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Duke Elder > Retina > Flashcards

Retina Flashcards

1
Q

What is the volume of the vitreous?

A

4-4.4ml

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2
Q

What three materials is the vitreous composed of?

A

water
hyaluronic acid
type 2 collagen

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3
Q

From which embryological structure is the retina derived?

A

diencephalon

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4
Q

How many layers make up the retina?

A

10

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5
Q

How many rods are there in the neurosensory retina?

A

120 million

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6
Q

Where is the highest density of rods in the retina?

A

mid-peripheral retina

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7
Q

What pigment is found in the rods?

A

rhodopsin

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8
Q

How many rods can one bipolar cell receive signals from?

A

50-100

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9
Q

What is the function of the rods?

A

Night and peripheral vision

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10
Q

How many cones are there in the neurosensory retina?

A

6 million

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11
Q

Where is the highest density of cones found?

A

macula and fovea

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12
Q

What pigment is found in the cones?

A

iodopsin

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13
Q

How many cones does one bipolar cell receive signals from?

A

1

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14
Q

What is the function of the cones?

A

central and colour vision

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15
Q

What are the three functions of the retinal pigment epithelium?

A

absorbs light, preventing scattering of light in the eye
blood-retinal barrier provides selectively permeable membrane to deliver nutrients to the photoreceptors and maintain homeostasis
transport of vitamins and metabolites

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16
Q

where is there macula located compared to the optic disc?

A

temporally

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17
Q

how does blood reach the fovea?

A

diffusion from choriocapillaries

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18
Q

what name is given to retinal glial cells?

A

Muller cells

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19
Q

Which artery supplies the outer 1/3 of the retina, including the photoreceptors and RPE?

A

short posterior ciliary artery

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20
Q

Which artery supplies the inner 2/3 of the retina?

A

central retinal artery

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21
Q

What is the pathophysiology of diabetic retinopathy?

A

hyperglycaemia caused increased retinal blood flow and damage to the endothelium and pericytes

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22
Q

How are hard exudates formed in diabetic retinopathy?

A

lipoproteins deposited in outer plexiform layer

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23
Q

Why are flame haemorrhages seen in diabetic retinopathy?

A

pericyte damage predisposes to microaneurysm and rupture of the capillary walls

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24
Q

What is the effect does decreased HbA1c by 1 have on progression of diabetic retinopathy?

A

decreases rate of progression by 37%

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25
Q

In T1DM, what is the risk of developing diabetic retinopathy at:
A 10 years
B 30 years?

A

A 50%

B 90%

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26
Q

At least one microaneurysm, intraretinal haemorrhages, exudates or cotton wool spots?

A

mild non-proliferative DR

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27
Q

intraretinal haemorrhages in 1-2 quadrants, venous beading in one quadrant or mild intraretinal microvascular abnormality

A

moderate non-proliferative DR

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28
Q

intraretinal haemorrhages in 4 quadrants, venous beading in >2 quadrants and moderate intraretinal microvascular abnormality in >1 quadrant.

A

severe non-proliferative DR

4-2-1 rule

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29
Q

what features make proliferative diabetic retinopathy “high risk”?

A

NVD >1/3 of dic
NVD plus vitreous haemorrhage
NVE >1/2 disc area plus vitreous haemorrhage

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30
Q

What is a sign of advanced proliferative diabetic retinopathy?

A

tractional retinal detachment

31
Q

What is the management for non-high risk PDR?

A

review in 2 months

32
Q

What is the management of high risk PDR?

A

panretinal photocoagulation within 1 week

33
Q

What is the management of diabetic maculopathy?

A

intravitreal vegf

34
Q

Is hypertension more closely related to CRVO or BRVO?

35
Q

where are dot/blot haemorrhages most commonly seen in BRVO?

A

superotemporal quadrant

36
Q

does RVO cause a painful or painless loss of vision?

37
Q

What is the management of non-ischaemic RVO?

A

anti vegf if VA >6/96 and OCT shows MO

38
Q

What is the management of ischaemic RVO?

A

urgent panretinal photocoagulation +/- cyclodiode laser of neovascularisation

39
Q

Sudden painless loss of vision, marked RAPD. Fundoscopy shows pale retina, cherry red spot, arteriolar attenuation.

40
Q

What conditions are associated with CRAO?

A

atherosclerosis

GCA

41
Q

What investigations should be carried out in suspected CRAO?

A

ESR, plasma viscosity, carotid doppler

42
Q

Altitudinal visual field loss. Wedge shaped pallor, arteriolar attenuation

43
Q

Which anatomical variation can spare some of the visual field loss associated with RAO?

A

cilioretinal artery

44
Q

What conditions are associated with cystoid macular oedema?

A 
diabetic macular oedema
CRVO/BRVO
ARMD
anterior and post. uveitis
retinitis pigmentosa
Irvine gass syndrome
45
Q

Which medications can cause cystoid macular oedema?

A

nicotinic acid
prostaglandin analogues
epinephrine

46
Q

Patient with abnormal Hb. Salmon patches (intraretinal haemorrhages) and black sunbursts (RPE hyperplasia)?

A

non-proliferative sickle cell retinopathy

47
Q

What system is used in classification of proliferative sickle cell retinopathy?

A

Goldberg classification

48
Q

What is an end-stage complication of proliferative sickle cell retinopathy?

A

retinal detachment

49
Q

What is the leading cause of blindness in developed countries?

50
Q

Older white female smoker. Central vision loss and metamorphosia. Soft drusen on fundoscopy.

51
Q

By which mechanism does cell death occur in ARMD?

52
Q

Mutation in which genes can increase risk of developing ARMD?

A

CFH and ARMS2

53
Q

What unilateral variant of wet ARMD is seen in middle aged, Asian populations?

A

polypoidal choroidal vasculopathy

54
Q

What is the management of dry ARMD?

A 
smoking cessation advice
vitamin supplementation (C, E, lutein, zeaxanthin and zinc)
55
Q

What is the management of wet ARMD?

A

anti-vegf
amsler grid
OCT

56
Q

Young male patient, type A personality. Unilateral decreased VA, metamorphosia, central scotoma. Slow recovery from bright lights. Associated with corticosteroid use. OCT shows triangle shaped subretinal fluid collection with neurosensory retinal detachment

A

central serous chorioretinopathy

57
Q

What is the management of central serous chorioretinopathy?

A

photodynamic therapy

58
Q

Young indian male. Recurrent vitreous haemorrhage. Associated with TB.

A

Eales disease

59
Q

What is the management of Eales disease?

A

corticosteroids

60
Q

What is the most common melanoma of the uveal tract? Where does it most commonly metastasise to?

A

choroidal melanoma

liver

61
Q

Unilateral decreased VA and field loss. Fundoscopy shows pigmented, raised, subreinal mass with collar stud appearance.

A

choroidal melanoma

62
Q

Angioid streak occurs as a result of breaks in which layer of the retina?

A

Bruch membrane

63
Q

Bilateral symmetrical peripapillary atrophy with multiple irregular streaks radiating from the optic disc (angioid streak). Plucked chicken appearance of skin in neck, inguinal folds and antecubital fossa

A

Pseudoxanthoma elasticum

64
Q

What is the inheritance pattern of:
A ocular albinism?
B oculocutaneous albinism?

A

A X linked

B AR

65
Q

Why is VA decreased in albinism?

A

foveal hypoplasia

66
Q

How does the optic chiasm differ from normal in patients with albinism?

A

more crossed fibres

67
Q

Patient with very pale skin and hair, nystagmus, strabismus, pink eyes.

68
Q

Condition causing mulberry lesions (creamy white, well circumscribed glial tumours), associated with TB, NF and retinitis pigmentosa.

A

Retinal astrocytic hamartomas

69
Q

AD condition. Retinal capillary haemangioma with tortuous feeder vessels, pheochromocytoma, hemangioblastoma, renal cell carcinoma

A

Von-Hippel Lindau

70
Q

Patient presents temp and new murmur. Fundoscopy shows pink fleshy lesions with white patches. What is this sign called?

A

Roth spots (infective endocarditis)

71
Q

What inherited systemic condition can cause retinal hamartomas? Patient has strange growths under their nails.

A

Tuberous sclerosis

72
Q

IVDU, appears emaciated, systemically unwell. Fundoscopy has pizza pie appearance.

A

CMV retinitis

73
Q

Patient 34 weeks pregnant. Complaining of headache and flashes in peripheral vision. Fundoscopy shows macular star, cotton wool spots and disc swelling bilaterally.

A

Pre-eclampsia

Duke Elder (8 decks)

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