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KMK Ocular Disease > 16 - Retina/Choroid4 > Flashcards

16 - Retina/Choroid4 Flashcards

1
Q

Gyrate atrophy

  • epidemiology
  • pathophys
A

AD, symptoms by age 10

BILATERAL chorioretinal degeneration due to deficiency in MITOCHONDRIAL ENZYME ORNITHINE AMINOTRANSFERASE
-ornithine blood plasma levels will be HIGH

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2
Q

Gyrate atrophy

-signs/symp

A

Signs: multiple, well-defined, scalloped areas of peripheral chorioretinal atrophy

  • begin in mid-periphery (childhood), coalesce to engulf most of post pole w/ macula being SPARED UNTIL 4th-7th decade
  • assoc with PSC, high myopia/astimatism

Symp: NYCTALOPIA, decr vision, constricted VF

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3
Q

Rhegamatogenous retinal detachments

  • epidemiology
  • risk factors
A

Males, >45yo

Risks:

  • previous ocular surgery
  • PVD (10-15% with acute symptomatic PVD -> RRD)
  • trauma
  • family hx
  • MYOPIA = #1, 40% of all RDs
  • lattice degen (30% of RRDs have lattice, only 1% with lattice have RRD)
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4
Q

Rhegamatogenous retinal detachments

-key words to think of

A

Full-thickness retinal break/defect

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5
Q

Rhegamatogenous retinal detachments

-pathophys

A

Result from RETINAL BREAKS (full-thickness retinal defects) that allow vitreous into subretinal space -> separation of sensory retina from RPE
-breaks = atrophic HOLES, vitreo-retinal traction TEARS

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6
Q

Breakdown of retinal detachment sub/categories

A

Rhegmatogenous:

  • atrophic holes
  • traction tears (vit pulls retina)

Non-rheg:

  • DRVOS (preret neo) = tractional (vit pulls neo)
  • CHBALA (subret neo) = exudative/serous
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7
Q

Rhegamatogenous retinal detachments

-atrophic holes

A

Round, small, full-thickness defects that aren’t assoc with traction -> LOW RISK FOR SUBSEQUENT DETACHMENT (i.e. less concerning than retinal tears)

Caused by CHRONIC ATROPHY of sensory retina

Most likely TEMPORAL retina (SUPERIOR > inferior)

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8
Q

Rhegamatogenous retinal detachments

-retinal tears

A

Caused by VITREOUS TRACTION

Flap/horseshoe/U-tear: due to UNEVEN vitreous traction
-worse than operculated due to PERSISTENT traction

Operculated: due to EVEN, SYMMETRIC vitreous traction, PULLS AWAY/no longer persists

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9
Q

Rhegamatogenous retinal detachments

-signs/symp

A

Signs:

  • acute: convex, undulating, clear subret fluid that doesn’t shift with body position, SHAFER’S sign, mild iritis, LOWER IOP
  • chronic: PIGMENT DEMARCATION LINE (3mo+ to develop), intraretinal cysts (1yr+), fixed folds, and/or subret precipitates

Symp: floaters, flashes, curtain/veil, decr VA

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10
Q

Rhegamatogenous retinal detachments

-most likely location

A

SUPERIOR TEMPORAL (60%)

50% of eyes with RRD will have more than one retinal break - usually 90 degrees from one another

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11
Q

Lattice degeneration

-epidemiology

A

Common (6-10% pts)

20-33% of pts with RRD have lattice, but only 1% with lattice have RRD
-most common peripheral retinal lesion assoc with RDs

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12
Q

Lattice degeneration

-what/app

A

Area of peripheral retinal thinning - typically circumferential (CIGAR-SHAPED) and CONCENTRIC to ora serrata

  • inner portion: atrophic/thin
  • outer margins: firm adhesion to vitreous

Majority of lesions DO NOT contain the criss-cross pattern of white sclerosed vessels (only 12% have)

Often bilateral (33-50%), SUPERIOR TEMPORAL

25% will contain an atrophic hole

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13
Q

Conditions assoc with “lattice-like” lesions/“atypical lattice” (3)

A

Marfan’s
Stickler
Ehlers-Danlos

*at incr risk for an RD

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14
Q

Vitreoretinal tufts

A

Small, focal areas of vitreous TRACTION located in periphery

Occur in 5% pop - 2nd most common peripheral retinal lession assoc with RD (lattice #1)
-less than 1% develop an RD

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15
Q

Non-rhegmatogenous retinal detachments

  • include (2)
  • by definition, these RDs are not cause by __
A

Serous/exudative RDs + Traction RDs

Retinal breaks

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16
Q

Non-rhegmatogenous retinal detachments

-exudative RDs

A 
From SUBRETINAL disorders = CHBALA
-AMD is most common
-others: 
—inflammatory: scleritis
—vascular: Coat’s
—neoplasms: choroidal melanoma
—miscellaneous: coloboma

Asymptomatic unless macular involvement

17
Q

Non-rhegmatogenous retinal detachments

-traction RDs

A

From PRE-RETINAL disorders = DRVOS
-esp PDR, ROP, sickle-cell

Usually no complaints/symp; decr vision, progressive VFD

18
Q

Age-related degenerative retinoschisis

  • epidemiology
  • pathophys
A

4-7% of gen pop, esp in 40yo+
70% of pts are HYPEROPIC

Degenergative process resulting from SPLITTING OF OPL and INL -> elevation of inner retina that mimics a detachment

19
Q

Age-related degenerative retinoschisis

-signs/symp

A

Signs: dome-shaped bullous elevation, esp INFERIOR-TEMPORAL (70%)

  • unlike retinal detachment: retina is immobile, BILATERAL common, ABSOLUTE VFD corresponding to area of elev (periph, so no biggie)
  • “snowflake” or “frosting” and sheathed retinal vessels

Symp: asymptomatic

20
Q

Age-related degenerative retinoschisis

-inner vs outer wall breaks

A

Outer: more dangerous - required to cause a retinoschisis-assoc RD, appear “pock-marked” on scleral depression

21
Q

Angioid streaks

-pathophys

A

Damage to ELASTIC core -> large breaks in Bruchs

50% IDIOPATHIC
PEPSI: pseudoxanthoma elasticum, ehlers-danlos, paget’s, sickle-cell, idiopathic

22
Q

Angioid streaks

-signs/symp

A

Signs: spoke-like, linear, well-demarcated red/orange or brown lines within elastic core of Bruchs, FROM THE DISC

Symp: asymptomatic; profound vision loss from CNVM
-70% will eventually have some vision loss

23
Q

Toxocariasis

-pathophys

A

Toxocara canis/cati - intestinal nematode

  • from eating dirt/infected veggies, meat, water or thru contact with infected kittens
  • after ingestion, larvae penetrate the intestinal wall -> travel to eye, brain, skin, liver, lungs

Common in children/young adults

24
Q

Toxocariasis

-signs/symp

A

Signs: significant UNILATERAL INFLAMMATORY response

  • optic nerve edema, RD, vitritis, endophthalmitis, subret granulomas
  • large, white chorioretinal scars present AFTER active infection resolves

Symp: floaters, blur

25
Q

Acute posterior multifocal placoid pigment epitheliopathy

A

aka White Dot syndrome

Young adults - typically after VIRAL illness

BILATERAL, yellowish, flat, subretinal lesions
-may have disc edema, RD

Usually resolves without tx in few weeks

26
Q

Central areolar choroidal dystrophy

A

AD
Bilateral large areas of GA in the macula
Vision loss in 4th-5th decade
-poor prognosis

KMK Ocular Disease (17 decks)

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