Pap Iv Test 3

Front 1

Optic Foramen transmits

Back 1

-optic nerve, optic artery, optic vein, and sympathetic nerves from carotid plexus

Front 2

Sclera

Back 2

fibrous out layer- adds rigidity to the eye-- anterior portion is transparent (cornea)

Front 3

Uvea

Back 3

Middle layer, vascular, contains iris, cilliary body, and choroid

Front 4

Mydriasis innervation

Back 4

dilator is sympathetic

Front 5

Miosis innervation

Back 5

constrictor and cilliary muscle are parasympathetic

Front 6

what does the retina do

Back 6

neurosensory, converts light into neural impulses, impulses carried via optic nerve to brain

Front 7

conjuctiva

Back 7

covers globe and lines eyelids --very absorbent membrane

Front 8

arterial blood flow to eye

Back 8

internal and external carotid arteries

Front 9

venous from orbit

Back 9

superior and inferior opthalmic veins

Front 10

venous from the eye

Back 10

primarily via central retinal vein

Front 11

all veins empty into the _______

Back 11

cavernous sinus

Front 12

Oculomotor nerve innervates

Back 12

motor to cillary ganglion --pupil sphincter and cillary muscle

Front 13

Trochlear nerve

Back 13

supplies to superior oblique muscle

Front 14

Abducens nerve

Back 14

supplies lateral rectus muscle

Front 15

trigeminal and facial nerves

Back 15

also supply musculature of the eye

Front 16

What makes Aqueous Humor

Back 16

Ciliary body 2/3 formed in posterior chamber 1/3 formed from vessels of the iris via passive filtration

Front 17

Production rate of AQ and total volume

Back 17

2.5 micro L/min and 250 micro L

Front 18

Aqueous humor osmotic pressure is _____ than plasma

Back 18

greater

Front 19

AQ active secretory process

Back 19

carbonic anhydrase and cytochrome oxidase systems

Front 20

What is actively transported to make AQ? what follows?

Back 20

NA hco3 and cl follow

Front 21

Flow of AQ

Back 21

1 cillary body 2 Posterior chamber via pupil 3 anterior chamber 4 drains to venous system through canal of schlemm

Front 22

Normal IOP=

Back 22

10-22

Front 23

rise in IOP causes

Back 23

acute glaucoma

Front 24

Positional changes cause what change in IOP

Back 24

1-6mmHg

Front 25

When is IOP atmospheric

Back 25

once eye cavity is opened

Front 26

3 main factors that affect IOP

Back 26

external pressure on the eye, scleral rigidity, and changes in intraocular contents which are semisolid or fluid

Front 27

Intubation and IOP

Back 27

increase

Front 28

Hyperventilation and IOP

Back 28

decrease

Front 29

hypoventilation, hypoxia, increased co2 and IOP

Back 29

increase IOP

Front 30

Inhalation agents IOP

Back 30

dose dependent decrease

Front 31

Caution with etomidate when

Back 31

ruptured globe decrease IOP

Front 32

Why does SUCC increase IOP

Back 32

tonic contractions of extraocular muscles -- choroidal dilation of vasculature -- relaxes orbital smooth muscle -- increases resistance of the outflow of aqueous humor from eye

Front 33

how much does succ increase IOP

Back 33

10-22

Front 34

pre treatment for succ

Back 34

Non depolarizers, benzos, b blocker acetazolamide.

Front 35

avoid succ in ______ surgery

Back 35

strabismus--- working of the muscles

Front 36

how does acetazolamide decrease IOP

Back 36

inactivates carbonic anhydrase and interferes with NA pump reducing AQ formation

Front 37

How do hypertonic solutions decrease IOP?

Back 37

elevate plasma oncotic pressure which reduces formation of aq humor

Front 38

explain oculocardiac reflex

Back 38

pressure on the globe or traction on the extraocular muscles stimulate vagus nerve and cause bradycardia or other arhythmia

Front 39

trigeminal nerve

Back 39

is afferent limb of oculocardiac reflex five and dime

Front 40

vagus nerve

Back 40

is efferent limb X of oculocardiac reflex

Front 41

treatment of oculocardiac reflex

Back 41

stop surgery, atropine, lidocaine at site, assess anesthetic depth, and ventilation

Front 42

Opthalmic drug Acetylcholine

Back 42

lens extractions, produces miosis, Systemic effects of bradycardia salivation, bronchial secretions, bronchospasm, hypotenstion

Front 43

Echothiophate

Back 43

glaucoma treatment, miosis, decrease IOP decrease resistance to aqueous humor ouflow.
Systemic effects: irreversible cholinesterase inhibitor, plasma cholinesterase activity 5% of normal, activity normalizes after 4-6 weeks

Front 44

Cocaine

Back 44

nasal packs, vasoconstriction, blocks reuptake of norepi, potentiates SNS, avoid sympathomimetics

Front 45

epinephrine

Back 45

open angle glaucoma treatment, don't know how it works!

Front 46

Phenylephrine

Back 46

mydriasis, capillary decongestant, systemic effects are rare, HTN tachycardia, headache, and tremulousness

Front 47

Timolol

Back 47

glaucoma treatment, nonselective B antagonist, decrease IOP by decrease aq humor production.
systemic absorption bradycardia, hypotension, asthma, myasthenia gravis

Front 48

Betaxalol

Back 48

B-1 glaucoma treatment, minimal systemic effects, more eye specific

Front 49

cyclopentolate

Back 49

anticholinergic, mydriasis, cns toxicity, dysarthria, disorientation, frank psychosis, sz in kids

Front 50

Anesthesia requirement for EYE surgery

Back 50

safety, akinesia, profound analgesia, minimal bleeding, obtundation of oculocardiac reflex, smooth emergence.

Front 51

local anesthetic injected into muscle cone behind the globe near cillary nerve

Back 51

retrobulbar block

Front 52

what can enhance the spread of local anesthetic with retrobulbar block

Back 52

hyaluronidase and Honan cuff

Front 53

complications

Back 53

optic nerve trauma, retrobulbar hemorrhage, increase IOP, oculocardiac reflex, intravascular injection, apnea

Front 54

advantages of RB block

Back 54

decrease incidence of coughing and straining, decrease incidence of PONV, minimal sedation requirements ANALGESIA AKINESIA

Front 55

brainstem anesthesia

Back 55

direct injection or spread of local anesthetic along optic nerve sheath. usually only lasts an hour

Front 56

treatment for retrobulbar hemorrhage.

Back 56

gentle pressure for 20 min lateral canthotomy

Front 57

disadvantages of topical eye anesthesias

Back 57

eye movement, anxiety, and allergic reactions

Front 58

goals of open globe surgery

Back 58

modified RSI, prevent aspiration, and prevent sudden increase in IOP

Front 59

strabismus surgery

Back 59

most common surgery of peds, triggers occulocardiac reflex, increased incidence of MH, avoid succ,

Front 60

oculogastric relfex

Back 60

frequent PONV, antiemetics, limit narcotics, hydrate, lidocaine at op site

Front 61

examples of intraocular surgery

Back 61

glaucoma drainage, vitrectomy, keraoplasty, cataract extraction

Front 62

gas bubble Air, sulfur, perfuoropropine, octafluorocyclobutane

Back 62

5, 10, 30, 14 days

Front 63

Inspiratory stridor

Back 63

upper airway obstruction

Front 64

expiratory stridor

Back 64

lower airway obstruction

Front 65

contraindications for Jet vent

Back 65

pediatrics, obesity, bullous emphysema

Front 66

advantages of laser therapy

Back 66

increased precision, less bleeding, rapid healing

Front 67

laser safety

Back 67

saline soaked eye pads, goggles, laser masks, paralyze patient, laser tubes fill cuff with liquid, reduce fio2 <30%

Front 68

in case of airway fire

Back 68

stop ventilation, turn off o2, remove ett, extinguish fire, reintubate and ventilate, CXR, bronch, steroids, ABGS Postop Vent

Front 69

Tonsillectomy pearls

Back 69

avoid sedation, consider steroids, oral rae ett- throat pack- paralysis or deep anesthesia, awake extubation, put in tonsil position. Large EBL

Front 70

Most common complication of tonsillectomy

Back 70

bleeding 4-6hr and then 5-10 days postop

Front 71

bleeding tonsil surgery

Back 71

rehydration is key fluid bolus until no orthostatic changes, ketamine or etomidate

Front 72

Manipulation of neck structures can cause dysrhythmias

Back 72

carotid sinus- vagal reflex
right stellate ganglion- prolonged QT interval

Front 73

pain control for myringotomy tubes

Back 73

rectal tylenol, im morphine or fentanyl, intranasal fentanyl

Front 74

25% of lefort 2 and 3 have what

Back 74

a dural tear resulting in a csf leak, need to rule out basilar skull fracture. NO NASAL tubes

Front 75

trach placement and complications

Back 75

3rd or 4rth tracheal cartilage and hemorrhage, false passage, pneumothorax, airway fire

Front 76

how many days to establish new tract

Back 76

5

Front 77

half life of t4

Back 77

6-7 days changes to t3 in the extrathyroid tissue

Front 78

Half life of t3

Back 78

24-30 hours, more potent 80% made in tissue 20% from thyroid, less protein bound

Front 79

Fibrous outer layer of eye

Back 79

Sclera

Front 80

Contains iris cilliary body and choroid

Back 80

Uvea

Front 81

Covers globe and lines eyelids

Back 81

Conjuctiva

Front 82

Controls pupillary sphincter and ciliary muscle

Back 82

Oculomotor

Front 83

Superior oblique

Back 83

Trochlear

Front 84

Lateral rectus

Back 84

Abducens

Front 85

Submandibular abscess progressing to generalized cellulitis

Back 85

Ludwigs angina

Front 86

Symptoms of Ludwigshafen angina

Back 86

Induration of neck drooling protruding tongue difficulty speaking

Front 87

Systemic effects of thyroxine

Back 87

^ contractile state of cardiac muscle, ^beta decrease alpha

Front 88

Hyperthyroidism

Back 88

Graves disease- goiter exophthalmos clubbed fingers

Front 89

Graves disease anesthesia

Back 89

Ptu beta blockers gluco corticoids

Front 90

Avoid what meds graves disease

Back 90

Ketamine pancuronium ephedrine epinephrine

Front 91

Unilateral Ron injury

Back 91

Hoarseness

Front 92

Bilateral Rln injury

Back 92

Aphonia tube em