Disorder of the Retina

Question 1

A pt comes in with eye pain, blurred vision, redness, and decreased visual acuity. You notice the pt also has inflammation of the retina. What is the most likely diagnosis for this pt?

Answer 1

Posterior uveitis

Question 2

A pt comes in complaining of eye pain and decreased vision. On the physical exam you notice inflammation of the vitreous, erythema, and hypopyon. What are the likely causes of this pt’s disorder?

Answer 2

Autoimmune disease
Inflammatory bowel disease
Syphilis
TB
Multiple sclerosis
(pt has posterior uveitis)

Question 3

What are the treatment options for posterior uveitis?

Answer 3

Treat the underlying condition
Systemic steroids (anti-inflammatories)
Abx if suspect infection
URGENT ophthalmologist referral

Question 4

A pt comes in with unilateral blurry vision. You notice redness in one eye along with decreased visual acuity. What is the most likely cause of this pt’s condition?

Answer 4

Infection

pt has choroiditis

Question 5

How do you treat choroiditis?

Answer 5

Treat underlying infection
Steroids if non-infectious
Refer to ophthalmologist

Question 6

What are the 3 forms of diabetic retinopathy?

Answer 6

Proliferative diabetic retinopathy
Diabetic macular edema
Ischemia of the macula

Question 7

A pt comes in complaining of a sudden decrease in vision. She says she sees a lot of floaters, almost like a shower, and has two blind spots. On the physical exam you notice neovascularization and loss of the red reflex. What is the most likely diagnosis?

Answer 7

Proliferative diabetic retinopathy

Question 8

A 65-year old male comes in complaining of a loss of vision over the past few weeks. He has floaters, and on the physical exam you notice neovascularization, preretinal hemorrhages, and cotton wool spots on the retina. What treatment would you recommend for the pt?

Answer 8

Glycemic control!
Retinal laser photocoagulation to adhere the retina to the choroid
(the pt has proliferative diabetic retinopathy)

Question 9

What are the causes of proliferative diabetic retinopathy?

Answer 9

Compromised retinal perfusion

Retinal ischemia leads to neovascularization

Question 10

A pt comes in with decrease of vision in her left eye. You notice an opaque macula and microaneurysms. What is the best treatment for this pt?

Answer 10

Refer to an ophthalmologist

pt has diabetic macular edema

Question 11

“Copper wiring” and “silver wiring” are associated with what condition?

Answer 11

Hypertensive retinopathy

Question 12

A pt comes in with slightly blurred vision and diplopia. You notice arteriolar narrowing and AV nicking. What is the most likely cause of this pt’s condition?

Answer 12

Thickened vessel walls
Narrow lumen
(pt has hypertensive retinopathy)

Question 13

A pt presents with suddenly decreased vision and a blind spot. You notice cotton wool spots on the retina and the vessels appear sclerotic. What condition is this likely to be?

Answer 13

Hypertensive retinopathy

Question 14

What are the treatment options for hypertensive retinopathy?

Answer 14

Treat underlying cause of HTN
Non-specific
Refer to ophthalmologist if needed

Question 15

A pt with a history of carotid disease comes in because he lost vision in his left eye earlier that day. His vision has been restored, but this has happened twice in the past. You notice a white retina and a cherry red spot in the macula. What is the best treatment for this pt?

Answer 15

EMERGENCY referral to an ER or ophthalmologist

pt has retinal artery occlusion

Question 16

A pt comes in with profound vision loss and a cherry red spot on her macula. What is the most likely cause of the pt’s condition?

Answer 16

An embolus

the pt has retinal artery occlusion

Question 17

A pt with a history of hypertension presents with retinal hemorrhages and dilated, tortuous veins. What is the most likely cause of the pt’s condition?

Answer 17

Thrombosis of the retinal vein

the pt has retinal vein occlusion

Question 18

How do you treat retinal vein occlusion?

Answer 18

EMERGENCY referral to an ER or ophthalmologist

Question 19

A pt presents complaining of shimmering lights and a blind spot. She has night blindness, but the fundus is normal. What condition does the pt likely have?

Answer 19

Retinitis pigmentosa

Question 20

A pt comes in with decreased vision, night blindness, and light sensitivity. You notice a normal fundus but a pale optic nerve. What is the most likely cause of this pt’s condition?

Answer 20

Maternal infections (syphilis, rubella, toxoplasmosis)
Vitamin A deficiency
(the pt has retinitis pigmentosa)

Question 21

How do you test for retinitis pigmentosa?

Answer 21

Test visual field
Obtain family history
Genetic studies

Question 22

A pt comes in with night blindness, photophobia, and blind spots. What treatment do you recommend for this pt?

Answer 22

Vitamin A supplements

pt has retinitis pigmentosa

Question 23

A 65 year old man presents with sudden vision loss in one eye. He complains of jaw pain, scalp tenderness, and neck pain. What diagnostic test should you perform on this pt?

Answer 23

Test for a Marcus-Gunn pupil

the pt has ischemic optic neuropathy

Question 24

A pt with a history of diabetes presents with sudden visual loss and recent weight loss. On exam the pt has a Marcus-Gunn pupil. What is the next step for this pt?

Answer 24

Immediate referral to an ophthalmologist

the pt has ischemic optic neuropathy

Question 25

A 22 year old female presents with painful eye movements and periorbital pain. She mentions having gradual visual loss over the past week. On exam you find the pt has a Marcus-Gunn pupil. What condition do you suspect?

Answer 25

Optic neuritis

Question 26

A multiple sclerosis pt presents with visual loss over the past few days. You notice a Marcus-Gunn pupil and optic disk edema. What treatment do you recommend for this pt?

Answer 26

IV corticosteroids
Refer to ophthalmology
Refer to neurology (if suspect MS)
(the pt has optic neuritis)

Question 27

What is the most common cause of acute visual loss in younger pt’s?

Answer 27

Optic neuritis

Question 28

A 70 year old pt presents with loss of central vision, and she believes her mother had the same problem (but can’t remember what it is). You notice hyaline nodules (drusen). What disease do you suspect?

Answer 28

Atrophic macular degeneration

Question 29

A pt presents complaining of flashes of lights, floaters, and wavy, distorted vision. You notice a Marcus-Gunn pupil and retinal ruggae (ripples). What is the most likely cause of this pt’s condition?

Answer 29

Fluid has separated the retina from the retinal epithelium
Tractional retinal detachment
(the pt has retinal detachment)

Question 30

A pt comes in with decreased vision, floaters, and complains of wavy/distorted lines. You notice unilateral vision loss, a Marcus-Gunn pupil, and retinal ruggae. What is the best course of treatment for this pt?

Answer 30

Immediate ophthalmologist referral

Surgical intervention

Question 31

What is a simple way to diagnose retinal detachment?

Answer 31

Compare red reflexes