Geriatrics Final Quiz Part I

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Geriatrics Final Quiz Part I - Quiz

Ocular Disease in Elderly Part 1


Questions and Answers
  • 1. 

    Which of the following represents a general ocular change in the geriatric population that could be a sign of kindey/heart failure and thyroid disease.

    • A.

      Baggy eyelids

    • B.

      Epiphora

    • C.

      Orbita fat prolapse

    • D.

      Enophthalmos

    Correct Answer
    A. Baggy eyelids
    Explanation
    Baggy eyelids in the geriatric population could be a sign of kidney/heart failure and thyroid disease. This is because as people age, the skin loses its elasticity and the muscles supporting the eyelids weaken, resulting in sagging or baggy eyelids. In cases of kidney or heart failure, fluid retention can occur, leading to swelling around the eyes and causing baggy eyelids. Thyroid disease can also cause changes in the skin, including the eyelids, due to hormonal imbalances. Therefore, baggy eyelids can be a general ocular change in the geriatric population that may indicate underlying kidney/heart failure or thyroid disease.

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  • 2. 

    Indicate ALL of the following that INCREASE with age.

    • A.

      Conj thickness

    • B.

      ATR astigmatism

    • C.

      WTR astigmatism

    • D.

      Lens thickness

    • E.

      IOP

    • F.

      Myopia

    • G.

      Aqueous production

    Correct Answer(s)
    B. ATR astigmatism
    D. Lens thickness
    E. IOP
    G. Aqueous production
    Explanation
    As individuals age, several factors tend to increase. ATR astigmatism refers to astigmatism that is more pronounced in the horizontal meridian, and this tends to increase with age. Lens thickness also tends to increase as the lens becomes less flexible and more rigid over time. Intraocular pressure (IOP) can also increase with age due to changes in the balance of fluid production and drainage in the eye. Finally, aqueous production, which refers to the production of the fluid in the front part of the eye, tends to increase as individuals age.

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  • 3. 

    Indicate ALL of the following structures/physio mechs that do NOT change with age.

    • A.

      Aqueous composition

    • B.

      RPE pigmentation

    • C.

      Phorias

    Correct Answer
    A. Aqueous composition
    Explanation
    The aqueous composition refers to the fluid that fills the anterior chamber of the eye. This fluid is responsible for maintaining the shape of the eyeball and providing nutrients to the surrounding tissues. The answer suggests that the aqueous composition does not change with age. This is because the composition of the aqueous humor remains relatively stable throughout life, ensuring proper eye function and maintaining a healthy intraocular environment.

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  • 4. 

    Phorias tend to shift to become more EXO.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Become more exo due to ciliary muscle atrophy

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  • 5. 

    Which of the following types of cataracts would be the worst in conjunction with a miotic pupil?

    • A.

      Cortical

    • B.

      NSC

    • C.

      PSC

    Correct Answer
    C. PSC
    Explanation
    Cortical worse with larger pupil

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  • 6. 

    A patient with normal visual fields should be expected to lose how many degrees per decade?

    • A.

      1-3

    • B.

      3-5

    • C.

      5-7

    • D.

      7-9

    Correct Answer
    A. 1-3
    Explanation
    As a person ages, it is normal for them to experience a gradual decline in their visual fields. This decline typically occurs at a rate of 1-3 degrees per decade. This means that over the course of 10 years, a person may lose 1-3 degrees of their visual field. This is considered to be within the range of normal age-related changes in vision.

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  • 7. 

    Keratoacanthoma is very slow growing which is one way to differentiate it from a squamous cell carcinoma.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Keratoacanthoma --> very fast growing (smooth margins)
    SCC --> slow growing (inflamed/crusted margins)

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  • 8. 

    Which of the following is the most common melanoma on the face?

    • A.

      Lentigo Maligna

    • B.

      Lentigo Malignan Melanoma

    • C.

      Superficial Spreading Melanoma

    • D.

      Nodular Melanoma

    Correct Answer
    B. Lentigo Malignan Melanoma
    Explanation
    Superficial Spreading Melanoma = most common malignant melanoma

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  • 9. 

    Which one of the following skin lesions is found on almost 100% of the elderly Caucasian population?

    • A.

      Actinic Keratosis

    • B.

      Cutaneous Horn

    • C.

      Xanthelasma

    • D.

      Papilloma

    Correct Answer
    A. Actinic Keratosis
    Explanation
    Actinic Keratosis: pre-malig, dry/rough/scaly/sandpaper
    Cutaneous Horn: raised, may have SCC/BCC at base
    Xanthelasma: yellow plques in medial upper lid
    Papilloma: benign, pedunculated, slow growing, no ulceration, crusty over time

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  • 10. 

    Chronic papillary conjunctivitis with SPK is a sign for which condition?

    • A.

      Floppy Eyelid Syndrome

    • B.

      Involutional Entropion

    • C.

      Benign Essential Blepharospasm

    • D.

      Aponeurotic Ptosis

    Correct Answer
    A. Floppy Eyelid Syndrome
    Explanation
    When sleeping, globe may be exposed

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  • 11. 

    Seborrheic keratosis is the most common benign tumor in the elderly.  It has no malignant potential.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Seborrheic keratosis: flat to start, becomes more warty and looks "stuck on"; most common in lower lid

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  • 12. 

    BCC is more common than SCC

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    BCC is most common type of eyelid skin cancer

    Both rarely metastasize and both eventually bleed & ulcerate (more often in SCC)

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  • 13. 

    Which of the following treatment for skin lesions produces the lowest recurrence rate?

    • A.

      Surgical excision

    • B.

      Cryosurgery

    • C.

      Radiation

    • D.

      Mohs Surgery

    Correct Answer
    D. Mohs Surgery
    Explanation
    Surgical excision: take out surrounding tissue too
    Cryosurgery: liquid nitrogen
    Radiation: preserves surrounding area
    Mohs: remove by thin layers, time consuming, good for lesions that may recur (BCC/SCC)

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  • 14. 

    Ocular Pemphigoid is an autoimmune disease.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Antibodies bind to the conjunctival basement membrane --> inflammation --> scarring --> entropion & trichiasis

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  • 15. 

    Indicate the 3 signs that are part of the triad for menangiomas

    • A.

      VF loss from optic atrophy

    • B.

      Pallor

    • C.

      Optociliary shunt

    • D.

      Macular edema

    • E.

      Ciliary spasms

    Correct Answer(s)
    A. VF loss from optic atrophy
    B. Pallor
    C. Optociliary shunt
    Explanation
    optociliary shunt is vaculature from the retina to the choroid, they are thicker vessels and more tortuous (vs neo which is thinner)

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  • 16. 

    Your elderly pt comes in for a check up.  While performing SLE you notice a build up of tissue in the limbal region.  You are not sure if its a notmal changes due to age or something potentially more serious.  You decide to stain with Rose Bengal and you note diffuse staining around the lesion and the adjacent cornea.  Your differential diagnosis at this point is:

    • A.

      Pinguecula

    • B.

      Pterygium

    • C.

      Conjunctival Intraepithelial Neoplasia

    • D.

      Corneal Arcus

    Correct Answer
    C. Conjunctival Intraepithelial Neoplasia
    Explanation
    CIN & ping look similar but here are differences:
    - Ping is N/T so if you see S/I consider more serious Dx
    - Ping usually bilateral
    - Ping does not stain w/ RB
    - Ping has 'dragged vessels' and CIN has more clustered vessels

    - CIN is pre-malignant and is a pre-cursor to SCC

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  • 17. 

    What does CIGMA stand for in regard to etiologies of necrotizing scleritis?

  • 18. 

    The main difference between scleromalacia perforans and necrotizing scleritis is that in scleromalacia there is NO inflammation

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Tx:
    Necrotizing scleritis - oral NSAID 1 week --> systemic steroids --> IV steroids or immunosupp
    Scleromalacia - tx underlying condition (almost always RA)

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  • 19. 

    Which of the following would you see if you stained a herpes simplex dendrite with RB & NaFl?

    • A.

      RB stains entire lesion, very little NaFl

    • B.

      NaFl stains middle, RB stains outside

    • C.

      RB stains middle, NaFl stains outside

    • D.

      Herpes simplex dendrites do not stain with these dyes

    Correct Answer
    B. NaFl stains middle, RB stains outside
    Explanation
    Opposite for Zoster: RB stains middle & NaFl stains outside

    **For Simplex, if you only use RB it will stain the entire dendrite

    Simplex: Mercedes sign, disciform keratitis, Wessely immune ring, necrotizing keratitis, ghost dendrite

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  • 20. 

    Describe the different treatment options for Herpes Simplex Keratitis

  • 21. 

    You notice something funky going on with your pt's cornea.  You think it might be Map Dot Dystrophy.  You remember from class that this is very common in older patients and usually only requires monitoring.  What potential complication could arise from this condition?

    • A.

      Guttata

    • B.

      Stromal edema

    • C.

      Recurrent corneal erosion

    • D.

      Geographic ulcer

    Correct Answer
    C. Recurrent corneal erosion
    Explanation
    If BM gets too thick so it's no longer sticking to the epithelium this may cause RCE

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  • 22. 

    You notice unilateral corneal arcus on your patient.  What could this be indicative of?

    • A.

      Very high cholesterol

    • B.

      Carotid occlusion

    • C.

      CRAO

    • D.

      Uncontrolled blood glucose

    Correct Answer
    B. Carotid occlusion
    Explanation
    Clear zone at limbus = Furrow's Degeneration (thinned area w/ epi intact, won't cause any problems)

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  • 23. 

    Mooren's Ulcer is a unilateral, painful, inflammatory lesion associated with HIV/AIDS

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Everything was true except Mooren's is assoc with Hep C

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  • 24. 

    Amiodarone can cause which of the following:

    • A.

      Whorl keratopathy

    • B.

      Band keratopathy

    • C.

      Hudson stahli line

    • D.

      Crocadile shagreen

    Correct Answer
    A. Whorl keratopathy
    Explanation
    Whorl K'topathy doesn't cause many problems, so just monitor

    Amiodarone Rx'd for heart arrhythmias

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  • 25. 

    Which of the following corneal conditions is the result of calcium deposits in the sub-epithelium which creates a 'swiss cheese' apperance

    • A.

      Band Keratopathy

    • B.

      Cornea Farinata

    • C.

      Guttata

    • D.

      Bullous Keratopathy

    Correct Answer
    A. Band Keratopathy
    Explanation
    Corneal Farinata: flour dust particles in deep stroma (no tx needed)
    Guttata: Deposits on Descemets which leads to cell drop out, 'beaten metal apperance'
    Bullous K'pathy: Sub-epi bullae develop due to stroma edema (tx w/ AB, transplant, Muro- only once bullae are healed)

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  • 26. 

    Which of the following would be an appropriate tx option for filamentary keratitis?

    • A.

      Muro 128

    • B.

      Bandage CL

    • C.

      Antibiotic

    • D.

      Topical steroid

    Correct Answer
    B. Bandage CL
    Explanation
    Bandage CL to prevent filaments from attaching

    Can also remove filaments, tx underlying condition, and use mucomyst

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  • 27. 

    Viroptic will be less effective on Herpes Zoster since the pseudo-dendrites are just an elevated region of dead cells.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Viroptic works for H. Simplex since there are true dendrites with viral cells to attack.

    If it becomes disciform keratitis put on topical steroid

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  • 28. 

    The #1 cause of decrease in tear production is MGD

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    #1 cause decrease tear production = autoimmune disease
    #1 cause increase tear evaporation = MGD

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