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Z Post Seg 2 > Final - Presentations Rogala > Flashcards

Final - Presentations Rogala Flashcards

1
Q

Toxoplasmosis:

  • definitive host
  • how it’s acquired***
  • affect in mice
  • CNS involvement***
  • prognosis
A

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

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2
Q

Pre-eclampsia:

  • most common type of HTN (in general, not pregnancy)
  • gestational HTN vs pre-eclampsia vs ecalampsia***
  • cortical blindness
  • OD’s job
A

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

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3
Q

Refractive shift:

  • presentation
  • common post seg things responsible: large myopic, hyperopic, myopic
A

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)

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4
Q

Rubella:

  • type of infection
  • 2 major forms***
  • way to make ddx***
  • tx
A

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)

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5
Q

Malarial retinopathy:

  • is unique to __
  • signs
  • why is this important research***
A

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

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6
Q

Wyburn-Mason syndrome:

  • decribe AVM (aterio-venous malformation)
  • inheritance pattern
  • laterality
  • ischemic or non
  • Sturge-Weber or von Hippel-Lindau
  • tx***
A

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***

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7
Q

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***
A

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

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8
Q

clincally significant macular edema w/ DR:

  • diabetic retinopathy vs DME vs CSME***
  • why it’s important to specify/dx
  • tx
  • OD’s role
A

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

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9
Q

Cone dystrophy and electrodiagnostics:

  • tx
  • dx***
A

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

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10
Q

Ocular manifestations of Noonan syndrome:

  • type of disorder
  • most ocular issues***
  • refractive errors***
  • important to look at __
A

Genetic, systemic

Ant seg - esp. lids (ptosis, epicanthal folds, etc.)

Myopia due to axial elongation (40%)
Amblyopia (32%)

ONH

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11
Q

Marfan syndrome

  • prevalence of RDs
  • consider rxing this
  • what to be on the look for***
  • great tool to evaluate
A

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

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12
Q

YAG vitreolysis for floaters:

  • caution
  • what it’s used for
A

Near macula or lens

Muscae volitantes/floaters
Nd:YAG for vitreolysis

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13
Q

Vitreous wick syndrome:

  • subset of
  • main concern
  • other concerns
  • clue to dx
  • possible tx***
A

Vitreous prolapse

Endopthalmitis

Traction -> distorted pupil, may lead to glaucoma, CME

Distorted pupil

Anterior vitrectomy

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14
Q

Hand, foot, mouth:

  • who gets it
  • what post seg problem can they get***
  • prognosis
A

Kids, immunocompromised adults

Maculopathy -> pretty severe vision loss

Benign, self-limited, good prognosis

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15
Q

Systemic chemotherapy induced retinal effects:

  • key to ocular SE
  • approach if vision-threatening***
A

Relatively uncommon

Involve whole healthcare team, possible alternatives?

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16
Q

Toxocariasis

  • what it is, where
  • who gets it
  • how gets to eye
  • specific scenarios that require tx*88
  • clinical dx and tx***
A

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

17
Q

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
A

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)

18
Q

Infrared imaging for AMD

  • why use IR***
  • drusen vs pseudo***
A

Less light scatter

Drusen = under RPE (images better with this)
Pseudo = above RPE, ~5x’s greater risk for progression, regardless of size, aka reticular
19
Q

Persistent fetal vasculature and retinoblastoma

  • dx
  • possible problem***
  • tx to avoid __
A

B-scan

Tractional RD

Amblyopia

20
Q

Subtle mactel 2

  • meaning of mactel
  • key ddx
  • retinal thickness***
  • management
A

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

21
Q

Retinal implants

  • only FDA approved for USA
  • if under retina***
  • epiretinal***
A

Epiretinal Argus 2

Electrical signal picked up by bipolar (second order) = better

Picked up by ganglion cells (third order)

22
Q

Sclopetaria

-describe

A 
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
23
Q

Susac

  • assoc eye problems
  • systemic signs
A

BRAO (-) embolus

Encephalopathy (HA, memory loss, confusion)
Hearing loss (vertigo, tinnitus)
24
Q

Macular pigment/MPOD measurement

  • importance
  • specific uses/interpretation
A

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

25
Q

Scanning laser ophthalmoscopy (multispectral imaging of retina)

  • short vs medium vs long wavelength (when is one better)
  • associations
A

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

26
Q

ARN

  • what
  • cause
  • appearance
A

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)

27
Q

FA

  • what it tells us
  • clinically useful
A

Whether occlusive or not

Whether to refer or not

28
Q

Roth spots

  • importance
  • concerns
A

Determine dx/give ddx list

  • usually bacterial endocarditits
  • also HTN, DM
  • tx of underlying cause resolves spots
29
Q

Dark adaptometry

  • application
  • tests
A

ARMD
-night vision affected first (rods need nutrients/recycling of vit A before cones)

Short = screening
Long = classification (early/intermediate/advanced disease)***best use
30
Q

OCT-A

  • application
  • how it works
  • pros/cons
A

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
31
Q

Widefield OCT

  • application
  • FOV
A

Major use = RD vs PVD***

50-169 degrees

32
Q

ForSeeHome

-application

A

Monitor AMD progression from dry to wet***

More pecise than Amsler
Good for type A/worriers

33
Q

Gene therapy RP

  • how helpful
  • significance of this being available
  • specific RP use
A

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
34
Q

Birth control

  • in general
  • associated with
  • mx
  • acute macular neuroretinopathy
A

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)

35
Q

AMD: ForSee vs Dark Adaptometry

A

FS: monitor progression (dry -> wet)

DA: diagnosis

Z Post Seg 2 (3 decks)

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