Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neuro Block 3 - KJ > Ophthalmology Clinical Correlation > Flashcards

Ophthalmology Clinical Correlation Flashcards

1
Q

What is a subconjunctival hemorrhage?

A

Blood on surface of sclera (under conjunctiva) - no inflammation, pain or discharge harmless

  • May be due to trauma, rubbing, may be spontaneous
  • Dry eyes
  • Lubricate, hot compress
  • Harmless, resolves on own in 7-10 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the big three that most opthamalogists spend their time seeing?

A
  1. Cataracts
  2. Macular Degeneration
  3. Glaucoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a cataract?

A

Opacity of the normally clear lens cause by age, metabolic disorder, trauma or heredity
-Can be caused by trauma = shaken eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How old are people with macular degeneration and what is it?

A
  • Age related - any time after age 50, usually >70 years old
  • Very common
  • Causes decreased central vision
  • Dry vs. Wet
  • Nutritional Concerns
  • 75-85
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does Dry Macular Degenearion Involve? Does it always affect vision?

A

-Drusen, pigmentary changes, pigmentary retinopathy & atrophy of retina
In minor cases, it may not affect vision, but may progress to affect vision later on.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is macular drusen?

A

Calcified byproducts of cellular metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does exudative (wet) macular degeneration look like?

A
  • Defects develop in deep retinal layers, growth of blood vessels under/in retina, edema and (sub-retinal) hemorrhage, eventual fibrosis/scarring and serious loss of vision
  • Dry macular degeneration can lead to wet!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do you treat dry macular degeneration?

A

Quit smoking, nutritional reccomendations, AREDS supplements, manage systemic diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you treat wet macular degeneration?

A

-All dry recommendations plus conventional laser, photodynamic therapy, anti-vegf drugs!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is Glaucoma?

A
  • Increased Ocular Pressure causes optic nerve loss
  • Can be multifactorial
  • Can occur at any age, but much more common over age 40
  • Genetic predisposition in some
  • Two main types: 1. Open angle
    2. Closed angle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the treatment for Glaucoma?

A

Lower Eye Pressure!

-Medical, Surgical, Laser

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the direction of aqueous flow?

A

Produced by cells in ciliary body ->around and through iris –> Trabecular meshwork –> Schemms canal –> Aqueous Vein –> Episcleral Vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does a normal optic nerve look like?

A

Pink, Good rim tissue, small central cup

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is optic nerve cupping? Why is the cup measured over time?

A

Enlarged cup due to loss of rim tissue that indicates loss of optic nerve fibers (Glaucoma!!)

  • Larger cup/disc ration over time can indicate worse glaucoma
  • Differnece in optic cup between two eyes may happen in glaucoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What can drops cause?

A

Significant side effects!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What do Glaucoma medications do?

A

Decreases intraocular pressure by decreasing aqueous production or increasing outflow.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why is acute glaucoma (narrow angle) dangerous?

A
  • Often its an eye emergency! (some ppl have intermittent symptoms - not flow blown attack)
  • Acute onset
  • Severe pain with loss of vision
  • +/- nausea
  • Red Eye
  • Cloudy cornea
  • EXTREMELY high ocular pressure >40 mmHg (eye feels like a rock)
  • Usually caused by closure of previously narrow angle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is OCT?

A

Optical Coherence Tomography

  • Used to quantify optic nerve tissue
  • Can show eye: open and closed angle glaucoma
  • Can view macula and fovea health also
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are symptoms of acute angle glaucoma?

A

Pain, photophobia, blur, halo around lights

-Redness, Corneal edema, fixed/mid-dilated pupil, high IOP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What do you use to treat Acute Glaucoma?

A
  1. Pilocarpine
  2. Acetazolamide (Diamox)
    - Sometimes with oral glycerine or isosorbide Icc/kg
    - -> after treatment immediately refer to Ophthamology URGENTLY (surgical or laser peripheral iridotomy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does Pilocarpine work?

A

It causes constriction of the pupil and helps move the iris away from the angle.

  • May not work right away, keep giving it!
  • If IP is very high, there is too much resistance to arterial inflow to allow for adequate absorption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How does Acetazolamide work?

A

It is a diuretic that lowers pressure by “dehydrating” the eye.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What surgery is used to correct acute angle glaucoma?

A

Laser Iridotomy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is laser iridotomy?

A

It creates a hole through the base of the iris near the trabecular meshwork. It allows aqueous flow out and decreases pressure.

25
Q

What systemic diseases need regular eye exams?

A
  1. Diabetes Mellitus
  2. Hypertension
  3. Cardiovascular Disease
  4. Thyroid Disease
26
Q

What can diabetic retinopathy cause? How is it treated?

A
  • Mild to severe forms
  • Usually slowly progressive
  • Can cause total blindness
  • Treatment: Prevention: Managing blood sugar
  • Laser therapy
  • Surgical - vitrectomy
  • Anti-vegf drugs
27
Q

How does diabetic retinopathy cause leakiness in arteries of retina?

A
  1. Alterations in pericytes and basement membrane
  2. Microocclusions/collapsed artery 2. Leakiness
  3. Retinal Ischemia 3. Hemorrhages/exudates
  4. VEGF upregulation
  5. Angiogenesis
  6. Hemorrhage
  7. Organization
  8. Traction
28
Q

What are the three stages of diabetic retinopathy?

A
  1. Nonproliferative diabetic retinopathy (NPDR)
  2. Preproliferative diabetic retinopathy
  3. Proliferative diabetic retinopathy (PDR)
29
Q

What does NPDR look like in retina?

A
  • Blot hemorrhages
  • Cotton wool spots (edges - cloudy light areas)
  • Microaneursyms (tiny red dots)
  • Macular Edema (swelling of macula) - OCT scan - bubbles under
  • Hard Exudates (white crust near end of artery –> cholesterol and fat that has leaked out of blood vessels - bright yellow deposits)
30
Q

What can you see on the retina through a fluorescein angiogram of a diabetic patient?

A

You can see vessels and if bad, significant leakage/edema.
It shows microaneurysms.
-After insulin therapy it looks better

31
Q

What does pre proliferative diabetic retinopathy look like?

A
  • worse than NPDR

- Intraretinal vascular changes, venous bleeding, ischemic areas (cotton wool spots)

32
Q

What does PDR (proliferative diabetic retinopathy) look like?

A

Neovascular (lots of vascularization) vitreoretinopathy, vitreous hemorrhage
-Very red all over, leakiness, large retinal hemorrhages

33
Q

What is laser pan retinal photocoagulation (PRP)?

A

Hold contact like lens in eye and you laser all around periphery a lot.

  • You’re wiping out the surrounding layers of the retina on the periphery so that the blood will resorb
  • You put in 1,000-15,000 laser spots over a few visits
34
Q

How often do diabetics need dilated eye exams?

A

Every year for Type II

After 5 years from diagnosis, every year for Type I

35
Q

What is seen in hypertensive retinopathy?

A
  • Narrowing and sclerosis of arterioles (arteriovenous nicking)
  • Flame hemorrhages within retina
  • Cotton wool spots (retinal micro-infarcts)
  • Optic nerve edema in severe cases
  • Disc edema, retinal edema, retinal hemorrhages, hard exudates, cotton wool spots, silver wired arterioles
36
Q

How do you treat hypertensive retinopathy?

A
  • Control blood pressure!!

- If significant vascular occlusions and ischemia, could require pan retinal photocoagulation

37
Q

What are these:

  • Amaurosis Fugax
  • Migraine Scotoma
  • Retinal Detachment
  • Retinal Artery Occlusion
  • Retinal Vein Occlusion
  • Temporal Arteritis (Giant Cell Arteritis)
  • Stroke
A

Causes of Sudden Visual Loss

38
Q

What is amaurosis fugax?

A
  • Sudden loss of vision in one eye
  • Generally only lasts minutes
  • Painless
  • Etiology - usually temporary vascular insufficiency (Carotid Artery Disease until proven otherwise)
  • Requires cardiovascular workup first!
  • Requires Ophthalmology evaluation second
39
Q

What is a retinal cholesterol emoli?

A

Yellow embolic material in arteriole of retina (hollenhorst plaque)

  • Non-occlusive
  • Warning sign of future disaster in vascular system - need to figure out where embolic material is coming from - can be very dangerous
  • Workup includes Carotid Ultrasound and Echocardiogram
40
Q

What is an ophthalmic migraine?

A
  • With headache: classic (cephalgic)
  • Without headache: cephalic
  • Scintillating scotoma is the hallmark
  • –Painless and temporary
  • –Involves both eyes causing temporary hemianopsia (blocks vision)
  • –Usually lasts 20-30 minutes
  • Etiology: spasm of arteriole in the occipital cortex
41
Q

What is the treatment for migraine?

A
  • Examine for visual loss or ocular pathology
  • Reassurance
  • Consider preventative therapy if attacks are frequent
  • Consider physical examination and work-up if attacks are frequent or atypical
42
Q

What is retinal detachment?

A
  • Sudden partial vision loss in one eye
  • Painless
  • May be progressive, always sustained (does not resolve on its own)
  • Often accompanied by floaters and photopsias
  • Higher frequency in myopia
  • Etiology - Usually spontaneous, can be associated with trauma
  • Treatment: refer immediately to ophthalmology for surgery
43
Q

How can you try to prevent/slow retinal detachment?

A
  • Can laser a tear

- Use Scleral buckling which decreases the diameter of the eye and makes it easier to push the retina back on

44
Q

What is retinal arterial occlusion?

A
  • Sudden severe loss of vision in one eye
  • Painless
  • Vision loss usually permanent, but may recover if treated rapidly
  • Cherry red spot indicates acute central retinal artery occlusion
45
Q

What does a cherry red spot indicate?

A
  • Acute central retinal artery occlusion

- It is a pale retina with a red fovea (rest of retina is pale and swollen)

46
Q

What does a white, swollen upper part of the retina indicate?

A
  • Branch retinal artery/partial retinal artery occlusion

- Patient will notice half of vision missing

47
Q

What happens in an acute arterial occlusion?

A

Embolus blocks retinal circulation - Treatment is urgent!!

48
Q

How do you manage Acute Arterial Occlusion?

A
  • Rebreathing CO2 in paper bag
  • Timolol or levobundolol to lower intraocular pressure –> decreasing aqueous humor production
  • Intravenous acetazolamide (Carbonic anhydrase inhibitor -> decreases aq. humor production- dec. osmotic flow)
  • Massaging of globe with lids closed
  • Refer to Ophthalmology
49
Q

What does an acute arterial occlusion look like?

A

Plaque spot on the retina and edema.

50
Q

What is retinal vein occlusion related to?

A

-More common in hypertension and diabetes

51
Q

What are important facts about retinal vein occlusion?

A
  • Central (CRVO) or branch (BRVO)
  • Prognosis guarded for central vein occlusion, with risk of neovascular glaucoma - requires Ophthalmology referral (not as urgent)
  • Treat underlying systemic diseases and rule out hyper coagulable states
52
Q

What does Central Retinal Vein Occlusion look like on the retina?

A

“Squashed tomato”

53
Q

What is temporal arteritis (giant cell arteritis)?

A
  • Headache and scalp tenderness
  • Fever, weight loss
  • Jaw claudication
  • Polymyalgia rheumatica
  • Vision loss secondayr to inflammatory vaso-occlusion . . .retinal arteriolar occlusion or optic nerve infarction
  • Vision loss can be sever involving one or both eyes
  • May result in total blindness
  • Rarely complicated by aortic aneurysm or stroke
54
Q

How do you diagnose temporal arteritis?

A

STAT Erythocyte Sedimentation Rate (ESR) and C-reactive protein (CRP)
—Schedule temporal artery biopsy to look for PMNs in the arterial wall within 2 weeks

55
Q

How to treat temporal arteritis?

A

Start high dose systemic steroids!! IMMEDIATELY!

-Even before you get test results, patient is at risk of loss of vision from other eye

56
Q

What does temporal arteritis show in a section?

A
  • Inflammation of arterial wall
  • Fragmentation/disruption of the internal elastic lamina
  • +/- multinucleate giant cells
  • Skip lesions (therefore often missed in biopsy) - have to section a long piece of the artery
57
Q

What happens in a visual cerebrovascular accident?

A
  • Sudden painless loss of vision causing bilateral hemianopsia
  • Usually involves the occipital cortex, but can occur anywhere in visual pathway
  • Visual loss occurs bilaterally on the contralateral side of a cortical lesion
58
Q

What could a stroke of the right occipital cortex cause?

A

Left homonymous hemianopsia (can’t see left visual field)

Neuro Block 3 - KJ (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions