Final - Presentations Rogala Flashcards
Toxoplasmosis:
- definitive host
- how it’s acquired***
- affect in mice
- CNS involvement***
- prognosis
Cat
Litter box, undercooked meat, raw veggies, passed during pregnancy (even w/ tx)
Alters neural pathways in mice —> eliminate fear response to cat odor
CNS involvment is very uncommon in immunocompetent individuals
~70% (“vast majority”) normal vision, 30% reactivation
Pre-eclampsia:
- most common type of HTN (in general, not pregnancy)
- gestational HTN vs pre-eclampsia vs ecalampsia***
- cortical blindness
- OD’s job
Essential
Gestational HTN = just HTN
Pre-eclampsia = HTN + end-organ failure (e.g. proteinuria w/ kidney damage)
Eclampsia = pre-eclampsia + seizures
CB = loss of vision due to impairment at level of cortex (visual cortex/occip lobe)
- Up to 15% of pts
- Recover w/in a week or so
Notify OBGYN right away of end-organ blindness
-HA, serous RD, cortical blindness
Refractive shift:
- presentation
- common post seg things responsible: large myopic, hyperopic, myopic
Dramatic/sudden myopic shift in 20+ y.o.
Large myopic (up to 7D): choroidal effusion***
- whole lens-iris diaphragm pushed forward
- due to 1) relatively low pressure outside BVs -> leak 2) something promoting leakage - inflamm, meds
Most common = hypotony due to over-doing glaucoma filtering sx
Hyperopic: pushing macula forward - central serous chorioretinopathy, solid tumor
Myopic: scleral buck for RD (~1mm = 2.5D)
Rubella:
- type of infection
- 2 major forms***
- way to make ddx***
- tx
Viral
Congenital: cardiac malformation, hearing loss, ocular changes (salt/pepper app.)
Acquired: “German measles”, flu-like, rash, ocular changes, conjunctivitis 70% (far more common than retinitis - seen in congenital)
Fundus, assoc systemic, ERG/EOG, antibody testing
No specific antiviral, supportively (tx complications as they occur)
Malarial retinopathy:
- is unique to __
- signs
- why is this important research***
Severe malaria (cerebral)
Lightning orange/white vessels, retinal whitening (similar to WWP)
Distinctive signs for cerebral malaria can be used to confirm dx/cause (avoid missing other coma-causing problem due to mis/over-diagnosis of malaria)
- i.e. not to miss something else going on in the brain due to mis/over-diagnosis of malaria
Wyburn-Mason syndrome:
- decribe AVM (aterio-venous malformation)
- inheritance pattern
- laterality
- ischemic or non
- Sturge-Weber or von Hippel-Lindau
- tx***
Lack of capillary or abnormal capillaries - arteries change to venules w/o capillary b/w
Sporadic mutation
Unilateral
Ischemia (due to lack of cap beds) -> NV
SW: port wine stain, usually leads to leakage
VHL: assoc w/ renal carcinoma
None, watch for complications***
Acute syphilitic posterior placoid chorioretinitis (ASPPC):
- describe what happens to retina in terms of OCT appearance
- fundus app
- if this is suspected, what tests should you run***
PIL loss (acute phase) and return (with tx)
- loss = low integrity, impaired, dysfunctional (NOT dead)
- return = return of normal structure -> return of normal function
Single, large, well-demarcated placoid, inflamm in choroid/outer retina
Neurosyphilis & HIV - very common to have co-infection with HIV
clincally significant macular edema w/ DR:
- diabetic retinopathy vs DME vs CSME***
- why it’s important to specify/dx
- tx
- OD’s role
DR = any retinal changes due to DM
DME = ME due to DM
CSME = 3 criteria met***
-thickening of retina at/within 500microns of macula
-hard exudates within 500microns
-zone of retinal thickening of 1DD which is within 1DD of the center of the macula
Determines whether or not retinal specialist will treat
Focal laser = pinpoint exact lesion with FA
Grid laser = diffuse/general area on FA
Detection, determine if clinically significant, refer
Cone dystrophy and electrodiagnostics:
- tx
- dx***
None, early dx helps avoid unneccessary testing and/or referrals
Photopic ERG - helpful in isolating cone dystrophy from other condns (Stargardt’s, RP)
-difficult to dx
Ocular manifestations of Noonan syndrome:
- type of disorder
- most ocular issues***
- refractive errors***
- important to look at __
Genetic, systemic
Ant seg - esp. lids (ptosis, epicanthal folds, etc.)
Myopia due to axial elongation (40%)
Amblyopia (32%)
ONH
Marfan syndrome
- prevalence of RDs
- consider rxing this
- what to be on the look for***
- great tool to evaluate
1/10 pts, up to 25% with lens changes/sx
Protective eyewear due to CT disorder —> incr risk of issues
Ectopia lentis, RDs
Ultra-widefield retinal imaging
YAG vitreolysis for floaters:
- caution
- what it’s used for
Near macula or lens
Muscae volitantes/floaters
Nd:YAG for vitreolysis
Vitreous wick syndrome:
- subset of
- main concern
- other concerns
- clue to dx
- possible tx***
Vitreous prolapse
Endopthalmitis
Traction -> distorted pupil, may lead to glaucoma, CME
Distorted pupil
Anterior vitrectomy
Hand, foot, mouth:
- who gets it
- what post seg problem can they get***
- prognosis
Kids, immunocompromised adults
Maculopathy -> pretty severe vision loss
Benign, self-limited, good prognosis
Systemic chemotherapy induced retinal effects:
- key to ocular SE
- approach if vision-threatening***
Relatively uncommon
Involve whole healthcare team, possible alternatives?
Toxocariasis
- what it is, where
- who gets it
- how gets to eye
- specific scenarios that require tx*88
- clinical dx and tx***
Primitive worm, dirt/veggies, tropical areas
Many ppl, usually kids - most immune systems erradicate
Burrows thru wall of intestine, into bloodstream -> either visceral (lung/liver) or eye
Vitritis, RD due to granulomas
ELISA or vitreous sample, tx with steroids, vitrectomy
Retinopathy of anemia
- how to differentiate/ddx***
- other signs/symptoms***
- who gets it
- what is the problem/physiology
- most common type
- most common ocular finding
CBC
Fatigue, weakness due to hypoxia
50% HTN, 25% DM
Lack of oxygen transmission
Iron deficiency - usually due to hemorrhage/blood loss
-tx underlying problem, usually not with Fe supplements
Flame-shaped hemorrhage (NFL)
Infrared imaging for AMD
- why use IR***
- drusen vs pseudo***
Less light scatter
Drusen = under RPE (images better with this) Pseudo = above RPE, ~5x’s greater risk for progression, regardless of size, aka reticular
Persistent fetal vasculature and retinoblastoma
- dx
- possible problem***
- tx to avoid __
B-scan
Tractional RD
Amblyopia
Subtle mactel 2
- meaning of mactel
- key ddx
- retinal thickness***
- management
Macular telangiectasia
AMD = drusen under RPE (OCT) MT2 = grey-ish fovea temporal margin, refractile crystals, (-) drusen Both = slowly progressive vision loss
Thinner
Watch unless full-thickness hole or AMD
Retinal implants
- only FDA approved for USA
- if under retina***
- epiretinal***
Epiretinal Argus 2
Electrical signal picked up by bipolar (second order) = better
Picked up by ganglion cells (third order)
Sclopetaria
-describe
Not same as nor mutually exclusive from commotio retinae Concussion injury (not penetrating) - shockwaves reverberate thru eyeball = split thru retina and choroid, tough sclera stays intact
Susac
- assoc eye problems
- systemic signs
BRAO (-) embolus
Encephalopathy (HA, memory loss, confusion) Hearing loss (vertigo, tinnitus)
Macular pigment/MPOD measurement
- importance
- specific uses/interpretation
Protects PRs from photo-oxidative stress dye to harmful blue light
Low MPOD = incr risk for AMD
High MPOD = help improve visual func by incr VAs and contrast sensitivity while lowering light sensitivity and glare recovery
Scanning laser ophthalmoscopy (multispectral imaging of retina)
- short vs medium vs long wavelength (when is one better)
- associations
Longer wavelength = deeper penetration
Medium wavelength (580-590) = metabolic monitoring of anterior-mid retina, retinal vasculature, NFL -hemorrhages, drusen, lipids, edema, exudates, NV
Shorter wavelength (550) = incr visibilty of the anterior layers (esp ILM) -ERM, VMT, VMA, macular holes
Stress, PVDs
ARN
- what
- cause
- appearance
Panuveitis with necrotizing retinitis
HSV - zoster or simplex, unilateral, normal immune system
assoc with PORN = immune compromised, bilateral, no inflamm (no immune response)
5th-7th decade of life
Unilateral (bilateral if immunocompromised)
FA
- what it tells us
- clinically useful
Whether occlusive or not
Whether to refer or not
Roth spots
- importance
- concerns
Determine dx/give ddx list
- usually bacterial endocarditits
- also HTN, DM
- tx of underlying cause resolves spots
Dark adaptometry
- application
- tests
ARMD
-night vision affected first (rods need nutrients/recycling of vit A before cones)
Short = screening Long = classification (early/intermediate/advanced disease)***best use
OCT-A
- application
- how it works
- pros/cons
Fast (~6 sec/eye)
DM, NV, AMD, choroidal osteoma
Detects movement of indiv blood cells
Pros = imaging at diff depths (vs FA), can look at areas of non-perfusion Cons = movement/artifact, uncertain of place in regular practice
Widefield OCT
- application
- FOV
Major use = RD vs PVD***
50-169 degrees
ForSeeHome
-application
Monitor AMD progression from dry to wet***
More pecise than Amsler
Good for type A/worriers
Gene therapy RP
- how helpful
- significance of this being available
- specific RP use
3-5 lines VA regained
First retinal dystrophy with FDA approved gene tx
Heterogenous set of diseases (various forms, similar presentations)
- gene tx only for specific subset
- need to confirm dx, ensure have enough viable cells to be worth it
Birth control
- in general
- associated with
- mx
- acute macular neuroretinopathy
Retinal vascular occlusions (venous and arterial)
Dosage
HTN, migraine, vacular issues
Currently not recommended to discontinue
Rare, paracentral scotoma
Petalloid lesions pointed toward fovea on IR
Impairment/loss of PRs (inner retina)
AMD: ForSee vs Dark Adaptometry
FS: monitor progression (dry -> wet)
DA: diagnosis
