Geriatrics Final Quiz Part I

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

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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About This Quiz
Geriatrics Final Quiz Part I - Quiz

The Geriatrics Final Quiz Part I assesses knowledge on ocular changes in the elderly, focusing on signs related to systemic conditions like kidney and heart failure, and thyroid... see moredisease. It evaluates understanding of age-related changes in vision and eye physiology, crucial for professionals in geriatric and ophthalmic care. see less

2. Ocular Pemphigoid is an autoimmune disease.

Explanation

Antibodies bind to the conjunctival basement membrane --> inflammation --> scarring --> entropion & trichiasis

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3. Phorias tend to shift to become more EXO.

Explanation

Become more exo due to ciliary muscle atrophy

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4. BCC is more common than SCC

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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5. 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?

Explanation

If BM gets too thick so it's no longer sticking to the epithelium this may cause RCE

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

Explanation

Seborrheic keratosis: flat to start, becomes more warty and looks "stuck on"; most common in lower lid

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

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

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

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

Explanation

When sleeping, globe may be exposed

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

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

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

Explanation

Clear zone at limbus = Furrow's Degeneration (thinned area w/ epi intact, won't cause any problems)

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

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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15. Amiodarone can cause which of the following:

Explanation

Whorl K'topathy doesn't cause many problems, so just monitor

Amiodarone Rx'd for heart arrhythmias

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16. Match the term with its definition

Explanation

These terms were discussed as signs of ocular pemphigoid

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

Explanation

Cortical worse with larger pupil

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

Explanation

Everything was true except Mooren's is assoc with Hep C

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19. 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:

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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20. 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.

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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21. The #1 cause of decrease in tear production is MGD

Explanation

#1 cause decrease tear production = autoimmune disease
#1 cause increase tear evaporation = MGD

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

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

Explanation

Keratoacanthoma --> very fast growing (smooth margins)
SCC --> slow growing (inflamed/crusted margins)

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24. Match the time of day dry eye is worse with the DDx

Explanation

AM: stagnant oil that is just sitting there w/o any blinking

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

Explanation

Bandage CL to prevent filaments from attaching

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

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

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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27. Match the condition with its treatment

Explanation

NEVER DILATE/PROBE/IRRIGATE dacryocystitis; will also need a dachryocystorinostomy

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28. Match the orbital disease with its description

Explanation

Plasmacytoma: proptosis, displacement of globe, ON compression
Menangiomas: dec VA, VFD, ophthalmoplegia, optic atrophy, optociliary shunt vessels
Mucocele: proptosis, displacement of globe, ON compression
Mucormyosis: pain, fever, proptosis, looks like orbital cellulitis, LOV from thrombosis of CRA, black dead tissue on palate/nasal mucosa

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

Explanation

Superficial Spreading Melanoma = most common malignant melanoma

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30. Match the conjunctival disorder with its description

Explanation

SCC: usually from conj intraepi neoplasia
Conj lymphoma: from non-Hodgkin's lymphoma or isolated, usually in females
Conj intraepi neoplasia: pre-malignant

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31. Indicate ALL of the following that INCREASE with age.

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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32. Match the location of the mucocele and the associated movement of the eye
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33. Match the conj disorder with its treatment.

Explanation

Scleritis (necrotizing): most severe form of scleritis, painful, LOV, NO TOPICAL STEROIDS & NO INJECTIONS
Scleromalacia perfoans: NO inflammation
Ocular pemphigoid: loss of goblet cells, ulcerations on mucous membs, will need dx once inflammation is quieted down

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The main difference between scleromalacia perforans and necrotizing...
Ocular Pemphigoid is an autoimmune disease.
Phorias tend to shift to become more EXO.
BCC is more common than SCC
You notice something funky going on with your pt's cornea....
Seborrheic keratosis is the most common benign tumor in the elderly....
Which one of the following skin lesions is found on almost 100% of the...
Viroptic will be less effective on Herpes Zoster since the...
A patient with normal visual fields should be expected to lose how...
Chronic papillary conjunctivitis with SPK is a sign for which...
Indicate ALL of the following structures/physio mechs that do NOT...
Which of the following corneal conditions is the result of calcium...
You notice unilateral corneal arcus on your patient.  What could...
Which of the following treatment for skin lesions produces the lowest...
Amiodarone can cause which of the following:
Match the term with its definition
Which of the following types of cataracts would be the worst in...
Mooren's Ulcer is a unilateral, painful, inflammatory lesion...
Your elderly pt comes in for a check up.  While performing SLE...
Which of the following represents a general ocular change in the...
The #1 cause of decrease in tear production is MGD
Which of the following would you see if you stained a herpes simplex...
Keratoacanthoma is very slow growing which is one way to differentiate...
Match the time of day dry eye is worse with the DDx
Which of the following would be an appropriate tx option for...
Indicate the 3 signs that are part of the triad for menangiomas
Match the condition with its treatment
Match the orbital disease with its description
Which of the following is the most common melanoma on the face?
Match the conjunctival disorder with its description
Indicate ALL of the following that INCREASE with age.
Match the location of the mucocele and the associated movement of the...
Match the conj disorder with its treatment.
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