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BOARDS2: Retina/vitreous > White Spots In Retina > Flashcards

White Spots In Retina Flashcards

1
Q

What causes toxoplasmosis

A

Parasite toxoplama gondii causing a unilateral retinochoroiditis (focal fluffy yellow white lesion adjacent to inactive scar) + vitritis (headlights in fog)

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2
Q

Congential toxoplasmosis

A

90%, transplacental

  • mother infected DURING pregnancy
  • 10% of cases have severe systemic involvement-convulsions and cerebral calcification
  • most common infectious retinitis
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3
Q

Acquired toxoplasmosis

A

10%

Inhalation of parasite in cat feces, eating undercooked meat or cheese

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4
Q

Treatment of toxoplasmosis

A

Small peripheral lesions
-observation or Bactrim

Mod-severe vitritis or sight threatening lesions
-systemic steroids + one anti-toxo agent x 5-6 weeks (pyramethamine, sulfadiazine)

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5
Q

Histoplasmosis cause

A

Fungal infection from histoplasma gondii

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6
Q

Signs of histo

A

Bilateral, multifocal chorioditis + PPA + maculopathy and NO VITRITIS

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7
Q

How do you get histo

A

Transmitted by inhalation of spores insoil (contaminated with bird or bat droppings)
OH/MS river valleys

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8
Q

Symptoms of histo

A

Asymptomatic unless mac invovled

-20% recurrence of CNVM over 3 years if mac invovled

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9
Q

Treatment for histo

A

AntiVEGF if CNMV

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10
Q

Bests disease

A

AD, abnormal accumulation of lipofuscin in RPE cells
Bilateral “egg yolk” subfoveal lesions
Dx in early childhood (5-10yo)
-75% have VA >20/40 at time of Dx
-only mild VA decrease (20/30-20/50) through midlife

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11
Q

Stage 1 bests

A

EOG < 1.8

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12
Q

Stage 2 bests

A

2 egg yolks

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13
Q

Stage 3 bests

A

Pseudohypopyon

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14
Q

Stage 4 bests

A

Scrambled eggs

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15
Q

Stage 5 bests

A

End stage, mod/severe VA loss d/t CNVM, mac atrophy

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16
Q

Treatment for bests

A

None, low vision if needed

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17
Q

Dominant drusen

A 
Bilateral scattered drusen in posterior pole
Asymptomatic unless mac involved 
Drusen in mac may cause CNVM or atrophy 
Decreased VA in 50-60yo
TX=antivegf, low vision if needed
18
Q

Adult foveomacular vitelliform dystrophy

A

Presents age 30-50. Signs similar to bests, but the overall prognosis is better; patients classically present with minimal metamorphopsia, mild VA loss, a normal EOG and ERG, and a slight tritan color defect

19
Q

Stargardts disease

A

Most common hereditary mac dystrophy
AR
Age of Dx=6-20yo

20
Q

Early stage Stargardts

A

Bilateral pisciform yellow flecks in posterior pole/mid periphery, no specific RPE molting in the macula, loss of FLR, normal ERG, decreased VA more than expected

21
Q

Late stage Stargardts

A

Beaten bronze mac (bulls eye mac) and “salt and pepper” changes in periphery + abnormal ERG=VA 20/200 by 30, then stable ish

22
Q

Treatment for Stargardts

A

None

Low vision

23
Q

Fundus flavimaculatus

A
  • Stargardts variant without macular dystrophy
  • dx 40-50yo
  • bilateral pisciform yellow flecks in post pole
  • asymptomatic unless flecks in macula
  • no treatment-low vision is needed
24
Q

Clinical use of ERG

A

Detecting retinal abnormalities that affect a significant portion of the retina
MfERG can be used to detect maculopathies

25
Q

Clinical use of EOGs

A

Best at assessing RPE function and is very useful in the diangosis of bests disease

26
Q

Sensitivity of ERG

A

Not very sensitive at detecting retinal diseases that’s only affects a small part of the retina

27
Q

Sensitivity of EOG

A

Effective at detecting subtly changes in toxic maculopathies such as plaquenil toxicity

28
Q

Administration of ERG

A

Electrodes embedded within a CL are placed on the eye

29
Q

Administration of EOG

A

Electrodes do not touch eye; placed on the skin adjacent tot the eye

30
Q

Parameter measured in ERG

A

Sum total of the electrical activity of the retina

31
Q

Parameter measured in EOG

A

Difference in the electrical potential between the front and back of the eye with eye movement (cornea (+), retina (-))

32
Q

Clinical interpretation of ERG

A

Amplitude of A wave and B wave; latency to the thought of the A wave and the peak of the B wave.

33
Q

Clinical interpretation of EOG

A

Ratio of the height of the light peak compared to the depth of the dark trough. Ratio should be 2:1 or greater; less than 1.8=abnormal

34
Q

Ocular structures assessed in ERG

A

PRs (rods and cones)
Bipolar and mueller cells
To a lesser extent: RPE

35
Q

Ocular structures assessed in EOG

A

Mostly RPE and macula

36
Q

Patient selection for ERG

A

Can be performed on patients of all ages but may require sedation

37
Q

Patient selection for EOG

A

Cannot usually be performed on kids under 5 because patient cooperation is required

38
Q

Patient particiapation in ERG

A

None required

39
Q

Patient cooperation in EOG

A

Must look left and right continuously

40
Q

Drugs that cause pigment changes in the retina

A

Chlorpromazine
Thioridazine
Indomethacin

BOARDS2: Retina/vitreous (8 decks)

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