Retina Flashcards
0
Q
3 Etdrs criteria for csme
A
- Thickening wi 500 microns of fovea
- Exudates wi 500 microns of fovea ass w thickening
- Thickening of 1DD wi 1DD of fovea
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
2
Q
What were the 2 main findings of the etdrs?
A
- Asa does not effect progression of dr
2. Early rx of csme w focal laser decr vision loss by 50%
3
Q
How does kenalog rx dme?
A
- Inhibits release of vegf and tnf
2. Stabilizes endothelial tight jxns so theres less leakage
4
Q
Name 3 types of high risk pdr (acc to the drs which looked at risk factors for va losa)
A
- Nvd w vh
- Nvd 1/3 dd wo vh
- Nve 1/2 dd in size w vh
5
Q
What did the diabetic vitrectomy study show?
A
Early (1-6 mo) rx of vh in type 1 dm is beneficial
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
7
Q
What causes vmt?
A
Incomplete pvd from macula
8
Q
Whats synchesis?
A
Separation of postrior hyaloid from ilm
9
Q
What were the prp settings in the drs?
A
500 spot size
0.1 sec
1200 burns
10
Q
Whats the triad in lofgrens syndrome and who does is affect?
A
- Hilar lymphadenop
- Erythema nodosum
- Iritis
Scandanavian women
Type of sarcoid syndrome
11
Q
Whats the triad of heerfordts syndrome
A
- Parotid swelling
- Cn7 palsy
- Iritis
Type of sarcoid syndrome
12
Q
Monofocal subretinal lesion think cause is…
A
Infectious
13
Q
When there are multifocal subretinal lesions cause is likely
A
Inflammatory
14
Q
Bad thing associated with appmpe?
A
Cerebral vasculitis
15
Q
Whats another name for goldman-favre dz and what are the findings?
A
Enhanced s cone syndrome
- Cme
- No rod fxn
- Too many blue cones
- Not enough red and green cones
16
Q
Angiod streaks
Pepsi
A
Pagets Ehlers danlos Pseudoxanthoma elasticum Sickle cell Ideopathic
17
Q
Whats another name for the bestrophin gene and what chromosome is it on?
A
Vmd2
Chrom 11
18
Q
Whats the eog and arden ratio in bests?
A
Abnormal
Arden ratio <1:5
19
Q
Fa findings in crvo
A
Delayed av transit time >20 secs
Late staining of veins
Cap dropout if ischemic
20
Q
Whats the tyndall effect?
A
Scattering of light through particles in a colloid (mix of oil in water)
21
Q
what’s the ellipsoid layer on OCT?
A
The IS/OS jxn (white line)
22
Q
whats the max daily dose of plaquenil to prevent toxicity?
A
6.5 mg/kg
23
Q
what % of pple w lattice will dev RD?
A
1%
24
what % of pple w RD have lattice?
20-30%
25
meridional fold- needs laser?
yes
26
whats the wavelength of argon green?
510nm
27
Whats the ddx of pigmentary retinopathy and deafness?
Rubella vs ushers
28
Calcaflour white stain- for what?
Acanthomeba
29
which type of rp has the worst prognosis?
x-linked
30
which type of rp has the best prognosis?
AD
31
Whats the ERG pattern in CSNB?
negative ERG (B wave never comes up- it stays down)
32
what type of dystrophy is RP?
ROD-CONE (not the opposite- in these dystrophies the predominant cell loss is named first)
33
whats the VF defect in RP?
ring scotoma bc rods die first and they are in the periphery
34
whats the chance that a choroidal nevus will transform into a melanoma over 10 years?
50%
35
what % of rp is sporadic?
50%
36
whats the axon of the ganglions cells called?
the RNFL
37
what do the bipolar cells do?
they connect PR to upper layer axons
38
2 main causes of inflammation of retinal veins
sarcoid
| eales dz
39
whats RP inversus?
RP in which vision loss starts centrally
40
whats retinitis punctata albescens (RPA)
RP with post-equatorial white dots
41
what is the cause of hunters, hurlers, sanfillipo and schie syndromes?
elevated heparin sulfate (the dz start w "HS" and the cause starts w "HS")
42
What is the retina findings in hunters, hurlers, sanfillipo, scheie syndrome?
RP variants
43
Whats kerns-sayre, whats the inheritance and what other eye prob is it ass with?
CPEO with pig retinopathy
A-V heart block
CPEO
Mitochondrial
44
what causes deafness in ushers?
Defect in the organ of corti (its in the choclea- has been a board question before!)
45
whats the inheritance of ushers?
AR
46
inherited chorioretinal dystrophies inheritance pattern is most commonly....
AR- if you don't know it guess AR
47
Bassen-Korszweig dz- inheritance, symptoms, how to rule-out, how to treat?
AR
Decr vision (RP-like) 2/2 no vit A
serum protein electrophoresis
supplement w vit A,D,E,K
48
Whats refsums disease-inheritance, symptoms, eye finings why is it important? (bc its treatable!)
```
AR
ischthyosis,
deficiency in phytanic acid
RP changes
restrict phytanic acid (milk, meats, leafy greens)
```
49
LCA- inheritance, eye findings, symptoms, appearance of disc
AR
RP variant that occurs in kids
poor vision since birth
waxy pallor
50
Batten disease- inher, symptoms, eye findings,
AR
RP variant
MR, seizures
51
Alstrom syndrome- inheritance pattern, systemic finding, eye finding
AR
deafness
Rod-cone dystrophy
52
Bardet-Biedl- inher pattrn, systemic findings, eye findings
AR
polydactyl, short, fat
RP s bone spicules
53
How is Laurence-moon different from Bardet Biedl?
same retinal findings plus choroidal atrophy and no syndactyly
54
how much vitamin A (PALMATATE!) do you give in RP?
15,000 U/day
| need to check LFTs
55
What vitamin should pple w RP avoid?
vitamin E (bc inhibits absoption of vit A)
56
What are the fat soluble vitamins
a,d,e,k
57
choroidemia - inher pattern
x-linked, rod-cone dystrophy
58
why does cone-rod dystrophy have a bulls-eye appearance>
bc all the cones are concentrated in the macula!
59
whats the erg in fundus flavimaculatis?
aka stargarts
normal erg early
abnormal erg late
60
gyrate atrophy- inher pattern, defect in which enzyme, looks like what type of dancer, how to treat
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
61
whats the inheritance of stargardts?
AR
62
whats the gene for bests?
VMD2
chromosome 11
coding bestrophin
63
whats the visual prognosis in bests?
20/40 unless dev cnv
64
whats the arden ratio in bests?
abnormal
| <1.5
65
whats retinitis punctata albescens? (RPA)
type of RP with white dots in post-equatorial zone
| see waxy pallor of disc
66
fundus albipunctatis- inher pattern, a subtype of what dz, erg finding in light, erg finding in dark
```
AR
subtype of CSNB w white dots everywhere
severe nyctalopia
abnormal ERG in light
normal ERG after being in dark for a while
```
67
oguchi dz- inher pattern, subtype of what, symptom, pathognomonic sign
AR
CSNB
nyctalopia
mizuo-nakamura phenomenon- normal appearance of fundus in dark, but upon flash of light fundus appears green
68
whats a fuchs spot in myopia (aka forster fuchs spot)
area of pigmentation within atrophy corresponding to break in bruchs- bad sign for dev of cnv
69
x-linked retinoschisis- wheres the splitting, whats the cause, what part of retina in involved most?
RNFL
Fucked up muller cells- poor adhesion of retina to itself
macula effected most
70
whats the other name of goldmann favre disease?
enhanced s-cone syndrome
71
what are the findings in enhanced s cone syndrome?
nyctalopia
increased sensitivity to blue light
lesions along the arcades
ERG markedly abnormal
72
whats the inheritance in FEVR?
AD
73
Why do you get VH in X linked retinoschisis?
bc the thin split NFL have the retinal vessels in them and they can break and bleed
74
what causes cholesterolosis bulbi?
recurrent VH, trauma
| crystals typically settle to the bottom
75
parent w unilat RB has a child w unilateral RB whats the chance the next kid will have unilat RB?
30%
76
parent had RB OU, has kid w no RB whats the chance the next kid could have RB?
45%
77
what type of scotoma is caused by schisis
absolute
78
whats the sign in sticklers
optically empty vitreous
79
whats SF6 in real words?
sulfer hexaflouride
80
whats c3f8 in real words
perfluoro propane
81
how long does ozurdex last?
6 months
82
what did the DRS define?
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
What did the DCCT show?
Intensive treatment of DM1 with insulin delays onset of retinopathy
84
WHAT IS THE UNIVERSAL FINDING IN ALL TISSUES IN THE EYE IN DIABETES?
BM THICKENING (VERY FIRST SIGN OF DM IN EYE)
85
What finding might you find in the angle in a pt who had a crvo a while ago?
PAS
86
how is ICG metabolized?
liver
87
what substance is responsible for the fluorescence of the retina?
lipofuscin
88
what % of pple will get a cataract s/p ppv wi 2 yrs
90%
89
whats the definition of pathological myopia
myopia >-8
| AL >32.5
90
whats the pathology in CSNB
PR are ok but connective/glial cells are sick therefore nrmal A wave but negative B wave
91
how does dusn present?
neuroretinitis
choroiditis
mild vitritis
fry the worm
92
ocriplasmin works for vmt in what % of eyes?
25%
93
whats the inheritance pattern of tritanopia?
AD
94
whats the inher pattern of deuteranopia?
x-linked recessive
95
if there is papilledema in HTN retinopathy, what grade is it?
grade 4 (worst)
96
what drug need to avoid in SS?
CAI
97
Who gets macroanuerysms most? males or females?
females
98
why do we observe MA first?
b/c its on the arterial side of the circulation, may spontaneously thrombose
99
what dz is eales connected to?
TB
100
BRVO Risks
HTN
Atherosclerosis
Age >50
Glaucoma (higher IOP presses on crossing)
101
what are the 5 stages of ROP?
1) demarcation line
2) demarcation line w elevation
3) popcorn/hotdogs (fibrovascular prolif)
4) Subtotal detachment a) extrafoveal b) foveal
5) Total RD
102
CRVO risks
******DM2******
HTN
Atherosclerosis
Glaucoma
103
whats the definition of threshold disease (as est in the CRYO-ROP trial in 1988?
any 8 clock hours (or 5 contiguous clock hours) of stage 3 ROP in zones 1 or 2 with plus dz
104
how does erm cause binocular diplopa?
macular dragging
105
the Geneva study looked at ozurdex for cme in brvo and crvo vs. what?
sham injections
106
what cells are attacked in MAR?
bipolar cells in inner nuclear layer
107
how do you treat toxocara?
steroids and it is self limited.
| anti-helminthic agents don't work well
108
whats "very severe" NPDR according to the ETDRS?
Having >2 criteria from the 4-2-1 rule
109
whats the chance of severe npdr turning into pdr in 1 yr
15%
110
whats the risk of very severe npdr turning into pdr at 1 year?
45%
111
Does cystinosis cause decreased vision, and when do you see retinopathy w cystinosis
retinopathy only when the kidneys are effected
| cystinosis does NOT effect vision
112
ddx for crystaline retinopathy
| "Too Many Nits BE"
```
Tamoxifen
Mellaril
Nitrofuratoin
Bietti
Etha;yne glycol
```
113
ganglioside GM2
tay-sachs
114
BMI is a risk factor for which type of vein occlusion?
BRVO
115
According to the BVOS when should you do PRP
When theres neo
| NOT based on # of clock hrs of ischemia
116
what constitutes the outer blood eye barrier?
RPE
117
Whats the gene for familial amyloidosis and how does it present in the vitreous
transthiretin
| vitreous opacities
118
what is transpupillary thermotherapy used for?
flat choroidal melanomas
119
whats the excitation light wavelength, flourescein floureses at what wavelength and what color is the filter
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
are wyburn-mason retinal angiomatosis lesions hereditary? and where else can they be?
sporadic
| can have a-v malformations in the brain.
121
what has "leopard spot" pattern on FA?
BDUMP- paraneoplastic 2/2 lung/ovarian ca
or
uveal effusion syndrome (2/2 transient thickened sclera)
122
what does "fixed retinal folds" imply?
PVR
123
PDT works best on what type of neo?
type 2
124
what did MARINA look at?
lucentis vs pdt for MINIMALLY classic (ie occult) cnv
125
what did anChor look at?
lucentis vs pdt for CLASSIC cnv
126
which type of lens give a 1:1 mag of the retina?
super 66
128
what does monochromatism mean? Ie rod monochromatism?
that that PR type is the only one they have
| ie rod monochromatism- only have rods
129
how is rod monochromatism inherited?
AR
130
how is blue cone monochromatism inherited?
x-linked recessive
131
amd risk factors
```
smoking
blue eyes
hyperopia
htn
hld
```
132
in high myopes which muscle might slip causing strabismus?
lateral rectus- causing eso
133
azoor- who gets it? initial presentation uni vs bilateral? fundus appearance, any prodrome?
```
women 30s- unilateral; men- bilateral
initial presentation- photopsias and vit cell
gets bone spiculing later
marked depression on mfERG
flu prodrome
vf defects
```
134
SE of intravitreal aminoglycosides
macular ischemia
135
CAR vs MAR- which cells effected?
CAR- cones AND rods
| MAR- rods only
136
most common malignancy ass w CAR?
scc of lung
137
incontinentia pigmenti- inheritance, skin finding, retinal finding
X-linked dominant (therefore lethal in males)
skin bullae
retina similar to ROP
138
Whats another name for incontinentia pigmenti?
bloch-sulzberger syndrome
139
where are pohs lesions usually located?
mid-periphery
140
Fabrys dz what enzyme is deficient?
alpha-galactosidase A (fabRAY "A")
141
Tay sachs enzyme deficient
hexosaminidase A (cherry red spot) (sacks of hey -hexamine-A)
142
gauchers dz enzyme deficient
glucose cerebrosidase
| white spots in retina
143
neimann pick enzyme deficieny
sphingomylinase (don't pick your nose with your sphinger) cherry red pot
144
What laser spot size increases risk for cnv?
small spot size
145
how many degrees of field does amsler test?
20 degrees
146
what did the cruise study show
crvo w cme rx w iva x 6 mo do better than sham
147
what are the risk factors for suprachoroidal heme?
```
old age
atherosclerosis
myopia
aphakia
HTN
```
148
Why is the erg the way it is in csnb?
Bc the dz effects bipolar cells and there is poor transmission to the inner retina therefore normal a but shitty b wave
149
What cells make up the outer nuclear layer?
Cell bodies of the pr
150
What cells make up the inner nuclear layer?
Bipolar and horizontal cella
151
What did the maritime themed studies look at?
Safety and efficacy of lucentis , esp as compared to pdt
152
yag increases your chance for RD by how much?
4x
153
high myope s/p CE, at 7 years out, whats the % chance he dev rd?
8%
154
bietti vs cystinosis
bietti- AR, decr ERG, corneal crystals
| cystinosis- lysosymal storage disorder, occurs in cornea when it effects kidney, not visually significant
