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53 Cards in this Set
- Front
- Back
Functions of the frontal lobe:
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planning and excecution of motor tasks
personality (reasoning & planning) Damage to the frontal lobe causes aphasia Broca's lesions cause broken speech contains broca's area - responsible for speech production |
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Functions of the Parietal lobe:
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Sensory activity and recognition
A patient with a parietal lobe lesion would be able to tell you that a pen is used for writing, but would be unable to call the object a pen. |
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Functions of the Temporal Lobe:
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Auditory stimuli, speech
Hippocampus: memory and spatial orientation Wernicke's area - wordy speech - words due not make any sense. |
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Function of the medulla:
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Controls autonaumic functions like heart rate, digestion, breathing.
UPPER MEDULLA: contains the PYRAMIDS and the MEDIAL LEMISCUS the MEDIAL LEMISCUS is made up of the gracillus and cuneate fasciculi, which carry information about lower body of trunk respecitvely The MLF (medial longitudianl fasiculus) relays vestibular information to EOMs and coordinates VOR. LOWER MEDULLA: pyramids, olivary nuclei (learning and memory), vestibular nuclei |
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Function of the pons:
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Pons coordinate movement related information and relay it to other areas of the brain.
It is the location of the PONTINE NUCLEI, which serve as relay stations for motor information transferred between the cortex and the cerebellum. Location of cranial nerves V-VIII |
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Function of the midbrain:
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Midbrain SIRE - superior & inferior colliculus, Red nucleus, & EWN
the midbrain controls an array of sensory and motor funtions, including the coordination of eye movement and visual reflexes. The upper midbrain is the location of the superior colliculus, which controls eye and head movements. Red nucleaus - which controls movement of the arms and the oculomotor nuclei The edengerwestphal (III) nuclei contribute to the parasympathetic innervation of the iris. The lower midbrain contains the inferior colliculus, which is responsible for reflex response head/neck to auditory stimuli, as well as teh cranial nerve IV nucleus which provides innervation to the contralateral eye. |
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A lesion to the OCULOMOTOR NUCLEUS or the EWN would result in the loss of all EOMs except_____________
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superior oblique and lateral rectus
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Paton's Folds
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Circumferential retinal folds -Papilledema
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Pathogenesis of papilledema
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axoplasmic stasis as a result of elevated cerebrospinal fluid pressure in the SUBARACHNOID space of the INTRAORBITAL portion of the optic nerve.
PAPILLA - SUBA - INTRA |
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Most common causes of papilledema
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Papilledema CHIPT:
Compromised venous flow Hypertension (malignant) Inflammatory Pseudotumor Tumor |
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Define orthograde degeneration as it relates to an atrophic optic nerve.
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From eye to brain -
Sufficient damage to retinal ganglion cells causing nerve pallor to develop. Examples are PRP & CRAO |
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Define retrograde degeneration as it relates to an atrophic optic nerve.
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From brain to eye -
Damage to the retrobulbar optic nerve eventually causing pallor to the optic nerve. An example of this is pituitary tumor. |
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What are the risk factors for NAION?
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HTN, DM, hypercholesteremia, disc at risk
Diabetic papillopathy is a form of NAION without the vision loss. |
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Define Optic Neuritis
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Primary inflammation of the optic nerve.
Usually occurs between the ages of 20-45, female predilection Sings: unilateral, rapid vision loss, PAIN on eye movement, +APD Vision will likely return to normal, patient will have a pale optic nerve and decreased contrast sensitivity Associated with MS |
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Define Internuclear ophthalmoplegia
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Due to a lesion of the MLF resulting in no ABduction on the ipsilateral side and possible nystagmus on the contralateral side. Convergence may or may not be intact.
MS patients may suffer from INO |
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Define Neuroretinitis
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anterior optic neuritis with a stellate macular star
infectious/immune mediated: CAT SCRATCH FEVER, histoplasmosis, toxoplasmosis CAT SCRATCH FEVER - PARINAUD'S OCULOGLANDULAR SYNDROME (granulomatous palpebral conjunctivitis) & NEURORETINITS |
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Name the two EOMs most often affected by Graves Disease.
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Inferior and Medial Recti
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NO SPECS grading system for Graves:
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N - no signs or symptoms
O - only signs such as upper lid retraction S - soft tissue involvement, such as lid edema, lagophthalmos, conjunctival chemosis P - Proptosis E - EOM involvement C - Corneal involvement S - slight loss, likely due to optic nerve compression |
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What is considered normal for exophthalmometry?
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whites 12-22, African Americans 12-24, Asians 12-18
also considered abnormal if the asymmetry is >3 mm |
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Define malignant hypertension.
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Papilledema wtih dangerously high blood pressure - send to the ER
Always check blood pressure on papilledema patients. |
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Foster - Kennedy syndrome
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Due to frontal lobe lesion
one eye has acuity loss while the other eye has disc edema |
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Name the possible causes of pseudotumor
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CANT - as in I CANT find the cause of pseudotumor
Contraceptives vitamin A Naladixic acid Tetracycline |
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Define Optic Nerve Pit.
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depression of the disc, usually inferior/temporal; unilateral; can develop a serous detachment extending from the pit to the macula; asymptomatic unless macula is involved.
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Morning Glory Syndrome
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unilateral, enlarged, funnel-shaped, excavated disc; poor acuity
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Melanocytoma
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Optic Nerve Tumor - darkly pigmented tumor lying adjacent to or on top of the optic nerve
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Optic Nerve Sheath Meningioma
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Generally benign; young, middle-aged women; typically unilateral; first is SWOLLEN and then PALE; progressive visual loss
Meningioma - think middle aged women |
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Optic Nerve Glioma
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If present in childhood, it is benign. If present in adulthood, it is malignant. Can be associated with neurofibromatosis.
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Which CN is responsible for efferent response of the pupil?
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CN III
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Which CN is responsible for afferent response of the pupil?
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CN II
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Differentials if pupil is mitotic in the dark:
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Horner's
Uveitis Argyll Robertson Pupil - (accommodative response present) |
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Differentials if the pupil is fixed and dilated - bigger in the light:
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Adie's Tonic Pupil
CN III (with ptosis & diplopia) Trauma to sphincter after intraocular surgery |
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If the pupil constricts with 0.125% pilocarpine
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Patient has Adie's Tonic Pupil
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Describe Adie's Tonic Pupil:
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Common in ages 20-40 years, more common in females.
Lesion is located in the ciliary ganglion or ciliary nerves |
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Describe Argyll Robertson Pupil
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Associated with NEUROSYPHILIS, diabetes, alcoholism.
Lesion of the tectotegmental tract - carries information from pretectal nuclei to EWN Begins unilateral and becomes bilateral with time Light - near dissociation |
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Describe Horner's Syndrome
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Mitotic pupil
Lesion of the sympathetic pathway - most notable in Pancoast's tumor at the apex of the lung Cocaine does NOT cause dilation in a patient with Horner's syndrome. If 1% Hydroxyamphetamine fails to dilate a Horner's pupil, then a postganglionic lesion is suspected. |
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Hutchison's Pupil
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Unilateral, dilated pupil in a comatose patient.
Commonly a result of an ipsilateral tumor or subdural hematoma that is compressing on the outside of the CN III (location of pupillary fibers) |
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Superior Division of CN III
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innervates the levator and the superior rectus
SUPERIOR division innervates the SUPERIOR rectus and the levator which elevates the lid SUPERIORLY |
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Inferior Division of CN III
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innervates the inferior rectus, medial rectus, inferior oblique and the parasympathetic pupil fibers run with this division, as well
INFERIORS AND MEDIALS |
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Complete lesion to CN III
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Down and out with ptosis
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Lesion to CN III involving the pupil
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most often a compressive lesion
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MOA Alpha 1:
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increases IP3, which increases intracellular ca2+
Found in radial muscle of iris, vascular smooth muscle, & GI tract |
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MOA Alpha 2:
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Inhibits Adenyl cyclase, decreases cAMP
Presynaptic adrenergic neurons, GI tract wall |
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Beta 1 MOA:
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Stimulates adenyl cyclase, increases cAMP
Located Heart, Sallivary Glands, Adipose tissue, Kidneys |
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Beta 2 MOA:
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Stimulates adenyl cyclase, increases cAMP
Located Bronchioles, GI tract, Bladder wall, Vascular SM |
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Nicotinic Cholinoreceptors
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Nicotinic Receoptors have a NAK for being unique
Opens Na and K channels - causes depolarization Nicotinic Receptors are UNIQUE - they are the only receptors that open Na and K channels. The other receptors either increase calcium or adenyl cyclase. Located: skeletal muscle, motor end plate, postganglionic neurons, SNS and PNS, Adrenal Medulla |
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Muscarinic MOA:
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Increases IP3, increasing intracellular calcium
Located: Vascular SM, sweat glands, PNS effector organs |
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What are the ocular structures supplied by the sympathetic system?
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IRIS DILATOR,
ciliary muscle, SMOOTH MUSCLE OF LIDS, lacrimal gland, and choroidal and conjunctival blood vessels. |
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What are the ocular structures supplied by the parasympathetic system?
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sphincter,
ciliary muscle, lacrimal gland, blood vessels Parasympathetic and sympathetic innervation to ciliary muscle, lacrimal gland, & blood vessels. |
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Sympathetic pathway to ocular structures:
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T1-T3 - ventral root - superior cervical ganglion - internal carotid plexus - enters skull through carotid canal
Internal Carotid Plexus - 3 Divisions: 1. Ophthalmic division - Nasociliary nerve - long ciliary nerve to iris dilator & sympathetic root to ciliary ganglion to short ciliary nerves to choroidal blood vessels 2. Oculomotor nerve - Superior tarsal muscle (widening of palpebral fissure) 3. Deep Petrosal nerve - pterygopalatine ganglion - maxillary nerve - zygomatic nerve - lacrimal nerve - lacrimal gland blood vessels |
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Parasympathetic pathway to ocular structures:
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EWN in midbrain - hitch ride with oculomotor fibers following the inferior division of the nerve into the orbit - leave the inferior division and enter the ciliary ganglion as the parasympatheic root.
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Describe the visual pathway.
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axons of gangion cells leave the retina via the optic nerve - the nasal fibers cross in the optic chiasm and terminate in the opposite side of the brain. The optic tract carries these fivers from teh chiasm to the LGN, where the next synapse occurs. The fibers leave the LGN as the optic radiations that terminate in the visual cortex of the occipital lobe.
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Define homonymous.
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A defect that affects the nasal field of one eye and the temporal field of the other eye is described as homonymous.
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The defects in a homonymous field are ___________ if the defects are similarly shaped and __________ if the defect shapes are disimilar.
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congruent, incongruent
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