, TSH, Prolactin, and Growth hormone.
195
Fill in the blank: The anterior pituitary secretes _______.
FLATPeG ## Footnote This includes FSH, LH, ACTH, TSH, Prolactin, and Growth hormone.
196
What are the three primary portions of the brain in early embryonic development?
prosencephalon (forebrain), mesencephalon (midbrain), rhombencephalon (hindbrain) ## Footnote These portions are fundamental in the initial stages of brain development.
197
How many main vesicles does the brain differentiate into during development?
5 main vesicles ## Footnote This differentiation occurs as the brain develops from the three primary portions.
198
What two structures does the prosencephalon separate into?
telencephalon and diencephalon ## Footnote These structures further develop into various components of the brain.
199
What does the telencephalon eventually become?
cerebrum (cerebral cortex, white matter, and basal ganglia) ## Footnote The telencephalon is crucial for higher brain functions.
200
What four components are formed from the diencephalon?
thalamus, subthalamus, hypothalamus, epithalamus ## Footnote These components play key roles in sensory and regulatory functions.
201
What is another name for the mesencephalon?
midbrain ## Footnote The midbrain is located below the cerebral cortex.
202
Does the mesencephalon separate further during development?
No ## Footnote The midbrain remains a singular structure.
203
What does the rhombencephalon ultimately divide into?
myelencephalon (develops into medulla oblongata) and metencephalon ( develops into pons and cerebellum) ## Footnote These divisions lead to the formation of important brain structures.
204
What structure is formed by the myelencephalon?
medulla oblongata ## Footnote The medulla oblongata is vital for autonomic functions.
205
What structures are formed by the metencephalon?
pons and cerebellum ## Footnote The pons and cerebellum are essential for motor control and coordination.
206
Chronic uveitis is associated with vision threatening conditions such as? (Name 4)
1) cataracts 2) glaucoma 3) retinal detachment 4) CME 5) band keratopathy 6) phthisis bulbi
207
Long term drift
Phenomenon with long term use of topical beta blockers where IOP decrease is stable but then IOP reduction effectiveness decreases within months of initial treatment
208
Short term escape
Phenomenon with use of topical beta blockers, IOP reduction occurs but effectiveness of drug decreases within a few days of starting treatment
209
Paresthesia
Tingling and numbness of fingers, toes, hands, feet and mucocutaneous junctions
210
What is the most common side effect of oral CAI’s?
Paresthesia * should be reported, if patient does not then compliance should be questioned
211
Side effects of topamax
Angle closure and myopic shift * angle closure because causes uveal effusion and swelling of ciliary body, causing pupillary block ** these side effects usually occur 2 weeks after introducing topamax therapy * must discontinue medication if angle closure
212
What is the most common ocular manifestation in AIDs?
Cotton wool spots
213
What initiates the pupillary light reflex?
The retinal photoreceptors ## Footnote The reflex involves neural pathways and connections that lead to pupillary constriction in response to light.
214
How many neurons are involved in the pupillary light reflex?
Four neurons ## Footnote These neurons connect various nuclei and ganglia to facilitate the reflex.
215
Where do the first neurons of the pupillary light reflex connect?
Both pretectal nuclei in the midbrain ## Footnote The pretectal nuclei are located in the area of the superior colliculi.
216
What happens to fibers running from the nasal retina at the optic chiasm?
They decussate and pass along the opposite optic tract ## Footnote This allows information from the nasal retina to reach the contralateral pretectal nucleus.
217
How are impulses from the temporal retina conducted?
By fibers that traverse the ipsilateral optic tract ## Footnote These fibers terminate at the ipsilateral pretectal nucleus.
218
What do the second neurons in the pupillary light reflex connect?
Each pretectal nucleus to both the ipsilateral and contralateral Edinger-Westphal nuclei ## Footnote This connection is crucial for bilateral pupillary constriction.
219
What phenomenon occurs due to damage to the neurons in the pupillary light reflex?
Light near dissociation ## Footnote This condition is commonly associated with neurosyphilis.
220
Which nucleus connects to the ipsilateral ciliary ganglion?
The Edinger-Westphal nucleus ## Footnote This connection is part of the pathway leading to pupillary constriction.
221
Fill in the blank: The pupillary light reflex ends at the _______.
iris sphincter ## Footnote The iris sphincter muscle is responsible for constricting the pupil in response to light.
222
True or False: A light stimulus presented to one eye results in only unilateral pupillary constriction.
False ## Footnote A light stimulus in one eye causes bilateral and symmetrical pupillary constriction.
223
What is the primary function of the tectum?
Integration of visual and auditory input ## Footnote The tectum is located in the midbrain.
224
What is the role of the cerebellum?
Coordination of unconscious motor activity for balance and spatial orientation ## Footnote The cerebellum is not part of the midbrain.
225
Which structures are classified as belonging to the forebrain?
Thalamus, hypothalamus, cerebrum ## Footnote These structures play critical roles in sensory processing and homeostasis.
226
What is the function of the thalamus?
Relay for sensory information and projects sensory signals to appropriate destinations ## Footnote The thalamus acts as a hub for sensory data before it reaches the cortex.
227
What is the main function of the hypothalamus?
Maintain homeostasis of internal organs ## Footnote The hypothalamus influences behaviors that sustain the internal 'status quo'.
228
What does the cerebrum specialize in?
Processing and integrating sensory input and motor responses ## Footnote The cerebrum is crucial for higher brain functions.
229
What is the role of the inferior olivary nucleus?
Thought to play a role in motor function and motor learning ## Footnote It is closely associated with the cerebellum.
230
What happens to the anterior surface of the lens during accommodation?
Moves forward while the posterior surface remains relatively stationary ## Footnote This movement is part of the process of focusing on near objects.
231
What effect does the forward movement of the lens have on the anterior chamber depth?
Decreases the anterior chamber depth ## Footnote This is a result of the lens moving forward during accommodation.
232
What is the effect of the contraction of the ciliary muscle during accommodation?
Results in a transitory decrease in intraocular pressure ## Footnote This contraction assists in changing the shape of the lens for focusing.
233
What shape does the lens take on during accommodation?
Becomes more spherical ## Footnote This change in shape allows for better focusing on near objects.
234
What happens to the equatorial circumference of the lens during accommodation?
Decreases ## Footnote This occurs as the lens becomes more spherical.
235
Patient with advanced Fuch’s disease wants to undergo cataract surgery, what is the GREATEST post-surgical risk of developing?
Pseudophakic bullous keratopathy * CE causes loss of endothelial cells secondary to inadvertent manipulation and stress during procedure, patients with decreased number of endo cells are at risk of long-standing edema * may need lamellar or full thickness corneal transplant if VA suffers
236
Visual information from ganglion cells of ipsilateral eye project to which layers of the dLGN?
Layers 2,3, and 5 *dLGN: dorsal lateral geniculate nucleus
237
Visual input from the contralateral eye is found in which layers of the dLGN?
1,4 and 6
238
What germ layers contribute to the development of ocular structures?
Neural crest and surface ectoderm *endoderm does NOT contribute, it makes the GI tract, endocrine, respiratory system, urinary bladders and auditory epithelium
239
What is the normal amount of tonic accommodation?
0.50 to 1.50 diopters * aka lead of accommodation, eyes have some amount of residual or resting level of accommodation
240
Scotopic system is mediated by rods and contains rhodopsin, what is the peak absorbency?
507nm * Scotopic systemic cannot discern colors, and is very sensitive to dim illumination * Scotopic has poor spatial resolution, poor temporal resolution and poor contrast sensitivity * good spatial summation, good temporal summation,
241
A patient brings a microscope marked 5x, what is the power of the lens in diopters?
+20.00D Use formula M= DLens/4 M: magnification DLens: power of lens in diopter Example: 5=Dlens/4 DLens= 5x4 = 20.00 D
242
What is Lyme disease?
An infectious tick-borne disease caused by Borrelia burgdorferi ## Footnote Lyme disease is characterized by symptoms such as fever, headache, fatigue, and a bulls eye skin rash.
243
What organism causes syphilis?
Treponema pallidum ## Footnote Syphilis is a sexually transmitted infection with stages that can lead to serious health complications if untreated.
244
What is responsible for cat scratch disease?
Bartonella henselae ## Footnote Cat scratch disease typically results from a scratch or bite from a cat and can cause swollen lymph nodes and fever.
245
Which organism causes onchocerciasis?
Onchocerca volvulus ## Footnote Onchocerciasis is also known as river blindness due to its potential to cause visual impairment.
246
What leads to cysticercosis?
Cysticercus cellulosae ## Footnote Cysticercosis can result in cysts in various tissues, most notably the brain, leading to neurological issues.
247
What organism causes cryptococcosis?
Cryptococcus neoformans ## Footnote Cryptococcosis is a serious fungal infection that can affect the lungs and central nervous system, particularly in immunocompromised individuals.
248
Myasthenia gravis is an autoimmune disease that affects which type of receptors?
Nicotinic acetylcholine receptors * damaged receptors leads to impairment at the neuromuscular junction causing weakness and fatigue of skeletal muscle (no affect on cardiac or involuntary muscles) * most common in women, third decade of life * early signs ptosis and diplopia * Ty with pyridostigmine or neistigmine (oral acetylcholinesterase inhibitor) * thymectomy if develop thymoma
249
Distortion that results when viewing a grid through a high plus powered lens
Pincushion (center of the grid is less magnified than edges)
250
What happens to the ciliary muscle during accommodation?
The ciliary muscle contracts, releasing resting zonular tension around the equator of the crystalline lens ## Footnote This contraction allows the lens to change shape for focusing on near objects.
251
What is the effect on the diameter of the lens during accommodation?
The diameter of the lens decreases ## Footnote This reduction in diameter is part of the lens's adaptation to focus on near objects.
252
How does the thickness of the lens change during accommodation?
The thickness of the lens increases ## Footnote Increased thickness contributes to greater optical power.
253
What happens to the anterior surface of the lens during accommodation?
The anterior surface of the lens moves anteriorly ## Footnote The posterior surface of the lens does not change position.
254
What is the result of the anterior and posterior surfaces becoming more curved?
This results in a subsequent increase in the optical power of the lens ## Footnote This increase allows the eye to focus on near objects.
255
What happens to the thickness of the lens nucleus during accommodation?
The thickness of the lens nucleus increases ## Footnote There is no change in the thickness of the cortex.
256
What is the overall purpose of the changes in the crystalline lens during accommodation?
To allow for an increase in the optical power of the eye, enabling focus on near objects ## Footnote These changes are crucial for clear vision at varying distances.
257
258
259
What oral medication is contraindicated in uveitis with concurrent hyphema?
Oral aspirin * can lead to increased leakage of blood which worsens hyphema
260
What is dissociated vertical deviation (DVD)?
An ocular condition commonly accompanied by a history of strabismus, notably infantile esotropia. ## Footnote DVD is characterized by involuntary eye movements that do not follow typical innervation laws.
261
What does 'dissociation' refer to in the context of DVD?
The idea that the innervation of one eye causes it to move involuntarily and independently of the contralateral eye. ## Footnote This term highlights the abnormal coordination between the two eyes in DVD.
262
What is known about the etiology and pathophysiology of DVD?
The exact etiology and pathophysiology of a dissociated vertical deviation is unknown. ## Footnote Research continues to explore the underlying mechanisms of this condition.
263
What are the characteristics of a dissociated vertical deviation?
Includes the presence of an up-drift with accompanying excyclorotation of the eye, which can occur spontaneously or when under cover. ## Footnote This characteristic movement is a key feature in diagnosing DVD.
264
What happens to the eye during a cover-test in DVD?
The eye may show an up-drift and excyclorotation when covered, and moves down to fixation upon removal of the cover without a corresponding down-drift of the fellow eye. ## Footnote This unique movement pattern helps differentiate DVD from other ocular conditions.
265
Is dissociated vertical deviation typically bilateral or unilateral?
Most commonly bilateral, although it may be asymmetrical. ## Footnote Understanding the bilateral nature of DVD is important for diagnosis and treatment.
266
Name 2 vector-borne diseases transmitted through a bite from a hard shelled tick
* Lyme disease * Rocky Mountain spotted fever
267
Lyme disease is caused by?
Bite from hard shelled tick carrying bacteria flagellated spirochete Borrelia burgdorferi
268
Rocky Mountain spotted fever is caused by?
Bite from hard shelled tick, carrying Rickettsia rickettsii bacteria
269
Mosquitos are vectors for?
Malaria Dengue fever Yellow fever
270
Domestic cats are hosts for?
Toxoplasmosis * parasitic protozoan Toxoplasma gondii
271
What is the vector for bubonic plane?
Fleas
272
What is pretibial myxedema?
An infiltrative dermopathy commonly associated with Grave's disease
273
Which other thyroid condition may also present with pretibial myxedema?
Hashimoto's thyroiditis
274
How does pretibial myxedema typically present on the skin?
Waxy, discolored, raised plaques of non-pitting edema
275
Where are the skin findings of pretibial myxedema most commonly located?
Anterior aspect of the lower legs and dorsum of the foot
276
Can pretibial myxedema extend to other areas of the body?
Yes, it may extend to the torso, chest, upper extremities, face, neck, back, and ears
277
What percentage of patients with Grave's disease experience pretibial myxedema?
1-5%
278
In patients with both Grave's disease and ophthalmopathy, what percentage may present with pretibial myxedema?
Up to about 15%
279
What diagnostic procedure can confirm pretibial myxedema?
Skin biopsy
280
What causes the accumulation of mucin in pretibial myxedema?
Accumulation of glycosaminoglycans, especially hyaluronic acid
281
HLA-B51
Bechet’s syndrome
282
HLA-A29
Birdshot
283
Tachyphylaxis
Tolerance or decreased response to a drug due to previous exposure
284
Idiosyncrasy
Unexpected or unusual response to a drug
285
Endophthalmitis
Inflammation involving all tissues of the eye except sclera
286
Panophthalmitis
Inflammation of the entire globe
287
Iridocyclitis
Inflammation of the iris and ciliary body
288
Inflammation of predominantly involving vitreous
Intermediate uveitis
289
Inflammation of the fundus, posterior to vitreous base
Posterior uveitis
290
PALs for a child should have fitting height approximately how many mm higher than normal?
4mm higher to guarantee child will actually look through the near add power for near tasks
291
Congenital anomaly white fibrous tissue attached to surface of optic disc representing remnant of hyaloid system
Bergmeister’s papilla
292
What is the approximate visual angle subtended by the foveola?
1.2 degrees * foveola is 0.3mm in diameter and have the greatest concentration of photoreceptors cells * corresponds to maximal visual acuity and resolution
293
Cushing syndrome is caused by?
Prolonged elevation of glucocorticoid levels in bloodstream *most common etiology is iatrogenically induced as result of systemic administration of steroids
294
Addison’s disease
Chronic endocrine disorder in which adrenal glands do not produce sufficient amount of steroid hormones
295
Conn’s syndrome occurs secondary to?
Aldosterone-producing adenoma of the adrenal glands
296
Paget’s disease
Chronic progressive bone disease characterized by abnormal bone destruction and regrowth
297
3 common side effects associated with morphine use
Constipation Respiratory depression Nausea * also vomiting, dyspepsia, dry mouth * morphine depresses central nervous system activity, leads to respiratory depression * miosis of pupils because it increases parasympathetic activity
298
Selective suppression
Ensures background is not blurred when performing saccades * vision is suppressed just before, during and just after saccadic motion *selective suppression of magno pathway maintains a clear retinal imagine during eye movements, magno is considered “where” pathway and responds to quickly-moving objects and high temporal frequencies
299
In general what colors is a healthy neuro sensory retina?
Clear *appears pink/red because of underlying vascular * RD or ischemic retina will appear white
300
Which layer of the cornea is MOST likely to result in graft rejection after a penetrating keratoplasty?
Endothelium * but rejection can occur at any layer
301
Add power is +2.50 How much yoked base down prism will be in PALs?
1.66 PD Add power x (2/3) 2.50 x 2/3=1.667
302
Binocular refractive technique in which each eye views a dissimilar target simultaneously through the use of polarized lenses that are set at different angles
Vectogram technique * allows for monocular testing without occlusion of fellow eye
303
What location of the retina displays greatest density of rods?
20 degrees from the fovea
304
Posterior polymorphous dystrophy affects which layer of cornea?
DESCEMET’S MEMBRANE * Gray/white vesicles or rings within descemet’s membrane “railroad track” * bilateral, asymmetrical and very slow progressive * most patients asymptomatic, no Tx required
305
Reis-Buckler dystrophy affects which layer of cornea?
BOWMAN’S * think BUCKLER= BOWMAN’S * autosomal dominant, first decade of life * sub-epi opacities in a ring, homecomb, or fishnet pattern in central to mid-peripheral cornea * cornea may become hazy, and overlying epi may thicken, but peripheral cornea is spared * suffer from RCE and decreased vision * mgt: bandage CL, phototherapeutic keratectomy, superficial keratectomy, or corneal transplant
306
Fleck dystrophy affects which layer of cornea?
Fleck or comma-like deposition of glycosaminoglycan in the stroma * autosomal dominant * onset first decade of life * rarely needs Tx
307
308
Weakness of both upper and lower portions of the right side of the face is due to a lesion in which motor neuron?
Right lower motor neuron * unilateral lesion to a lower motor neuron of facial nerve will result in weakness of upper and lower portions of face on IPSILATERAL side of the lesion * therefore if right upper and lower face affected = right lower motor lesion
309
Worth 4-dot and red lens test are examples of what degree of fusion?
Second degree fusion * superimpose like objects with end result being the perception of a single object that is a composition of two separate images
310
Levels of visual impairment: no light perception
Total blindness
311
Levels of visual impairment: 20/30 to 20/60 is considered?
Near normal vision * based on better seeing eye
312
Levels of visual impairment: 20/200 to 20/400 (or a visual field of 20 degrees or less)
Severe visual impairment
313
What VA is considered profound visual impairment?
20/500 - 20/1000 (or visual field of 10 degrees or less)
314
Near-total blindness
VA is worse than 20/1000 in better seeing eye (or visual field is 5 degrees or less)
315
Acquired color vision deficiency in optic nerve disease
Red-green * Koller’s rule: optic nerve disease hard for pt to tell between reds and greens, for macular disease, hard to tell blues from yellows
316
Which amino acid is not chiral?
Glycine * chiral means asymmetry (central alpha carbon is surrounded by 4 different groups) * glycine is achiral because it has 2 hydrogen groups around its central carbon that are the same, making it symmetrical * all other 19 amino acids are chiral
317
Ferry’s line
Line of iron pigmentation found at the edge of filtering bleb
318
Drugs classified as central nervous system depressants
Ethyl alcohol Heroin Marijuana Codeine
319
Drugs classified as CNS stimulants
Cocaine Caffeine Amphetamines Nicotine
320
Which part of lens is responsible for continued growth?
Anteiror epithelium * single cell thick and located beneath the capsule of anterior portion of the lens * central, intermediate and equatorial zones * central: cuboidal cells, slow mitotic rate * equatorial: cells elongate, increase mitotic activity, highest metabolic rate and are most elongated * cells move inferiorly, elongate, lose their nuclei and become lens fibers * lens fibers are produced all thru life, with older fibers pushed towards center of lens
321
Lens capsule is produced by?
Anterior epithelium and superficial fiber cells of the posterior lens
322
True or False Cornea is stronger than sclera
TRUE * sclera is thinner than cornea * less organized * weakest point of sclera is just behind the rectus insertion junctions
323
Name some Immunosuppressants (name at least 3)
*Methotrexate (Tx RA, decreases methyl groups for synthesis of purines and pyrimidines) *Cyclosporine (decreases interleukin-2, Tx autoimmune disorders and prevents graft rejections) Glucocorticoids: (decrease interleukin-1, decrease phagocytosis suppressing immune response, Tx autoimmune and graft rejections) *Dexamethasone *Prednisone *Triamcinolone
324
Sub-retinal hemorrhages occur at which level of the retina?
Between RPE and sensory retina
325
Which layer of retina metabolizes and stores vitamin A?
RPE * vitamin A used to form rhodopsin photopigments * deficiency in vitamin A leads to prolonged dark adaptation
326
What is the function of the retinal pigment epithelium?
Forms part of the blood-retinal barrier, phagocytoses fragments from shedding photoreceptor discs, metabolizes, and stores vitamin A. ## Footnote Vitamin A is used in forming photopigment.
327
What does the photoreceptor cell layer contain?
Outer and inner segments of rods and cones.
328
What is the external limiting membrane made up of?
Intercellular junctions of photoreceptor cells.
329
What is found in the outer nuclear layer?
Cell bodies and nuclei of the rods and cones.
330
What composes the outer plexiform (synaptic) layer?
Fibers of rods and cones, and synapses between photoreceptor cells and inner nuclear layer cells.
331
What does the inner nuclear layer contain?
Cell bodies of several types of neurons and Muller cells.
332
What is the inner plexiform (synaptic) layer responsible for?
Contains synapses of bipolar cell axons and ganglion cell dendrites.
333
What types of cells are in the ganglion cell layer?
Amacrine cells, Muller cell bodies, and astroglial cells.
334
What is the nerve fiber layer composed of?
Ganglion cell axons.
335
What forms the internal limiting membrane?
Footplates of Muller cells.
336
Fill in the blank: The retinal pigment epithelium metabolizes and stores _______.
vitamin A
337
True or False: The outer plexiform layer contains synapses between photoreceptor cells and ganglion cells.
False ## Footnote It contains synapses between photoreceptor cells and cells from the inner nuclear layer.
338
What does CEA stand for?
Carcinoembryonic Antigen ## Footnote CEA is a biomarker primarily associated with cancer.
339
What type of cancer is CEA mainly a biomarker for?
Colon cancer ## Footnote CEA is also associated with lung cancer.
340
Is CEA used as a screening test?
No ## Footnote CEA is used to follow people with a known disease.
341
What is a common cause of central retinal vein thrombosis?
Long-standing hypertension ## Footnote Hypertension is the most common cause of this condition.
342
What usually causes central retinal vein thrombosis?
Hypercoagulability/hyperviscosity ## Footnote These conditions lead to the development of central retinal vein thrombosis.
343
What laboratory finding suggests myeloma or macroglobulinemia?
Elevated IgG or a distinctive spike observed with IEP ## Footnote Both myeloma and macroglobulinemia are associated with central retinal vein thrombosis.
344
What is an appropriate test for patients with diabetes?
Blood glucose determination ## Footnote Diabetes is a common condition that requires monitoring.
345
True or False: Central retinal vein thrombosis is primarily associated with diabetes.
False ## Footnote While diabetes is common, long-standing hypertension is the most common cause.
346
Side effects of prolonged topical NSAID use
Redness Irritation Pruritus (itching) Delayed wound healing Corneal deposits Stinging Blurred vision Corneal melt
347
What is the most common type of pituitary tumor?
Lactotrophic adenoma * aka prolactinomas * prolactin-secreting tumors of the pituitary gland * also secrete growth hormones
348
Approximately how many axons compromise the normal adult human optic nerve?
1,200,000 * 1.2 million retinal ganglion cell axons
349
Stage 3 macular holes
Full thickness hole (350-600um) * smooth edged appearance, small surrounding donut cuff of subretinal fluid * yellow deposits at base of neuro retinal defect along with peritoneal cystic changes * operculum may be present, but vitreofoveal separation still has not occurred
350
What is a plaque?
A palpable but flat lesion of the skin that is greater than 0.5cm in diameter ## Footnote Plaques may have well-defined or ill-defined borders.
351
What characterizes a macule?
A localized area of color change without any associated infiltration or elevation, typically less than 1.5cm in diameter ## Footnote The lesion may be pigmented (as in a freckle), hypopigmented (vitiligo), or erythematous (as in a capillary hemangioma).
352
What is the size of a papule?
Usually less than 0.5cm in diameter ## Footnote Papules are small palpable lesions that may be flat-topped or dome-shaped.
353
Define a vesicle.
A small fluid-filled lesion that is typically less than 0.5cm in diameter ## Footnote There may be a single lesion or multiple lesions.
354
What is a nodule?
A solid area of elevated skin; a papule that is enlarged in three dimensions (height, width, and length) ## Footnote Nodules are typically larger and more prominent than papules.
355
True or False: A plaque can have either well-defined or ill-defined borders.
True ## Footnote This characteristic can help in the diagnosis of various skin conditions.
356
Fill in the blank: A _______ is a solid elevation of the skin that is usually less than 0.5cm in diameter.
papule ## Footnote Papules can appear as single or multiple lesions.
357
Which type of white blood cell releases histamine?
Basophils
358
According to FDA what amount of corneal neovascularization is significant?
1.5 mm into the cornea
359
Oculomotor nerve innervates which muscles?
SR MR IR IO levator Iris sphincter Ciliary muscle *CN III palsy will result in: Hypotropia (eye is down) Exotropia (eye is out) Large ptosis Pupil-involving = blown out = emergency because could be aneurysm
360
Myope with 3.00 D of ametropia will have a far point located at what distance in meters?
0.33 meters Explanation: 1/3 = 0.33 meters An object placed at 33cm in front of eye will be in focus, anything last 33cm will be blurry
361
Reading test analysis, definition of sensitivity
Ability of test to correctly classify individuals with the disease ** can detect patients HAVE the disease
362
Reading test analysis, specificity definition
Ability of test to correctly classify patients as disease free * test can detect patients WITHOUT the disease
363
Cornea absorbs what percentage of UV-A, B and C light?
A: 60% (315-400nm) B: 90% (280-315nm) C: 100% (100-280nm)
364
Which configuration describes all amino acids found naturally in proteins?
L-amino acids
365
Which structure of the ear responds to angular acceleration?
Semicircular canals * part of vestibular apparatus * positioned at right angles to each other and help to code for acceleration, deceleration and rotational head movements = angular acceleration * filled with endolymph fluid * at base of canals, are ampullae that rest atop of specialized hair cells that bend in response to movement of fluid, allowing for processing in brain
366
Tight junctions present between superficial squamous cells of corneal epithelium
Zonula occludens * barrier to create movement of water and solutes between epithelial layers
367
What junction attaches corneal epithelial cells to their basal membrane?
Hemidesmosomes
368
What is the number one cause of hyperthyroidism in the US?
Grave’s disease * autoantibodies stimulate TSH, which cause excess TH production causing up regulation of receptors * decreased TSH, increased T3 and T4
369
Moore’s lightening streaks
Phenomenon where brief vertical light flashes seen in temporal visual field at night are elicited by acceleration of the head *associated with vitreoretinal traction
370
True or False Central retinal artery leaves and ganglion cell axons enter at the optic disc
FALSE! It’s the opposite CRA enters the eye to supply nutrients and oxygen, while ganglion cell axons leave to relay visual information from eyes to brain
371
Bagolini striated lens test evaluates for?
Anomalous retinal correspondence
372
Testing procedure for Bagolini Striated Lens test
373
What is an X-Chrome contact lens?
A red contact lens that acts as a long-pass filter
374
What wavelengths does the X-Chrome contact lens block?
Short wavelengths
375
What wavelengths does the X-Chrome contact lens allow to pass through?
Longer wavelengths
376
Who can benefit from wearing an X-Chrome contact lens?
Patients with abnormal color vision such as dichromats
377
How does wearing the X-Chrome lens in one eye affect color distinction?
It shifts the color absorption curve of that eye, altering confusion lines between the eyes
378
What is essential for the X-Chrome lens to work properly?
The patient must easily alternate vision between the eyes for comparison
379
What is one drawback of the X-Chrome contact lens?
Many patients will suppress the eye with the red lens or fuse the images
380
True or False: The X-Chrome contact lens enhances color distinction for all patients.
False
381
Fill in the blank: The X-Chrome contact lens aids in _______ distinction for patients with abnormal color vision.
color
382
Which population has the highest prevalence of angle closure glaucoma?
Chinese * anatomical pre-disposing factors, shallow anterior chamber depths
383
Which bifocal lens design will create the largest amount of image jump?
Round 28 bifocal
384
Stage 4 macular hole
1) Full thickness macular hole (350-600um) 2) Donut shaped cuff of sub retinal fluid 3) yellow deposits can be observed at base of defect with perifoveal cystic changes 4) operculum 5) complete PVD (and Weiss ring is present)
385
Each kidney has approximately how many nephrons?
One million
386
Contrast sensitivity of an elderly person will typically be shifted in which direction?
Towards the left due to loss of high spatial frequencies * due to pupil miosis which decreases retinal illumination and increased light scatter from NSC
387
Which preservative if used excessively is toxic to cornea?
BAK (benzalkonium chloride) * damage lipid layer and lead to increase epithelial permeability
388
Which Purkinje image is used to obtain keratometry values?
Purkinje imagine I * reflection from anterior corneal surface and is the brightest image
389
What is the Ocular Surface Disease Index?
Survey about patient’s symptoms and a score is calculated. Way to monitor improvement in symptoms after initiation of treatment
390
Which tests are used to aid in diagnosis of aqueous deficient dry eye?
Tear Osmolarity phenol red thread test Schirmer’s
391
Evaporative dry eye is often caused by what type of dysfunction?
Meibomian gland dysfunction * evaluate with meibography
392
Meiosis results in what cell types?
Gametes * reduction division because end result is four daughter haploid cells with 23 chromosomes each
393
Somatic cells contain how many chromosomes?
46 chromosomes * diploid cells contain
394
Mitosis results in formation of what cell types?
2 diploid daughter cells
395
Which type of aberration is a distortion in which a lens is unable to focus all wavelengths of light on the same convergence point
Chromatic aberration * as seen using Red-Green test for subjective refraction
396
Letters in each line of Bailey-Lovie visual acuity chart progresses by 0.1 LogMar. What does 0.0 LogMar equal to on Snellen?
20/20
397
What type of headache typically occurs secondary to poor control of blood pressure?
Hypertension headaches
398
How do patients typically describe the intensity of hypertension headaches?
Moderate-to-severe
399
When are hypertension headaches usually worse?
In the morning
400
What is a common remedy reported by patients to lessen hypertension headaches?
Drinking black caffeinated coffee
401
What are tension headaches also known as?
Muscular contraction headaches
402
What are common causes of tension headaches?
* Stress * Poor posture * Hunger * Fatigue
403
What type of pain is associated with tension headaches?
Throbbing pain
404
Where is the muscle stiffness typically felt in tension headaches?
In the neck region
405
What is the most common type of headache?
Tension headaches
406
What is the nature of migraine headaches?
Neurological
407
What are common triggers for migraine headaches?
* Hormonal changes * Neurotransmitter imbalances
408
What is a typical duration for a migraine headache?
2-72 hours
409
What associated symptoms do patients typically experience with migraines?
* Nausea * Vomiting * Photophobia * Phonophobia
410
What percentage of migraine patients perceive an aura before a headache?
Up to 30%
411
What type of disturbances can an aura involve?
* Transient visual disturbances * Sensory disruptions * Language disruptions * Motor disruptions
412
What can suspend some migraine attacks?
Ingestion of strong coffee
413
What type of pain is commonly associated with sinus headaches?
Deep and constant pain
414
Where is pain typically felt in sinus headaches?
* Cheekbones * Forehead * Bridge of the nose
415
What are other symptoms associated with sinus headaches?
* Rhinorrhea * Feeling of fullness in the ears * Fever * Facial swelling * Lacrimation
416
What sensory change do patients typically report with sinus headaches?
Transient loss of the sense of smell
417
What increases pain or pressure when bending down in sinus headaches?
Pain
418
Definition of OPP (ocular perfusion pressure)
systemic blood pressure minus IOP
419
Drugs that are capable of crossing the blood-brain barriers have what property?
Lipid soluble * diffuse thru lipid bilaterally * that’s why nicotine barbiturates, caffeine, heroine, alcohol, can readily pass BBB and cause rapid alteration of normal brain function
420
Which vitamin is also known as thiamine?
Vitamin B1 * important for carbohydrate metabolism and for maintenance of neuronal tissue
421
Beriberi
Vitamin B1 deficiency * symptoms: hard to walk, loss of sensation in hands and feet, paralysis, nystagmus, speech difficulties/mental confusion, ophthalmoplegia, congestive heart failure
422
Vitamin B2 is also known as?
Riboflavin * aids in metabolism of nutrients
423
Vytorin is a combo of what drugs? (Systemic lipid-lowering medication)
Simvastatin+ Ezetimibe
424
Advicor is a combo of what drugs?
Niacin + lovastatin (inhibits cholesterol production in liver) Tx: high cholesterol
425
Caduet is a combo of which 2 drugs?
Amlodipine + atorvastatin
426
Microorganisms that can synthesize its own food from inorganic sources
Autotrophs * plants, algae use photosynthesis or chemosynthesis to make their food
427
Heterotrophs
Cannot fix carbon sources, must get it from other organic sources * animals, fungi
428
Prototroph
Organism can synthesize its own amino acids, vitamins and other nutrients from inorganic compounds
429
Auxotrophs
Microorganisms that lost ability to synthesize component for grown due to mutation, therefore must obtain from their environment
430
Asteroid hyalosis composed of?
Calcium soaps * small, white vitreal refractile bodies * attached to collagen in vitreous, that’s why they don’t fall to bottom of globe * rarely affect vision
431
MRD1 and MRD2 average mm
MRD1: 4-4.5 mm MRD2: 5-5.5 mm
432
Parietal stomach cells secrete glycoprotein for absorption of vitamin B12 by small intestine, what’s the name of it?
Intrinsic factor
433
Carboxypeptidase is secreted by what organ?
Pancreas * passes into small intestine to help digest proteins
434
Chyme
Food becomes broken down in stomach and mixes with acid and enzymes to form liquid called chyme, propelled to small intestine to be broken down more
435
Hydrochloric acid is used to denature what?
Proteins, secreted by cells in stomach
436
What do Class I agents affect?
Sodium channels ## Footnote Class I agents ultimately serve to either lengthen or shorten the duration of the action potential and help to prevent ventricular arrhythmias.
437
What is an example of a Class I agent?
Lidocaine
438
What do Class II agents MOA
Beta blockers (decrease sympathetic) Class II agents block beta adrenergic receptors and aid in preventing recurrence of myocardial infarction.
439
What is an example of a Class II agent?
Propranolol
440
What do Class III agents block to prolong repolarization?
Potassium channels ## Footnote Class III agents prevent arrhythmias.
441
What is an example of a Class III agent?
Amiodarone
442
What do Class IV agents block?
Calcium channels ## Footnote Class IV agents decrease conduction through the AV node.
443
What are two examples of Class IV agents?
Verapamil and diltiazem
444
Sensory information for upper and lower eyelid come from with cranial nerve?
Trigeminal nerve * upper eyelid is supplied by ophthalmic branch of trigeminal, supraorbital, suprateochlear, infratrochlear and lacrimal nerves * lower eyelid supplied by ophthalmic and maxillary branches, infratrochlear and infraorbital
445
Clinically significant macular edema criteria
1) retinal edema occurring within 500um of center of macula 2) hard exudates occurring within 500um of the center of the macula if there is associated retinal thickening (which may be outside of the 500um) 3) retinal edema that is at least 1 DD in size, in which any part is within 1 DD of the center of the macula
446
Eryptosis
Programmed red blood cell death
447
Erythropoesis
New red blood cell production
448
Erythropoietin
Kidneys produce and release to promote production of new red blood cells * stimulates stem cells in red bone marrow * lifespan of RBC is 120 days
449
True or False Absolute contradiction to using 10% phenylephrine for patients on tricyclic antidepressants
TRUE
450
Visual field pattern deviation
Determines size, shape, and depth of VF defect
451
Signs associated with vernal keratoconjunctivitis
1) corneal shield ulcer 2) cobblestone papillae 3) Horner-trantas dots
452
What do Class I agents affect?
Sodium channels ## Footnote Class I agents impact the duration of the action potential and help prevent ventricular arrhythmias.
453
What is the effect of Class II agents on the heart?
Decrease sympathetic activity ## Footnote Class II agents block beta adrenergic receptors and aid in preventing recurrence of myocardial infarction.
454
What do Class III agents do?
Prolong repolarization by blocking potassium channels ## Footnote This mechanism helps prevent arrhythmias.
455
What is the primary action of Class IV agents?
Block calcium channels ## Footnote This action decreases conduction through the AV node.
456
True or False Increase in blood pressure and increase in blood vessel resistance will lead to increase in blood flow
FALSE * increase in blood pressure will increase blood flow but an increase in blood vessel resistance will decrease blood flow
457
Sabourad’s agar
Culture fungi * this agar has a low pH, causing inhibition of most bacterial growth allowing better isolation of fungus
458
Blood agar plates
Detecting pathogenic vs hemolytic organisms (ability of organisms to lyse or destroy RBC)
459
Are blood agar plates a selective medium?
No because many different types of organisms can grow on this agar
460
Axon hillock
Action potential is initiated here * means “little hill” * trigger zone, located at the junction between the cell body and the axon * has much higher density of voltage-gates ion channels
461
Nodes of Ranvier
Naked portions of axon that are not enveloped in myelin sheath * this is where action potential conduction occurs
462
Describe the flow of aqueous humor as it leaves the eye through the trabecular meshwork outflow pathway
UVEAL LAYER —> CORNEOSCLERAL LAYER—> JUXTACANALICULAR LAYER —> SCHLEMM’S CANAL
463
What are the 3 layers of the Trabecular meshwork?
1) UVEAL 2) CORNEOSCLERAL 3) JUXTACANALICULAR
464
Virtual image characteristics
1) vergence is negative 2) light rays are diverging 3) image is upright * image in not focusable on screen = virtual
465
What receptors does Timolol maleate block?
Timolol maleate blocks both beta1 and beta2 adrenergic receptors
466
What is the effect of Timolol maleate on intraocular pressure (IOP)?
Decreases intraocular pressure
467
How soon can the effects of topical Timolol be observed after drop instillation?
As early as 30 minutes
468
When does Timolol maleate reach peak efficiency after instillation?
1-2 hours post-instillation
469
What type of receptor does Brimonidine tartrate agonize?
Alpha-2 adrenergic receptor
470
How does Brimonidine tartrate decrease IOP?
By increasing uveoscleral outflow and decreasing aqueous production
471
When does Brimonidine tartrate reach peak IOP reduction after instillation?
Approximately 2 hours
472
What is Latanoprost a type of?
Prostaglandin analog
473
How does Latanoprost decrease IOP?
By increasing uveoscleral outflow
474
When does Latanoprost reach peak effectiveness after instillation?
Roughly 2 hours
475
What is Bimatoprost a type of?
Prostaglandin analog
476
How does Bimatoprost reduce IOP?
By increasing both uveoscleral and trabecular meshwork outflow
477
When can the effects of Bimatoprost be observed after instillation?
Approximately 4 hours
478
When does Bimatoprost reach peak effectiveness after instillation?
After 8-12 hours
479
What are the muscular boundaries of the carotid triangle?
1) posterior belly of the diagstricus 2) omohyoideus 3) sternocleidomastoid *important vessels and nerves run thru the carotid triangle including; Carotid sheath (& its contents common carotid artery, internal jugular vein and vagus nerve)
480
Which fluid portion of the blood carries dissolved ions, molecules and clotting factors like fibrinogen?
Blood plasma * 55% of blood volume * keeps RBCS in suspension and comprised of water, extracellular fluid, dissolved proteins, minerals, glucose, carbon dioxide, hormones and clotting factors
481
Hematocrit
Amount of blood occupied by cells and cellular components per given volume of blood
482
A1c (glycated hemoglobin, hemoglobin A1c)
Glycated hemoglobin test *provides average blood sugar levels over 2-3 months (measures percentage of RBC coated in glucose) Normal= below 5.7% Pre-diabetes= 5.7-6.4% Diabetes= 6.5 or higher
483
Fluorescein angiography should be performed with caution in patients taking what drug class of medication?
Beta blockers * if allergic reaction occurs, harder to manage if pt on beta blockers because epinephrine less effective
484
Vogt-Koyanagi-Harada Syndrome
Autoimmune disease, body attacks melanocytes * inflammatory response of tissues that contain melanocytes such as ear, skin, meninges, uveal tissues * anterior uveitis non-granulomatous in acute, granulomatous in recurring * posterior uveitis, bilateral can result in severe loss of vision due to RD, CNVM and subretinal fibrosis in advanced cases
485
Evisceration
Removal of iris, cornea, and internal contents of eye. Leaving sclera and attached EOMS intact
486
Removal of entire eyeball. Leaving eyelids and adjacent structures intact
Enucleation
487
Exteneration
removal of entire contents of eye socket, including eyeball and adjacent fat, muscles * eyelids and maxilla may also be removed
488
Acquired macular disease tends to cause what color vision deficiency?
Blue-yellow
489
Optic nerve lesions typically produce what color vision deficiency?
Red-green
490
What does metaplasia refer to?
The reversible substitution of one differentiated cell type for another fully differentiated cell type within a given tissue ## Footnote Most commonly occurs in epithelial tissues and can be part of normal maturation or a response to abnormal stimuli.
491
In which tissues does metaplasia most commonly occur?
Epithelial tissues ## Footnote An example is Barrett's esophagus, where cells change due to chronic stomach acid exposure.
492
What is dysplasia?
A disorderly arrangement of cells due to an alteration of size, shape, and organization of cells within a tissue ## Footnote Typically affects epithelial tissues and is usually reversible.
493
What characterizes dysplasia?
An expansion of immature cells and a decrease in number and location of mature cells ## Footnote An example is epithelial dysplasia of the cervix, identified on a pap smear.
494
Define anaplasia.
An alteration of differentiation where cells are usually poorly differentiated or undifferentiated ## Footnote Anaplastic cells divide rapidly but do not resemble normal cells.
495
What is hyperplasia?
An increase in the number of cells in a tissue that may result in gross enlargement of a tissue or organ ## Footnote An example is benign prostatic hyperplasia, leading to prostate enlargement in males.
496
What does neoplasia refer to?
A new growth composed of cells originally derived from normal tissue that have become unresponsive to normal growth controls, creating a tumor ## Footnote Cells often undergo abnormal growth patterns like metaplasia or dysplasia before neoplastic growth.
497
True or False: Metaplasia is always a pathological process.
False ## Footnote It can be part of the normal maturation process.
498
Fill in the blank: Dysplasia usually affects ______ tissues.
epithelial ## Footnote This condition involves a disordered arrangement of cells.
499
What is a common example of hyperplasia?
Benign prostatic hyperplasia ## Footnote This condition leads to the enlargement of the prostate in males.
500
Fill in the blank: Anaplastic cells divide rapidly but do not resemble ______ cells.
normal ## Footnote Anaplasia indicates poor differentiation.
NBEO Part 1
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