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Posterior Segment > CRAO > Flashcards

CRAO Flashcards

1
Q

Name the diseases in the 10A club.

A
  1. Papilladema
  2. GCA
  3. Anuerysm
  4. Pituitary Apoplexy
  5. Carotid Artery Dissection
  6. Perforated Globe
  7. Acute Angle Closure Glaucoma
  8. Acid/Alkaline Chemical Burn
  9. Hyphema
  10. CRAO
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2
Q

What are the 4 categories of CRAO?

A
  1. Non-Arteritic
  2. Transient Non-Arteritic
  3. Non-arteritic w/ cilioretinal artery
    sparing
  4. Arteritic w/ GCA
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3
Q

What type of vision loss is found in the CRAO? What type of VA will the patient have?

A

rapid, unilateral painless vision loss

- count fingers to light perception

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4
Q

What would a brain aneurysm give you ocularly?

A

3rd nerve palsy w/ unreactive or slowly reactive pupil

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5
Q

What’s the most common cause of a 3rd nerve palsy?

A

diabetes/HTN

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6
Q

What connects the anterior and posterior blood systems?

A

The circle of willis

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7
Q

When someone has a CRAO, what main cell layer is destroyed?

A

Ganglion cell layer

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8
Q

Why does CRAO have a cherry red spot?

A

this is the foveal avascular zone supplied by the choroid

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9
Q

If we don’t see an embolus, what 2 diseases should we ask about?

A
  1. GCA

2. Polyarteritis Nodosa

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10
Q

What are the 2 common places an embolus comes from?

A

Carotid and heart

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11
Q

What 2 tests will a patient get who presents with an embolus?

A

Doppler - for carotid

Echocardiogram - for heart

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12
Q

If the embolus is yellow, where did it come from?

A

Carotid

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13
Q

If the embolus is white, where did it come from?

A

heart

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14
Q

When does whitening of the retina occur?

A

20mins after blockage

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15
Q

If we cannot dislodge the embolus by __ minutes, the retina will begin to die

A

97 mins

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16
Q

What is the 1st and 2nd line of treatment for a CRAO?

A
  1. Ocular Massage

2. Lower IOP using beta blocker, Diamox (CAI)

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17
Q

What 4 things do we look for in a patient with a CRVO?

A

i. Atrial fibrillation
ii. GCA/Lupus/PA
iii. Hypercoagulable State
iv. Stroke

18
Q

Does GCA ever cause a BRAO?

A

No, it doesn’t target small vessels

19
Q

If you only see a cilioretinal artery occlusion, what disease do you think the patient has?

A

GCA - only goes after medium and large vessels

20
Q

Fibroplatelet emboli come from where?

A

Carotid

21
Q

Calcific emboli come from where?

A

heart

22
Q

What medication do you give a patient who has an artery occlusion?

A

Aspirin

23
Q

What % of CRAO cases are due to arterial emboli (cholesterol, fibroplatelet, calcific)?

A

20% of cases

24
Q

What systemic testing do you request for a patient over 55 yo?

A

Immediate Westergren Sed. Rate

25
Q

What systemic testing do you request for a patient with a CRAO?

A
  1. Carotid artery evaluation
  2. Blood pressure/sugar
  3. Lipid Profile
  4. FA
  5. Echocardiogram
26
Q

Which type of ECG is performed first? second?

A
  1. Transthoracic

2. Transesophageal

27
Q

CRAO due to occlusion in carotid disease can occur by what 3 mechanisms?

A
  1. Embolism
  2. Hemodynamic
  3. Serotonin
28
Q

What is the life expectancy for a CRAO patient vs a patient w/o a CAO?

A

5.5 years vs. 15.4 years

29
Q

What % of patients get neo of the iris at about 4 weeks?

A

20%

30
Q

What % of patients get neo of the disc?

A

3%

31
Q

The Beaver Dam Study said a retinal emboli was found in ___% of population and increased to ___% of patients who were 75 or older

A
  1. 3%

3. 1% in 75 +

32
Q

The beaver dam study found an increase of what 2 diseases in patients with a retinal emboli?

A

Stroke and Heart Disease

33
Q

What is the most common cause of a CRAO?

A

Carotid artery disease

34
Q

A hypercoagulable state is associated with what 3 diseases?

A
  1. Coronary Artery Disease
  2. Cerebral Vascular Accidents
  3. Peripheral Vascular disease
35
Q

What’s the #1 hypercoagulable state in America? What % of whites have this?

A

Factor V

- 10% of whites

36
Q

What are the 4 reasons why we don’t clot?

A
  1. Thrombomodulin binds to thrombin
  2. TPA breaks up fibrin clots
  3. Heparin-like molecule binds to A-III
  4. Tissue factor pathway inhibitor
37
Q

Where is Tissue plasminogen Activator (TPA) from? what does it do?

A
  • Comes from endothelium

- breaks up fibrin clots (it’s fibrinolytic)

38
Q

How does the heparin-like molecule stop clotting?

A
  1. binds to antithrombin III and inactivates thrombin + factors X/IX
39
Q

The tissue factor pathway inhibitor inactives what factors?

A

7 and 8

40
Q

What is Factor V resistant to ?

A

resistant to normal degradation of activation protein C

41
Q

What are the top 5 primary states of hypercoagulation?

A
  1. Antithrombin III
  2. Factor V
  3. Hyperhomocysteinemia
  4. Prothrombin 20210
  5. Antiphopholipid Syndrome
42
Q

Hyperhomocysteinemia causes what 2 findings? What age are we worried about?

A

CRA and brain occlusion

  • 40years or less

Posterior Segment (8 decks)

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