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Retina Flashcards

0
Q

3 Etdrs criteria for csme

A
  1. Thickening wi 500 microns of fovea
  2. Exudates wi 500 microns of fovea ass w thickening
  3. Thickening of 1DD wi 1DD of fovea
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1
Q

Choroidal melanoma risk factors

To find small ocular melanoma usinghelpful hints daily

A 
Thickness > 2mm
Fluid (srf)
Symptoms
Orange pigment
Margin next to onh
Ultrasound Hollowness
Halo none
Drusen none
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2
Q

What were the 2 main findings of the etdrs?

A
  1. Asa does not effect progression of dr

2. Early rx of csme w focal laser decr vision loss by 50%

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3
Q

How does kenalog rx dme?

A
  1. Inhibits release of vegf and tnf

2. Stabilizes endothelial tight jxns so theres less leakage

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4
Q

Name 3 types of high risk pdr (acc to the drs which looked at risk factors for va losa)

A
  1. Nvd w vh
  2. Nvd 1/3 dd wo vh
  3. Nve 1/2 dd in size w vh
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5
Q

What did the diabetic vitrectomy study show?

A

Early (1-6 mo) rx of vh in type 1 dm is beneficial

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6
Q

What did the drcr.net show? (Diabetic retinopathy clinical research network)

A

A) @ 2 yrs focal laser worked better than both 1mg or 4 mg of kenalog for csme
B) laser +lucentis = laser + kenalog for DME
C) laser + lucentis better than laser alone

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7
Q

What causes vmt?

A

Incomplete pvd from macula

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8
Q

Whats synchesis?

A

Separation of postrior hyaloid from ilm

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9
Q

What were the prp settings in the drs?

A

500 spot size
0.1 sec
1200 burns

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10
Q

Whats the triad in lofgrens syndrome and who does is affect?

A
  1. Hilar lymphadenop
  2. Erythema nodosum
  3. Iritis

Scandanavian women
Type of sarcoid syndrome

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11
Q

Whats the triad of heerfordts syndrome

A
  1. Parotid swelling
  2. Cn7 palsy
  3. Iritis

Type of sarcoid syndrome

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12
Q

Monofocal subretinal lesion think cause is…

A

Infectious

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13
Q

When there are multifocal subretinal lesions cause is likely

A

Inflammatory

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14
Q

Bad thing associated with appmpe?

A

Cerebral vasculitis

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15
Q

Whats another name for goldman-favre dz and what are the findings?

A

Enhanced s cone syndrome

  1. Cme
  2. No rod fxn
  3. Too many blue cones
  4. Not enough red and green cones
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16
Q

Angiod streaks

Pepsi

A 
Pagets
Ehlers danlos
Pseudoxanthoma elasticum
Sickle cell
Ideopathic
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17
Q

Whats another name for the bestrophin gene and what chromosome is it on?

A

Vmd2

Chrom 11

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18
Q

Whats the eog and arden ratio in bests?

A

Abnormal

Arden ratio <1:5

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19
Q

Fa findings in crvo

A

Delayed av transit time >20 secs
Late staining of veins
Cap dropout if ischemic

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20
Q

Whats the tyndall effect?

A

Scattering of light through particles in a colloid (mix of oil in water)

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21
Q

what’s the ellipsoid layer on OCT?

A

The IS/OS jxn (white line)

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22
Q

whats the max daily dose of plaquenil to prevent toxicity?

A

6.5 mg/kg

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23
Q

what % of pple w lattice will dev RD?

A

1%

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24
Q

what % of pple w RD have lattice?

A

20-30%

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25
Q

meridional fold- needs laser?

A

yes

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26
Q

whats the wavelength of argon green?

A

510nm

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27
Q

Whats the ddx of pigmentary retinopathy and deafness?

A

Rubella vs ushers

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28
Q

Calcaflour white stain- for what?

A

Acanthomeba

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29
Q

which type of rp has the worst prognosis?

A

x-linked

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30
Q

which type of rp has the best prognosis?

A

AD

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31
Q

Whats the ERG pattern in CSNB?

A

negative ERG (B wave never comes up- it stays down)

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32
Q

what type of dystrophy is RP?

A

ROD-CONE (not the opposite- in these dystrophies the predominant cell loss is named first)

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33
Q

whats the VF defect in RP?

A

ring scotoma bc rods die first and they are in the periphery

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34
Q

whats the chance that a choroidal nevus will transform into a melanoma over 10 years?

A

50%

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35
Q

what % of rp is sporadic?

A

50%

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36
Q

whats the axon of the ganglions cells called?

A

the RNFL

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37
Q

what do the bipolar cells do?

A

they connect PR to upper layer axons

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38
Q

2 main causes of inflammation of retinal veins

A

sarcoid

eales dz

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39
Q

whats RP inversus?

A

RP in which vision loss starts centrally

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40
Q

whats retinitis punctata albescens (RPA)

A

RP with post-equatorial white dots

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41
Q

what is the cause of hunters, hurlers, sanfillipo and schie syndromes?

A

elevated heparin sulfate (the dz start w “HS” and the cause starts w “HS”)

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42
Q

What is the retina findings in hunters, hurlers, sanfillipo, scheie syndrome?

A

RP variants

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43
Q

Whats kerns-sayre, whats the inheritance and what other eye prob is it ass with?

A

CPEO with pig retinopathy
A-V heart block
CPEO
Mitochondrial

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44
Q

what causes deafness in ushers?

A

Defect in the organ of corti (its in the choclea- has been a board question before!)

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45
Q

whats the inheritance of ushers?

A

AR

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46
Q

inherited chorioretinal dystrophies inheritance pattern is most commonly….

A

AR- if you don’t know it guess AR

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47
Q

Bassen-Korszweig dz- inheritance, symptoms, how to rule-out, how to treat?

A

AR
Decr vision (RP-like) 2/2 no vit A
serum protein electrophoresis
supplement w vit A,D,E,K

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48
Q

Whats refsums disease-inheritance, symptoms, eye finings why is it important? (bc its treatable!)

A 
AR
ischthyosis, 
deficiency in phytanic acid
RP changes
restrict phytanic acid (milk, meats, leafy greens)
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49
Q

LCA- inheritance, eye findings, symptoms, appearance of disc

A

AR
RP variant that occurs in kids
poor vision since birth
waxy pallor

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50
Q

Batten disease- inher, symptoms, eye findings,

A

AR
RP variant
MR, seizures

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51
Q

Alstrom syndrome- inheritance pattern, systemic finding, eye finding

A

AR
deafness
Rod-cone dystrophy

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52
Q

Bardet-Biedl- inher pattrn, systemic findings, eye findings

A

AR
polydactyl, short, fat
RP s bone spicules

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53
Q

How is Laurence-moon different from Bardet Biedl?

A

same retinal findings plus choroidal atrophy and no syndactyly

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54
Q

how much vitamin A (PALMATATE!) do you give in RP?

A

15,000 U/day

need to check LFTs

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55
Q

What vitamin should pple w RP avoid?

A

vitamin E (bc inhibits absoption of vit A)

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56
Q

What are the fat soluble vitamins

A

a,d,e,k

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57
Q

choroidemia - inher pattern

A

x-linked, rod-cone dystrophy

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58
Q

why does cone-rod dystrophy have a bulls-eye appearance>

A

bc all the cones are concentrated in the macula!

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59
Q

whats the erg in fundus flavimaculatis?

A

aka stargarts
normal erg early
abnormal erg late

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60
Q

gyrate atrophy- inher pattern, defect in which enzyme, looks like what type of dancer, how to treat

A

AR
defet in ornithine aminotransferase
think of the whirling dervishes like white circles
appearance of the retina is “islands that grow together” scalloped border, myopia, psc
restrict arginine (proteins) and give B6

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61
Q

whats the inheritance of stargardts?

A

AR

62
Q

whats the gene for bests?

A

VMD2
chromosome 11
coding bestrophin

63
Q

whats the visual prognosis in bests?

A

20/40 unless dev cnv

64
Q

whats the arden ratio in bests?

A

abnormal

<1.5

65
Q

whats retinitis punctata albescens? (RPA)

A

type of RP with white dots in post-equatorial zone

see waxy pallor of disc

66
Q

fundus albipunctatis- inher pattern, a subtype of what dz, erg finding in light, erg finding in dark

A 
AR
subtype of CSNB w white dots everywhere
severe nyctalopia
abnormal ERG in light
normal ERG after being in dark for a while
67
Q

oguchi dz- inher pattern, subtype of what, symptom, pathognomonic sign

A

AR
CSNB
nyctalopia
mizuo-nakamura phenomenon- normal appearance of fundus in dark, but upon flash of light fundus appears green

68
Q

whats a fuchs spot in myopia (aka forster fuchs spot)

A

area of pigmentation within atrophy corresponding to break in bruchs- bad sign for dev of cnv

69
Q

x-linked retinoschisis- wheres the splitting, whats the cause, what part of retina in involved most?

A

RNFL
Fucked up muller cells- poor adhesion of retina to itself
macula effected most

70
Q

whats the other name of goldmann favre disease?

A

enhanced s-cone syndrome

71
Q

what are the findings in enhanced s cone syndrome?

A

nyctalopia
increased sensitivity to blue light
lesions along the arcades
ERG markedly abnormal

72
Q

whats the inheritance in FEVR?

A

AD

73
Q

Why do you get VH in X linked retinoschisis?

A

bc the thin split NFL have the retinal vessels in them and they can break and bleed

74
Q

what causes cholesterolosis bulbi?

A

recurrent VH, trauma

crystals typically settle to the bottom

75
Q

parent w unilat RB has a child w unilateral RB whats the chance the next kid will have unilat RB?

A

30%

76
Q

parent had RB OU, has kid w no RB whats the chance the next kid could have RB?

A

45%

77
Q

what type of scotoma is caused by schisis

A

absolute

78
Q

whats the sign in sticklers

A

optically empty vitreous

79
Q

whats SF6 in real words?

A

sulfer hexaflouride

80
Q

whats c3f8 in real words

A

perfluoro propane

81
Q

how long does ozurdex last?

A

6 months

82
Q

what did the DRS define?

A

it defined high risk PDR- ie whos likely to bleed nd determined that these pple need PRP!

a) any NVD w VH
b) NVD >1/3 DD
c) NVE >1/2 DD + VH

83
Q

What did the DCCT show?

A

Intensive treatment of DM1 with insulin delays onset of retinopathy

84
Q

WHAT IS THE UNIVERSAL FINDING IN ALL TISSUES IN THE EYE IN DIABETES?

A

BM THICKENING (VERY FIRST SIGN OF DM IN EYE)

85
Q

What finding might you find in the angle in a pt who had a crvo a while ago?

A

PAS

86
Q

how is ICG metabolized?

A

liver

87
Q

what substance is responsible for the fluorescence of the retina?

A

lipofuscin

88
Q

what % of pple will get a cataract s/p ppv wi 2 yrs

A

90%

89
Q

whats the definition of pathological myopia

A

myopia >-8

AL >32.5

90
Q

whats the pathology in CSNB

A

PR are ok but connective/glial cells are sick therefore nrmal A wave but negative B wave

91
Q

how does dusn present?

A

neuroretinitis
choroiditis
mild vitritis
fry the worm

92
Q

ocriplasmin works for vmt in what % of eyes?

A

25%

93
Q

whats the inheritance pattern of tritanopia?

A

AD

94
Q

whats the inher pattern of deuteranopia?

A

x-linked recessive

95
Q

if there is papilledema in HTN retinopathy, what grade is it?

A

grade 4 (worst)

96
Q

what drug need to avoid in SS?

A

CAI

97
Q

Who gets macroanuerysms most? males or females?

A

females

98
Q

why do we observe MA first?

A

b/c its on the arterial side of the circulation, may spontaneously thrombose

99
Q

what dz is eales connected to?

A

TB

100
Q

BRVO Risks

A

HTN
Atherosclerosis
Age >50
Glaucoma (higher IOP presses on crossing)

101
Q

what are the 5 stages of ROP?

A

1) demarcation line
2) demarcation line w elevation
3) popcorn/hotdogs (fibrovascular prolif)
4) Subtotal detachment a) extrafoveal b) foveal
5) Total RD

102
Q

CRVO risks

A

**DM2**
HTN
Atherosclerosis
Glaucoma

103
Q

whats the definition of threshold disease (as est in the CRYO-ROP trial in 1988?

A

any 8 clock hours (or 5 contiguous clock hours) of stage 3 ROP in zones 1 or 2 with plus dz

104
Q

how does erm cause binocular diplopa?

A

macular dragging

105
Q

the Geneva study looked at ozurdex for cme in brvo and crvo vs. what?

A

sham injections

106
Q

what cells are attacked in MAR?

A

bipolar cells in inner nuclear layer

107
Q

how do you treat toxocara?

A

steroids and it is self limited.

anti-helminthic agents don’t work well

108
Q

whats “very severe” NPDR according to the ETDRS?

A

Having >2 criteria from the 4-2-1 rule

109
Q

whats the chance of severe npdr turning into pdr in 1 yr

A

15%

110
Q

whats the risk of very severe npdr turning into pdr at 1 year?

A

45%

111
Q

Does cystinosis cause decreased vision, and when do you see retinopathy w cystinosis

A

retinopathy only when the kidneys are effected

cystinosis does NOT effect vision

112
Q

ddx for crystaline retinopathy

“Too Many Nits BE”

A 
Tamoxifen
Mellaril
Nitrofuratoin
Bietti
Etha;yne glycol
113
Q

ganglioside GM2

A

tay-sachs

114
Q

BMI is a risk factor for which type of vein occlusion?

A

BRVO

115
Q

According to the BVOS when should you do PRP

A

When theres neo

NOT based on # of clock hrs of ischemia

116
Q

what constitutes the outer blood eye barrier?

A

RPE

117
Q

Whats the gene for familial amyloidosis and how does it present in the vitreous

A

transthiretin

vitreous opacities

118
Q

what is transpupillary thermotherapy used for?

A

flat choroidal melanomas

119
Q

whats the excitation light wavelength, flourescein floureses at what wavelength and what color is the filter

A

460-490 nm
520-530 nm
yellow-green
(the newborn wakes up at 4:30, you get them at 530 and their poop is yellow-green)

120
Q

are wyburn-mason retinal angiomatosis lesions hereditary? and where else can they be?

A

sporadic

can have a-v malformations in the brain.

121
Q

what has “leopard spot” pattern on FA?

A

BDUMP- paraneoplastic 2/2 lung/ovarian ca
or
uveal effusion syndrome (2/2 transient thickened sclera)

122
Q

what does “fixed retinal folds” imply?

A

PVR

123
Q

PDT works best on what type of neo?

A

type 2

124
Q

what did MARINA look at?

A

lucentis vs pdt for MINIMALLY classic (ie occult) cnv

125
Q

what did anChor look at?

A

lucentis vs pdt for CLASSIC cnv

126
Q

which type of lens give a 1:1 mag of the retina?

A

super 66

128
Q

what does monochromatism mean? Ie rod monochromatism?

A

that that PR type is the only one they have

ie rod monochromatism- only have rods

129
Q

how is rod monochromatism inherited?

A

AR

130
Q

how is blue cone monochromatism inherited?

A

x-linked recessive

131
Q

amd risk factors

A 
smoking
blue eyes
hyperopia
htn
hld
132
Q

in high myopes which muscle might slip causing strabismus?

A

lateral rectus- causing eso

133
Q

azoor- who gets it? initial presentation uni vs bilateral? fundus appearance, any prodrome?

A 
women 30s- unilateral; men- bilateral
initial presentation- photopsias and vit cell
gets bone spiculing later
marked depression on mfERG
flu prodrome
vf defects
134
Q

SE of intravitreal aminoglycosides

A

macular ischemia

135
Q

CAR vs MAR- which cells effected?

A

CAR- cones AND rods

MAR- rods only

136
Q

most common malignancy ass w CAR?

A

scc of lung

137
Q

incontinentia pigmenti- inheritance, skin finding, retinal finding

A

X-linked dominant (therefore lethal in males)
skin bullae
retina similar to ROP

138
Q

Whats another name for incontinentia pigmenti?

A

bloch-sulzberger syndrome

139
Q

where are pohs lesions usually located?

A

mid-periphery

140
Q

Fabrys dz what enzyme is deficient?

A

alpha-galactosidase A (fabRAY “A”)

141
Q

Tay sachs enzyme deficient

A

hexosaminidase A (cherry red spot) (sacks of hey -hexamine-A)

142
Q

gauchers dz enzyme deficient

A

glucose cerebrosidase

white spots in retina

143
Q

neimann pick enzyme deficieny

A

sphingomylinase (don’t pick your nose with your sphinger) cherry red pot

144
Q

What laser spot size increases risk for cnv?

A

small spot size

145
Q

how many degrees of field does amsler test?

A

20 degrees

146
Q

what did the cruise study show

A

crvo w cme rx w iva x 6 mo do better than sham

147
Q

what are the risk factors for suprachoroidal heme?

A 
old age
atherosclerosis
myopia
aphakia
HTN
148
Q

Why is the erg the way it is in csnb?

A

Bc the dz effects bipolar cells and there is poor transmission to the inner retina therefore normal a but shitty b wave

149
Q

What cells make up the outer nuclear layer?

A

Cell bodies of the pr

150
Q

What cells make up the inner nuclear layer?

A

Bipolar and horizontal cella

151
Q

What did the maritime themed studies look at?

A

Safety and efficacy of lucentis , esp as compared to pdt

152
Q

yag increases your chance for RD by how much?

A

4x

153
Q

high myope s/p CE, at 7 years out, whats the % chance he dev rd?

A

8%

154
Q

bietti vs cystinosis

A

bietti- AR, decr ERG, corneal crystals

cystinosis- lysosymal storage disorder, occurs in cornea when it effects kidney, not visually significant

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