Central retinal arterial occlusion/Retinal Detachment Flashcards

1
Q

There are lots of causes of vision loss including optic nerve, retina and the vitreous. Vascular causes of vision loss due to the optic nerve can be:

  • Arteritic anterior ischaemic optic neuropathy (A-AION) – Giant Cell Arteritis
  • Non-arteritic ischaemia optic neuropathy (N-AION)

What does N-AION resemble to cause vision loss by affecting the optic nerve?

1 - infection
2 - conjunctivitis
3 - allergic reaction
4 - stroke

A

4 - stroke

N-AION resemble a stroke to the the optic disc caused by occlusion of the anterior ciliary arteries

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2
Q

Do patients with Non-arteritic ischaemia optic neuropathy (N-AION) have any giant cell arteritis symptoms?

A
  • no
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3
Q

All of the following are risk factors for Non-arteritic ischaemia optic neuropathy (N-AION), EXCEPT which one?

1 - hypertension
2 - ischaemic heart disease
3 - young age
4 - diabetes

A

3 - young age

Typically affects those over 50 years old

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4
Q

Non-arteritic ischaemia optic neuropathy (N-AION), there can be vision loss, which of the types of image loss is present?

A
  • right hand image

This is called an altitudinal field defect

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5
Q

In patients with non-arteritic ischaemia optic neuropathy (N-AION), giant cell arteritis (GCA) must be ruled out. Which 3 of the following are used to rule out (GCA)?

1 - temporal biopsy
2 - FBC
3 - CRP
4 - ESR

A

2 - FBC
3 - CRP
4 - ESR

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6
Q

Arteritic anterior ischaemic optic neuropathy (A-AION), secondary to Giant Cell Arteritis (GCA) is a common cause of vision loss. Does this typically affect older or younger patients?

A
  • older patients

Typically aged >50 years old

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7
Q

Is arteritic anterior ischaemic optic neuropathy (A-AION), secondary to Giant Cell Arteritis (GCA) dangerous?

A
  • yes

An ophthalmic medical emergency

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8
Q

Arteritic anterior ischaemic optic neuropathy (A-AION), secondary to Giant Cell Arteritis (GCA) can result in vision loss. How does the vision loss typically present?

1 - insidious vision loss in both eyes
2 - sudden loss of vision in both eyes
3 - insidious vision loss in one eye
4 - sudden loss of vision in one eye

A

4 - sudden loss of vision in one eye

If left untreated can spread and cause vision loss in the second eye

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9
Q

Which of the following has the strongest association with Arteritic anterior ischaemic optic neuropathy (A-AION), secondary to Giant Cell Arteritis (GCA)?

1 - sarcoidosis
2 - polymyalgia rheumatica
3 - lupus
4 - RA

A

2 - polymyalgia rheumatica

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10
Q

Which of the following systemic symptoms do patients NOT typically present with in Arteritic anterior ischaemic optic neuropathy (A-AION), secondary to Giant Cell Arteritis (GCA)?

1 - fever >39
2 - jaw claudication
3 - malaise
4 - headache

A

1 - fever >39

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11
Q

In patients with Arteritic anterior ischaemic optic neuropathy (A-AION), secondary to Giant Cell Arteritis (GCA) they can experience a Relative Afferent Pupillary Defect (RAPD). What is the RAPD?

1 - patient has no direct response in eye with lesion
2 - patient has no indirect response in eye with lesion
3 - swing test in affected eye causes pupil dilation
4 - swing test in affected eye causes pupil constriction

A

3 - swing test in affected eye causes pupil dilation
- lesion in eye that dilates as the lesion is impairing the afferent signal

direct = pupil dilates when light shone in that eye
in-direct/consensual = pupil dilates when light shone in opposite eye

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12
Q

Is visual acuity affected in arteritic anterior ischaemic optic neuropathy (A-AION), secondary to Giant Cell Arteritis (GCA)?

A
  • yes
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13
Q

Does arteritic anterior ischaemic optic neuropathy (A-AION), secondary to Giant Cell Arteritis (GCA) affect the optic disc?

A
  • yes

Can cause swelling

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14
Q

In arteritic anterior ischaemic optic neuropathy (A-AION), secondary to Giant Cell Arteritis (GCA), which can cause vision loss, needs to be diagnosed asap. Which of the following is NOT one of the 3 tests that is done urgently?

1 - U&E
2 - FBC
3 - ESR
4 - FBC

A

1 - U&E

Significantly raised inflammatory markers are present in A-AION

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15
Q

Confirmatory diagnosis of arteritic anterior ischaemic optic neuropathy (A-AION), secondary to Giant Cell Arteritis (GCA) is performed using atemporal biopsy. But can the wait for this delay the treatment, which is with steroids?

A
  • no

Oral steroids often given before an official diagnosis is given

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16
Q

Central retinal arterial occlusion (CRAO) and central retinal vein occlusion (CRVO) can cause vision loss. In CRVO what is the cause of the vision loss?

1 - vein clots and causes compression of optic disc
2 - vein becomes blocked, bursts causing widespread haemorrhage
3 - vein forms embolism
4 - all of the above

A

2 - vein becomes blocked, bursts causing widespread haemorrhage

17
Q

Which of the following are risk factors for developing central retinal vein occlusion (CRVO)?

1 - hypertension
2 - ischaemic heart disease
3 - high cholesterol
4 - diabetes
5 - all of the above

A

5 - all of the above

18
Q

If the blood supply is severely impaired in central retinal vein occlusion (CRVO) is the prognosis fore their vision good or bad?

A
  • bad
19
Q

If the blood supply is severely impaired in central retinal vein occlusion (CRVO) the patients can develop what?

1 - rubeosis iridis
2 - hyphema
3 - neovascular glaucoma
4 - hypopyon

A

1 - rubeosis iridis

Formation of new blood vessels on the iris

20
Q

Central retinal arterial occlusion (CRAO) and central retinal vein occlusion (CRVO) can cause vision loss. In CRAO what is the cause of the vision loss?

1 - vein clots and causes compression of optic disc
2 - vein becomes blocked, bursts causing widespread haemorrhage
3 - embolism from heart or carotid can occlude the artery
4 - all of the above

A

3 - embolism from heart or carotid can occlude the artery

21
Q

In Central retinal arterial occlusion (CRAO) what condition must be ruled out as a cause?

1 - diabetes
2 - malignant hypertension
3 - graves disease
4 - giant cell arteritis

A

4 - giant cell arteritis

22
Q

Patients with In Central retinal arterial occlusion (CRAO) should be referred to which specialist clinic?

1 - diabetic
2 - transient ischaemic attack clinic
3 - cardiology
4 - neurology

A

2 - transient ischaemic attack clinic

Needed to investigate and manage the patient

23
Q

Looking at the images below, which is Central retinal arterial occlusion (CRAO) and which is Central retinal vein occlusion (CRVO)?

A
  • left = CRVO
  • right = CRAO