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Opthamology rotation > Optho #2 > Flashcards

Optho #2 Flashcards

1
Q

what is the number one cause of blindness in working age Americans?

A

diabetes!

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2
Q

what is more important to control in order to maintain a healthy retina and to prevent retinopathy; blood glucose or hypertension?

A

The UK study found that blood pressure control was just as important as glycemic control in preventing diabetic retinopathy

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3
Q

what are the first signs of diabetes in the retina?

A

micro aneurysms (are leaky)

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4
Q

what are the intermediate signs of diabetes of the retina?

A

dot and blot hemorrhages
hard exudates
cotton wool spots (infarction of nerve fiber layer)
Macular edema

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5
Q

what single factor is the most common cause of visual impairment in diabetic retinopathy?

A

macular edema (Pg 166)

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6
Q

what does non-proliferative diabetic retinopathy mean?

A

That the patient is in the initial stage of retinal damage

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7
Q

what percent of diabetes get macular edema that causes visual impairment?

A

5-15%

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8
Q

what do exudates look like on the retina?

A

small white blotches, often in a “ring” formation

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9
Q

what does a hemorrhage look like on the retina?

A

increased redness and unable to see vessels clearly because of blood.

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10
Q

what do you see in severe non-proliferative diabetic retinopathy (AKA pre-proliferative retinophathy)?

A 
increased vascular tortuosity and hemorrhage
venous beading (not bleeding)
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11
Q

Of patients diagnosed with severe NPDR, what percent will develop into proliferative diabetic retinopathy within one year?

A

40%

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12
Q

what do you see in severe proliferative retinopathy?

A

Neovascularization! (this can occur anywhere on the retina, optic disk, and also in the iris causing glaucoma)

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13
Q

how do you treat neovascularization of the retina?

A

photocoagulation (laser) and anti-VEGF

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14
Q

Besides hemorrhage, new vessel formation also increase retinal detachment. Why?

A

Because with the formation of new vessels there is also a lot of fibrous tissue that causes traction on the retina resulting in detachment.

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15
Q

what is DME?

A

diabetic macular edema

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16
Q

what is FBS?

A

foreign body sensation

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17
Q

what is CRAO?

A

central retinal artery oclusion

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18
Q

what is CNVM?

A

choroidal neovascular membrane

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19
Q

what is PDR?

A

proliferative diabetic retinopathy

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20
Q

what is CSME?

A

clinically significant macular edema

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21
Q

why is photo-coagulation (laser) done on the retina? 2x

A

1) reduces the oxygen demand of the retina to reduce the VEGF released reducing the amount of new vessel formation
2) directly kills new vessels

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22
Q

What is PRP?

A

pan retinal photocoagulation

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23
Q

Is PRP effective?

A

Yes, it can reduce severe visual loss by at least 50% and as much as 90% if done at the right time.

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24
Q

What anti VEGF is often prescribed to help with neovascularization?

A

Ranibizumab (Lucentis)

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25
Q

when should you start screening diabetics every year?

A

once they are post pubertal and have had diabetes for 5 years or more

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26
Q

T/F diabetic retinopathy slows during pregnancy?

A

False, it actually progresses much quicker so an evaluation needs to be done every trimester!

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27
Q

Arteriolar sclerosis causes the retinal arteries to change in appearance. what is the normal progression?

A

1) normal appearing vasculature
2) increased light reflex (called copper wire arterioles)
3) loss of light reflex (called silver wire arterioles)

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28
Q

BRVO leads to what findings?

A

retinal hemorrhages and cotton wool spots

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29
Q

BRAO leads to what findings?

A

arteriol occlusion causing whitening of the retina in that area and cherry red spot if involving the fovea.

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30
Q

In a person with giant cell, what do you give the patient for treatment?

A

systemic prednisone

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31
Q

ACUTE high blood pressure (greater than 200/120) result in what effects in the retina? 5x

A 
exudates
cotton wool spots
flame hemorrhages
subretinal fluid
Optic disk swelling (resembling papilledema)
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32
Q

the most common/sensitive changes of the retinal vessels associated with chronic hypertension are?

A

1 attenuation of retinal arterioles

a) focal narrowing of vessels
b) A/V crossing changes
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33
Q

T/F Lowering of the intraocular pressure, decrease in corneal sensitivity and transient loss of accommodation are all normal with pregnancy?

A

True

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34
Q

T/F there is an increased risk of chorioretinopathy and uveal melanomas during pregnancy?

A

True

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35
Q

T/F women with gestational diabetes are not more at risk for retinopathy?

A

True

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36
Q

sarcoidosis causes anterior uveitis. what parts of the eye are involved?

A

Iris, ciliary body, and cornea

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37
Q

Sarcoidosis also causes posterior uveitis. What part of the eye is affected?

A

The choriod

38
Q

what is posterior synechiae?

A

adherence of the lens to the iris

39
Q

neurosarcoidosis can present with what ocular findings?

A

CN 3 and 6 palsy

Optic neuropathy

40
Q

Juvenile RA is frequently associated with which eye condition?

A

iritis

41
Q

Iritis is also common to which 3 other systemic diseases involving the joints?

A

Reiters
ankylosing spondylitis
Behcets syndrome

42
Q

what is a kerotic precipitate?

A

inflammatory cells that stick onto the posterior surface of the cornea with anterior uveitis

43
Q

which 4 rheumatological diseases are known to cause keratitis sicca (dry eye syndrome)?

A

Sjogrens
SLE
RA
Sarcoidosis

44
Q

Cotton wool spots, CMV retinitis, and kaposi sarcoma of the eylids are the most common complications all associated with which disease?

A

AIDS

45
Q

what is the leading cause of visual loss in patients with AIDS?

A

CMV retinitis (only takes weeks to months)

46
Q

what eye disease develops from untreated congenital syphilis?

A

acute interstitial keratitis with uveitis

usually between 5 and 25 years old and bilateral if congenital and unilateral if aquired

47
Q

what should you do if you suspect syphilitic uveitis?

A

check spinal fluid

48
Q

what causes a fluffy white to yellow superficial retinal infiltrate that can lead to an overlying vitrious haze and eventual viritis?

A

candida infection of the eye. This is common along with herpes zoster.

49
Q

what do you give to treat candidiasis of the eye? 2x

A

amphoteracin B or voriconazole

50
Q

what is hutchinsons sign?

A

Vesicles on the tip of the nose, or vesicles on the side of the nose, precedes the development of ophthalmic herpes zoster.

51
Q

T/F Herpes zoster can cause anterior uveitis without the associated skin lesions?

A

true

52
Q

what is the most common cause of unilateral proptosis?

A

thyroid disease just like in bilateral proptosis

53
Q

You have a guy with HIV and hemorrhage, what is the #1 cause of this?

A

CMV (candida and toxo are also common with HIV but usually do not present with hemorrhage)

54
Q

T/F Glaucoma is asymptomatic in most patients until it is very advanced?

A

True

55
Q

What are the disadvantages of having glaucoma in African americans.

A

Higher prevalence
earlier onset
more difficult to treat
8X as much blindness

56
Q

vertical lengthening of the cup on the optic nerve means what? (Vertical Cupping)

A

pathological! most likely Glaucoma

57
Q

what causes congenital glaucoma?

A

failure of trabecular meshwork to develop.

58
Q

If you see big eyes and cloudy corneas in a baby, what should you think and not miss?

A

congenital glaucoma

59
Q

who is at highest risk for acute glaucoma?

A

hyperopics
Asians
elderly

60
Q

what are the two anesthetics used for the eye?

A

Proparacaine

Tetracaine

61
Q

which 3 drugs are frequently used in optho for mydriatics and work by blocking cholinergic receptors?

A

Tropicamide
Cyclopentolate
Homatropine

62
Q

which drug is an andrenegric stimulating drug that is used as a mydriatic?

A

Phenylephrine

63
Q

what is declofenac?

A

NSAID

64
Q

what is Ketorolac?

A

NSAID

65
Q

T/F anti cholinergic drugs not only cause mydriasis but also cycloplegia?

A

true

66
Q

T/F mydriatics are more effective in people with blue eyes compared to those with brown eyes?

A

True

67
Q

what are the 3 major sypathomimetic drugs used to reduce eye injection?

A

Naphazoline
Phenylephrine
Tetrahydrozaline

68
Q

what is triflurdine used for?

A

treating opthalmic herpes simplex (not zoster)

69
Q

How do beta blockers reduce ocular pressure?

A

Reduces aqueous humor produced by the ciliary body

70
Q

what is levobunolol?

A

Beta blocker (1 &2)

71
Q

what is Cartenolol?

A

Beta blocker (1 &2)

72
Q

why is Betaxolol different from the other beta blockers?

A

It is Beta 1 selective so it doesn’t have the pulmonary side effects

73
Q

what is pilocarpine and how does it work on the eye?

A

cholinergic stimulating drug increases aqueous outflow by causing the iris to constrict. (also lacrimation, salivation, perspiration, nausea)

74
Q

what is brimonidine?

A

alpha 2 agonist that lowers IOP by decreasing aqueous production and increasing aqueous outflow

75
Q

what is apraclonidine and what does it do?

A

alpha 1 and 2 agonist that decreased IOP by decreasing aqueous production and increasing aqueous outflow

76
Q

How do prostaglandins help with glaucoma?

A

they increase outflow through the trabecular meshwork

77
Q

what is latanoprost?

A

prostaglandin

78
Q

How do you identify prostaglandins?

A

-prost suffix (bimatoprost, travoprost)

79
Q

what are the only drugs used for long term glaucoma treatment?

A

CA inhibitors

80
Q

what are the 3 most common Carbonic anhydride inhibitors?

A

Acetazolamide
Methazolamide
Dichlorphenamide

81
Q

what are Droxolamide and brinzolamide?

A

topical CA inhibitors

82
Q

amioderone has what effect on the eye?

A

decreased vision
bilateral optic disc swelling
pigmented deposits on cornea

83
Q

bisphosphonates have what effect on the eye? (-dronates)

A

conjunctivitis
scleritis
uveitis

84
Q

chloroquines (originally for malaria) are also used to treat RA, SLE, ect. What effects does it have on the eye?

A

corneal deposits and retinopathy

85
Q

corticosteroids to what to the lens?

A

cause posterior capsule cateracts

86
Q

What does ethambutol do to vision?

A

red/green color blindness and permanent visual loss

87
Q

what is Rifabutin? what does it do to the eyes?

A

Antiviral med used for mycobacterium avium complex.

Can cause severe uveitis.

88
Q

what is Tadalifil? Vardenafil?

A

same as Sildenafil (phosphodiesterase 5 inhibitor)

89
Q

what causes intraoperative floppy iris syndrome?

A

Tamsulosin (alpha 1 antagonist) not reversed when stopped.

90
Q

What does topiramate do to the eye?

A

It can cause bilateral angle closure glaucoma because of ciliary body swelling

Opthamology rotation (2 decks)

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