Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Medicine I > Vascular/Retinal Disorders > Flashcards

Vascular/Retinal Disorders Flashcards

1
Q

What is important to remember when transporting a retinal detachment to referral?

A

patient head positioned so retinal tear is placed at lowest point of eye to minimize extension
inferior – keep head upright
temporal – keep temporal side of head down
minimize motion of eyes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the prognosis of retinal detachments?

A

90% can be cured. The worst are if the macula detaches or long time of detachment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are potential complications of retinal detachment?

A

vision loss or decreased visual acuity, recurrence, cataract formation, glaucoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the development of the nonproliferative diabetic retinopathy?

A

asymptomatic –> symptomatic
retinopathy –> maculopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What types of macular degeneration are there and which is the most common?

A

wet and dry (much more common)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the clinical presentation of dry macular generation?

A

central vision loss, gradual, bilateral, distortion of images, scotomas, declining visual acuity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are risk factors for macular generation (both!)?

A

age related, female, white, tobacco, alcohol, excessive sunlight, CAD, HTN, HLD, family Hx, hyperopia, light iris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the causation of dry macular degeneration?

A

cellular debris Densen accumulates between retina and choroid leading to scarring and atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What helps in diagnosis for dry macular degeneration?

A

Snellen (visual acuity), Amsler grid (curvy if +), need DILATED eye exam, focused exudates called DRUSEN upon exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the treatment of dry macular degeneration?

A

vitamins help! STOP SMOKING!!!

Pegcetacoplan & avacincaptad pegol injection

note risk of wet ARMD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the clinical presentation of wet macular degeneration?

A

RAPID onset and severe, hemorrhaging and fibrosis within the eye, bilateral CENTRAL vision loss, distortion, scotomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the causation of wet macular degeneration?

A

new blood vessels popping up that leak blood and hemorrhage and fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the key on fundoscopy for wet ARMD?

A

fluorescein angiography can help, but really a lot of blood in eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does chronic steroid use cause?

A

glaucoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do you treat wet ARMD?

A

inhibitors of vascular endothelial growth factors (VEGF)
-mab
ranibizumab, bevacizumab, aflibercept, farcimab
brolucizumab risk of vision loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the clinical presentation of retinal detachment?

A

curtain of vision loss, LONG LASTING, med emergency, acute onset, tunnel vision
photopsias followed by floaters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the risk factors for retinal detachment?

A

age, myopia, cataract extraction, ocular trauma, smoking, DM retinopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the two kinds of retinal detachment?

A

rhegmatogenous detachment “natural” MCC – fluid goes into subretinal space, detaches

tractional - scars pull on retina, exudative- fluid trapped (wet ARMD), causes detachment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does the fundoscopy look like for retinal detachment?

A

retina elevated and gray/cloudy, superior temporal quadrant; wave on a beach
Positive Shafer’s sign of clumping brown pigment

20
Q

What is the treatment for retinal detachment?

A

closing retinal holes and tears through laser photocoagulation, crypexy, pneumatic retinopexy, vitrectomy

if exudative/secondary, treat underlying cause

21
Q

What is the clinical presentation of diabetic retinopathy?

A

blurry vision, decreased acuity, visual distortion, scotomas not always noticed

proliferative has more severe symptoms

22
Q

What are risk factors for diabetic retinopathy?

A

Diabetes. 99% type I get it. 60% type II. 20% already have it with uncontrolled diabetes

23
Q

What is the difference between nonproliferative or proliferative diabetic retinopathy?

A

Nonpro- circinate ring yellow exudates, cotton wool spots
pro- growth of new vessels and fibrous tissue

24
Q

What is important to always do on diabetic patients?

A

need baseline fundoscopy after diagnosis of type II, 5 years after type I, then annual dilated exam

25
Q

How do you manage diabetic retinopathy?

A

optimize control of BG, BP, kidney function, lipids (could worsen before getting better..initially check every 3-4 months until managed for 18-24 months)

VEGF inhibitors – Ranibizumab, bevacizumab, aflibercept, faricimab, brolucizumab may do laser photocoag, corticosteroid, virectomy

26
Q

What is the treatment for severe diabetic retinopathy?

A

panretinal laser photocoagulation prophylatically

27
Q

What is the clinical presentation and cause of acute hypertensive retinopathy?

A

sudden onset of severe HTN >200/110 which could be from hyperthyroidism, drugs, pregnancy

28
Q

What would confirm hypertensive retinopathy on a fundoscopy?

A

cotton wool spots, dot blot and flame hemorrhages, papilledema

29
Q

What makes chronic hypertensive retinopathy different on a fundoscopy (note: hard to see, so just good to know)?

A

AV nicking and crossing, hemorrhage, narrowing, copper/silver wiring (severe), macular star

30
Q

How do you treat acute hypertensive retinopathy?

A

emergency! Treat underlying cause!
Complications: retinal detachment, optic neuropathy

31
Q

What are the risks for acute hypertensive retinopathy?

A

older patients

32
Q

what are the risks for chronic hypertensive retinopathy?

A

high sodium, obesity, tobacco, alcohol, family hx

33
Q

What is the cause of chronic hypertensive retinopathy?

A

chronic HTN; atherosclerosis

34
Q

How do you treat chronic hypertensive retinopathy?

A

increase risk of stroke -> MI, CAD, PAD, ARMD
control HTN!!!!!!!!!!!!

comps=retinal vein occlusion, retinal detachment, optic nerve atrophy

35
Q

What is the clinical presentation of retinal artery occlusion?

A

sudden monocular vision loss – no pain, redness, UNILATERAL

this is assumed with these symptoms

36
Q

What are risks for retinal artery occlusion?

A

diabetes, hyperlipidemia, HTN, young = migraines, oral contraceptives, vascular disease

37
Q

What is the cause of retinal artery occlusions?

A

occlusion of CENTRAL or BRANCH artery (eye stroke), embolism/thrombosis (thrombophilic disorders, SLE, giant cell arthiritis) from atherosclerotic plaques, atrial fibrillation, endocarditis

38
Q

What’s the difference between acute and chronic papilledema?

A

acute = no loss of acuity
chronic/severe acute = visual field loss, profound loss of acuity

39
Q

What should you consider with retinal artery occlusion?

A

ask about neck pain, neck trauma –> carotid artery dissection
giant cell arteritis (check inflammatory mediators); if >50 yr old with central occlusion
young people check for clotting disorders!

40
Q

What on the fundoscopy is key for retinal artery occlusion?

A

central =cherry red spot, “box car” segmentation, pale optic disk
branch= cotton wool spots, limited to area

41
Q

What do you do to manage retinal artery occlusion?

A

work up as a stroke!!!!!!! urgent referral to ER for imaging
angiography, opthalmology referral

lay patient flat, ocular massage, high conc. of inhaled O2, IV acetazolamide, anterior chamber paracentesis

42
Q

What is the clinical presentation of vein occlusion?

A

more common –> sudden monocular loss of vision, no pain or redness
maybe RAPD?

43
Q

What is a risk for vein occlusion?

A

glaucoma but everything from artery too: diabetes, hyperlipidemia, HTN, young = migraines, oral contraceptives, vascular disease

44
Q

What causes a retinal vein occlusion?

A

clot formation
Virchow’s triad: vessel damage, stasis, hypercoagulability, atherosclerosis

45
Q

What is key on fundoscopy of retinal vein occlusions?

A

central = widespread hemorrhages, cotton-wool spots, optic disk swelling “blood & thunder”
branch = confined to area

46
Q

How do you treat a retinal vein occlusion?

A

VEGF inhibitor injection for macular edema
Panretinal laser photocoagulation for neovascularization
or
Triamcinolone (central), implant with dexamethasone (either), focal laser coag (branch)

Clinical Medicine I (33 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions