Geriatrics Final Quiz Part I
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 eyelidsExplanation
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.Rate this question:
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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 productionExplanation
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.Rate this question:
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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 compositionExplanation
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.Rate this question:
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- 4.
Phorias tend to shift to become more EXO.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Become more exo due to ciliary muscle atrophyRate this question:
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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. PSCExplanation
Cortical worse with larger pupilRate this question:
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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. 1-3Explanation
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.Rate this question:
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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. FalseExplanation
Keratoacanthoma --> very fast growing (smooth margins)
SCC --> slow growing (inflamed/crusted margins)Rate this question:
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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 MelanomaExplanation
Superficial Spreading Melanoma = most common malignant melanomaRate this question:
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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 KeratosisExplanation
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 timeRate this question:
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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 SyndromeExplanation
When sleeping, globe may be exposedRate this question:
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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. TrueExplanation
Seborrheic keratosis: flat to start, becomes more warty and looks "stuck on"; most common in lower lidRate this question:
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- 12.
BCC is more common than SCC
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
BCC is most common type of eyelid skin cancer
Both rarely metastasize and both eventually bleed & ulcerate (more often in SCC)Rate this question:
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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 SurgeryExplanation
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)Rate this question:
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- 14.
Ocular Pemphigoid is an autoimmune disease.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Antibodies bind to the conjunctival basement membrane --> inflammation --> scarring --> entropion & trichiasisRate this question:
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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 shuntExplanation
optociliary shunt is vaculature from the retina to the choroid, they are thicker vessels and more tortuous (vs neo which is thinner)Rate this question:
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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 NeoplasiaExplanation
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 SCCRate this question:
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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. TrueExplanation
Tx:
Necrotizing scleritis - oral NSAID 1 week --> systemic steroids --> IV steroids or immunosupp
Scleromalacia - tx underlying condition (almost always RA)Rate this question:
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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 outsideExplanation
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 dendriteRate this question:
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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 erosionExplanation
If BM gets too thick so it's no longer sticking to the epithelium this may cause RCERate this question:
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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 occlusionExplanation
Clear zone at limbus = Furrow's Degeneration (thinned area w/ epi intact, won't cause any problems)Rate this question:
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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. FalseExplanation
Everything was true except Mooren's is assoc with Hep CRate this question:
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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 keratopathyExplanation
Whorl K'topathy doesn't cause many problems, so just monitor
Amiodarone Rx'd for heart arrhythmiasRate this question:
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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 KeratopathyExplanation
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)Rate this question:
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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 CLExplanation
Bandage CL to prevent filaments from attaching
Can also remove filaments, tx underlying condition, and use mucomystRate this question:
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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. TrueExplanation
Viroptic works for H. Simplex since there are true dendrites with viral cells to attack.
If it becomes disciform keratitis put on topical steroidRate this question:
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- 28.
The #1 cause of decrease in tear production is MGD
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
#1 cause decrease tear production = autoimmune disease
#1 cause increase tear evaporation = MGDRate this question:
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Current Version
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Mar 21, 2023Quiz Edited by
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Nov 04, 2012Quiz Created by
Tseemore
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