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BOARDS2: ONH/neuro > Painful Vision Loss > Flashcards

Painful Vision Loss Flashcards

1
Q

DiffDx for painful vision loss: cornea

A

Abrasion and ulcers

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2
Q

DiffDx for painful vision loss: AC

A

Uveitis

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3
Q

DiffDx for painful vision loss: lens

A

Subluxation d/t trauma

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4
Q

DiffDx for painful vision loss: vit

A

Vitritis

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5
Q

DiffDx for painful vision loss: Mac

A

Choroidal rupture from trauma

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6
Q

DIffDx for painful vision loss retina

A

RD from trauma

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7
Q

DiffDx of painful vision loss: ONH

A

Optic neuritis, GCA

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8
Q

Things that cause pain on eye movement

A

DED
Scleritis
Optic neuritis

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9
Q

Classic example of optic neuritis

A

Young female patient with sudden onset, unilateral vision loss (2/20 to NLP) and pain on EOMs

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10
Q

What is optic neuritis

A

Primary inflammation of the optic nerve. Will present with an APD, decreased perceived brightness on brightness comparison test, decreased contrast sensitivity, and VF defects

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11
Q

Vision after initial episode of optic neuritis

A

VA returns to near normal or normal over the course of 2-4 weeks, although most patients will have reduced contrast sensitivity and optic nerve pallor

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12
Q

Brightness comparison test

A

Often abnormal with unilateral or asymmetric optic neuropathies

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13
Q

What is optic neuritis associated with

A

MS. The 15 year risk of developing MS after an isolated episode of optic neuritis is appx 50% (75% if one or more white matter lesions are present on an MRI and 25% if there are no white matter lesions on an MRI

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14
Q

What is the ONTT

A

A study that says an MRI should be considered for patients who present with acute optic neuritis in order to determine the patient’s risk of developing MS, as well as the need for treatment with IV steroids and/or interferon beta

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15
Q

Is an MRI necessary to confirm the diagnosis of MS

A

No

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16
Q

Symptoms suggestive of MS

A

Uhthoffs phenomenon
Lhermittes phenomenon
INO

17
Q

Uhtoffs

A

Transient vision loss that occurs in response to an increase in body temperature (after exercise); although it only occurs in 6% of patients, it is considered highly characteristic of MS

18
Q

Lhermittes phenomenon

A

The sensation of an electric chock that quickly travels down the back and into the limbs with flexure of the neck; occurs in 30-40% of MS patients

19
Q

INO

A

Characterized by a lack of adduction on the affected side with contralateral nystagmus on abduction. It occurs due to an MS lesion in the MLF

R INO=R adduction problem with L nystagmus

20
Q

Bialteral INO

A

Considered highly suggestive of MS; an estimated 15-30% of patient with MS present with bilateral INO

21
Q

Overview of optic neuritis

A
  • sudden painful vision loss
  • VA can range from 20/20 to HM
  • vision usually gets better over 3 week period
  • Be aware of others (ex atypical optic neuritis) where VA does not improve
  • order MRI to evaluate risk of MS
  • Tx is IV steroids
22
Q

Things other than MS that can cause optic neuritis

A 
Idiopathic 
Syphilis 
Cat scratch 
Lyme 
Meningitis 
Sarcoidosis 
SLE 
Devics
23
Q

Devic’s disease (neuromyelitis optica)

A

Bialteral demyelinating disease characterized by optic neuritis and transverse myelitis; commonly found in children, and will not have white matter lesions prestn on an MRI

MS meds actually make this worse

24
Q

Types of optic neuritis with MS

A

Papillitis
-secondary to inflammation of the anterior optic nerve and will present with disc edema (1/3 of cases)

Retrobulbar optic neuritis
-secondary to posterior inflammation of the optic nerve (2/3 of cases); the optic nerve will appear normal, but the patient will still have an APD, decreased VA, and decreased contrast sensitivity

25
Q

AAION

A

Secondary to occlusion of the SPCA, most commonly due to GCA, a systemic vasculitis of the medium and large blood vessels. Recall that AAION occurs in patietns >55. Will likely have an elevated ESR and CRP and elevated platelets

26
Q

Normal ESR for females

A

< (age+10)/2

27
Q

Normal ESR for men

A

< age/2

28
Q

Normal CRP

A

0-1 mg/dL

CRP?2.45 is associated with a 3x greater risk of GCA

29
Q

Normal platelets

A

<400,000

30
Q

Lebers optic neuropathy

A

Hereditary condition that occurs from mutations in the mitochondrial DNA that are inherited from the mother. 85% are males, with an onset in the late teens to early 20s. The condition most commonly begins in one eye with a sudden onset decreased VA, before occurring in the other eye.

  • early signs include: optic disc edema, disc hyperemia, and telangiectatic vessels on the surface of the ONH
  • late signs include optic disc atrophy

The condition may spontaneously improve in appx 35% of cases. There is no treatment.

31
Q

Optic nerve sheath meningioma

A

Most common in young to middle aged women; they are generally benign, unilateral tumors that restful in compression of the optic nerve with resulting optic disc edema, followed by optic atrophy and progressive vision loss. Treatment includes observation, radiation, and/or surgery. An MRI will detect the presence of an optic nerve cheats meningioma

32
Q

ONTT and treatment for MS

A

IV steroids = oral taper

-oral pred does not improve final VA or speed up recovery and is associated with a higher risk of recurrence

33
Q

CHAMPs study

A

Treatment with IV steroids + Avenova reduces the risk of development of MS from 50-35% over 3 years

34
Q

Treatment based on ONTT and CHAMPS

A

Consider IV steroids (followed by an oral taper) + Avenova in patients with an acute episode of unilateral optic neuritis with at least 2 white matter lesions on a baseline MRI in order to reduce the risk of progression to MS

35
Q

Optic nerve pallor in MS associated optic neuritis

A

Becomes pale 4-6 weeks after initial incident

36
Q

Why might someone with MS complain of diplopia

A

INO

BOARDS2: ONH/neuro (7 decks)

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