Geriatrics Final Quiz Part II
Ocular Diseases in the Elderly Part II
Questions and Answers
- 1.
Your pt presents to your office with hyphema in the left eye after being hit in the eye with a football. During your exam of the retina which of the following this are you looking for in particular?
- A.
Commotio retinae
- B.
Macular edema
- C.
Chorodial rupture
- D.
CWS
- E.
Optociliary shunt
Correct Answer(s)
A. Commotio retinae
B. Macular edema
C. Chorodial ruptureExplanation
During the examination of the retina, the healthcare provider is specifically looking for signs of commotio retinae, macular edema, and choroidal rupture. Commotio retinae refers to retinal whitening or opacification caused by blunt trauma, while macular edema is the accumulation of fluid in the macula, the central part of the retina. Choroidal rupture refers to a tear or break in the choroid, the layer of blood vessels beneath the retina. These conditions can occur as a result of trauma to the eye, such as being hit with a football. The healthcare provider will examine the retina to assess for any signs of these specific injuries.Rate this question:
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- 2.
Oral aminocaproic acid is a treatment option for which of the following conditions?
- A.
Hyphema
- B.
Iritis
- C.
Asteroid hyalosis
- D.
Neurotrophic keratopathy
Correct Answer
A. HyphemaExplanation
Aminocaproic acid prevents re-bleeding but should be avoided in pts with cardiac, hepatic, or renal diseaseRate this question:
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- 3.
Your patient has hyphema-related elevated IOP. You would like to Rx something to control the IOP, which would be the safest option?
- A.
Prostaglandins
- B.
Pilocarpine
- C.
CAI
- D.
Beta Blocker
Correct Answer
D. Beta BlockerExplanation
Avoid mitoics (PGs & Pilo)
Avoid CAI for potential sickle cellRate this question:
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- 4.
Which of the following etiologies of iritis will have little to no flare.
- A.
Idiopathic
- B.
Phacolytic
- C.
Laser-induced
- D.
Lens particle
Correct Answer(s)
A. Idiopathic
C. Laser-inducedExplanation
Phacolytic & lens particle will have lots/large flare
multi-focal yellow-white lesions in retina --> Candidiasis (fungus) & TB
Serpiginous: atrophy & inflamm around ONH in 'snake pattern'Rate this question:
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- 5.
Indicate ALL the statements that are true for Iris Melanomas
- A.
Inferior portion of iris
- B.
Superior portion of iris
- C.
Arises from iris stroma
- D.
Arises from iris pigmented epithelium
- E.
Causes pupil distortion
Correct Answer(s)
A. Inferior portion of iris
C. Arises from iris stroma
E. Causes pupil distortionExplanation
Iris melanoma can also cause heterochromia and unilateral elevation in IOP (due to unilateral PDS, which is usually bilateral)Rate this question:
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- 6.
If you diagnose your pt with an iris melanoma, it is imperative to seek immediate treatment since these lesions have a chance for metastasis
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Iris melanomas don't metastisize
Tx: Surgery, plaque radiation therapy, Transpupillary thermal radiationRate this question:
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- 7.
Latanoprost usage is a risk factor/cause for iris cysts.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Other causes or iris cysts: surgery, iritis, latanoprost
Location: back of iris
SLE: best seen w/ retroilluminationRate this question:
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- 8.
Indicate ALL the true statement about asteroid hyalosis.
- A.
Calcium soaps
- B.
Cholesterol
- C.
Unilateral mostly
- D.
Bilateral mostly
- E.
Reduced VA if get really dense
Correct Answer(s)
A. Calcium soaps
C. Unilateral mostlyExplanation
If asteroid hyalosis becomes really dense it will make it difficult to see inside the pts eye but it will not affect pt's VARate this question:
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- 9.
Nongeographic atrophy is RPE hypopigmentation where you can see the underlying choroid vessels.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Nongeographic Atrophy: RPE hypopigmentation, CAN'T see underlying choroid vessels, NOT distinct
Geographic Atrophy: regression of soft drusen, can see underlying choroid, distinct
Drusenoid RPE Detachments: caused by coalesced soft drusen, NOT assoc w/ CNVM & usually resolves w/o txRate this question:
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- 10.
MPOD (macular pigment optical density) and PHP (preferential hyperacuity perimetry) are 2 tests that help you to determine the effectiveness of hypertensive retinopathy treatment
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
MPOD + PHP for ARMD txRate this question:
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- 11.
Which of the following can lead to hemmorahgic Pigmented Epithelium Detachments (PED)?
- A.
Serous PED
- B.
Fibrovascular PED
Correct Answer
B. Fibrovascular PEDExplanation
Serous: fluid from choriocap goes into sub-retinal space
Fibrovascular: secondary to CNVM (occult)
--> both can cause tear in RPERate this question:
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- 12.
HTN choroidopathy is usually found in Grade 3 & 4
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Garde 3/4 = acute
Choriocap is very sensitive to HBP --> damage to RPERate this question:
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- 13.
Elschnig's Spots & Siegrit's is found in which condition?
- A.
HTN choroidopathy
- B.
HTN retinopathy
- C.
BRVO/CRVO
- D.
Acute Ophthalmic Artery Obstruction
Correct Answer
A. HTN choroidopathyExplanation
Elschnig's: yellow circular lesion that later becomes pigmented due to RPE damage
Siergrist's: linear pigmented areas that run along sclerotic choroidal vesslesRate this question:
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- 14.
In the early signs of HTN retinopathy, the arteries are straight.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Straightened in early stages and then become tortuous over time
Some people are born with naturally tortuous vessels howeverRate this question:
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- 15.
BRVO/CRVO is typically caused by plaques that obstruct the blood flow.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
2 main causes for CRVO:
1) impingement of artery on vein (leads to endo cell damage)
2) thickening of venous blood (BC or sickle cell)
Plaques cause CRAO/BRAORate this question:
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- 16.
When differentiating btwn CRVO vs hemi-central CRVO, if the vessels bifurcate before the lamina cribosa it is:
- A.
Hemi-central CRVO
- B.
BRVO
- C.
CRVO
- D.
All of the above possible
Correct Answer
A. Hemi-central CRVOExplanation
Vessel bifurcates before LC --> hemi-central CRVO
Vessel bifurcates after LC --> CRVORate this question:
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- 17.
To determine if a CRVO is ischemic or non-ischemic, you perform a FA. At what level of capillary dropout will it be considered ischemic?
- A.
> 5 dd
- B.
> 10 dd
- C.
> 20 dd
- D.
> 7 dd
Correct Answer
B. > 10 ddExplanation
A fluorescein angiography (FA) is used to determine if a central retinal vein occlusion (CRVO) is ischemic or non-ischemic. Ischemic CRVO is associated with more severe vision loss and has a higher risk of developing complications. The level of capillary dropout observed on the FA is used to classify the CRVO as ischemic or non-ischemic. In this case, a capillary dropout of greater than 10 disc diameters (dd) is considered ischemic.Rate this question:
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- 18.
Choose the FALSE statement.
- A.
Acute ophthalmic artery obstruction will have little to no cherry red spot
- B.
CRAO and AOAO both cause opacified retinas, but AOAO is usually worse
- C.
CRAO generally causes larger VA reduction that AOAO
- D.
CRAO will cause an immediate APD
Correct Answer
C. CRAO generally causes larger VA reduction that AOAOExplanation
The given answer is correct because it states that CRAO generally causes a larger reduction in visual acuity (VA) compared to AOAO (Acute Ophthalmic Artery Obstruction). This means that in cases of CRAO, the loss of vision is typically more severe than in cases of AOAO.Rate this question:
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- 19.
The most common etiology of epiretinal membrane is retinal vascular diseases.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Most common cause is idiopathic
Signs: glistening, pseudoholes, wrinkling, hemesRate this question:
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- 20.
Impendiing macular holes typically resolve 50% of the time, otherwise treat with a vitrectomy and gas bubble
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Macular holes affect women > men
Due to tractional forces of the vitreous
Early stage signs = yellow spots w/ loss of foveal depressionRate this question:
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- 21.
Choose the TRUE statement abut Vitrealmacular Traction Syndrome.
- A.
Aphakia/pseudoaphakia can be protective
- B.
Most require vitrecomy w/ ILP peel
- C.
Present in 25% of pts > 70 yo
- D.
None of the above are true
Correct Answer
A. Aphakia/pseudoaphakia can be protectiveExplanation
- Cataract sx causes vitreous to pull away from retina
- Most resolve on own w/ PVD but if VA 20/60 or worse do vitrectomy w/ ILP peel
- Present in 50% of pts over 70 yo
- can lead to CME, ERM, macular hole
- Def: partial attachment of posterior hyaloid membraneRate this question:
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- 22.
Choose ALL of the correct statement about Idiopathic Juxtafoveal Telangiectasia.
- A.
Group 3 associated with CNS vasculitis
- B.
Signs associated with area nasal to fovea
- C.
Signs associated with area temporal to fovea
- D.
FA hypofluroescece
- E.
Yellow intra-retinal crystals
- F.
Associated with HTN
Correct Answer(s)
A. Group 3 associated with CNS vasculitis
C. Signs associated with area temporal to fovea
E. Yellow intra-retinal crystalsExplanation
Def: incompetent retinal caps in foveal region or one or both eyes (thickening of retinal caps)
- Group 1 = unilateral | Group 2 = bilateral | Group 3 = bilateral + CNS vasculitis
- Temporal to fovea: localized retinal thickening, RPE hyperplasia, FA leakingRate this question:
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- 23.
Irvine-Gass Syndome refers to what sign of Sickle Cell Ret?
- A.
Salmon patch hemes
- B.
Iridecent spot
- C.
Sunburst spot
- D.
Sea fan neo
- E.
Cystoid macular edema post cataract sx
Correct Answer
E. Cystoid macular edema post cataract sxExplanation
iridescent spot: smalls schisis that contains hemosidern macrophages
salmon patch: heme secondary to obstruction of BV that ruptures
sunburst: collection of RPE cells from chorodial occlusions
associated with: DR, vein occlusion, iritisRate this question:
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- 24.
Which of the following is NOT a s/s of Ocular Ischemic Syndrome?
- A.
Dilated and tortuous vessels
- B.
Neovascularization
- C.
Anterior uveitis
- D.
Lenticular stress leading to true exfoliation
- E.
Ocular angina (dull ache)
Correct Answer
A. Dilated and tortuous vesselsExplanation
in OIS vessels are dilated but NOT tortuous
cause: carotid obstruction
- men > women
- no flow obstruction in carotid until 70%
- no flow obstruction in CRA until 90% (50% decrase in perfusion of CRA)Rate this question:
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- 25.
The most common cause of Macroanerysms is DM
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
most common cause of macroanys is HTN
Def: dilation of major arterial branch (can rupture)
- indicates high mortality rate --> refer to cardiologistRate this question:
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- 26.
Lacqure cracks, tilted disc, Fuch's spots, posterior staphaloma are all signs of what disease?
- A.
Degenerative myopia
- B.
Birdshot chorioretinitis
- C.
Amiodarone neuropathy
- D.
Acute ophthalmic artery obstruction
Correct Answer
A. Degenerative myopiaExplanation
> -6.00 D
- Dec VA from atrophy @ macula
- myopic crescent from RPE atrophy (temporal or 360)
- complete PVD common
- post. staphaloma: outward bulging of ONH, ONH sinks, ON looks deeper than rest of retinaRate this question:
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- 27.
Which of the following is NOT a potential cause of chorodial/chorioretinal folds?
- A.
High hyperopia
- B.
Tumors
- C.
Buckle surgery
- D.
Idiopathic
- E.
Posterior scleritis
- F.
All of the above are potential causes
- G.
3 of the above are potential causes
Correct Answer
F. All of the above are potential causesExplanation
IMPT to RO ocular tumor when you see these foldsRate this question:
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- 28.
Progressive Outer Retinal Necrosis (PORN) is due to:
- A.
Varicella Zoster Virus
- B.
Herpes Virus
- C.
Moraxella Virus
- D.
Ron Jeremy
Correct Answer
A. Varicella Zoster VirusExplanation
Moraxella --> angular bleph
- Found in immunocompromised (think porn & AIDS...insensitive, maybe, but anything helps at this point!!!)
- Devastating, necrotizing retinitis (reduce VA quickly)Rate this question:
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- 29.
Amiodarone Neuropathy leads to sudden vision loss
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
gradual vision loss
- bilateral ONH edemaRate this question:
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- 30.
A small disc is a risk factor for AION
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Non-AION RFs: small disc, HTN, DM, chl, profound blood loss, Viagra (if small disc)Rate this question:
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- 31.
Indicate ALL of the signs of Non-AION
- A.
APD
- B.
Bilateral
- C.
Occurs in AM usually
- D.
Altitudinal defect (inferior most common)
- E.
Disc edema w/ hemes
- F.
Many systemic symptoms
Correct Answer(s)
A. APD
D. Altitudinal defect (inferior most common)
E. Disc edema w/ hemesExplanation
Non-AION s/s: APD, unilateral always, occurs in AM, disc edema w/ hemes, sectoral edema --> altitudinal VFD, sectoral pallor, NO systemic sx
- No tx other than control underlying issues
- PION has no disc edema, all the symptoms of non-aion but NO SIGNSRate this question:
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- 32.
Non-AION & AION involve occlusion of the posterior ciliary arteries.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
AION has worse VA & vision rarely improvesRate this question:
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- 33.
What is the appropriate tx for AION?
- A.
Topical steroids
- B.
Oral steroids
- C.
IV steroids
- D.
Tx underlying condition
Correct Answer
C. IV steroidsExplanation
aion = ocular emergency
- systemic sins
- due to GCA
- ON is infarcted & chalk white
- cupping following resoutionRate this question:
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- 34.
Peripheral Senile Pigmentary Degeneration occurs in which quadrant of the retina?
- A.
Nasal
- B.
Temporal
- C.
Superior
- D.
Inferior
Correct Answer
A. NasalExplanation
- Due to aging
- Hyper/hypo pigmentation
- Seen with drusen
- Doesn't cause much of a problem visuallyRate this question:
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- 35.
Retinoschisis typically occurs in which area of the retina?
- A.
Superior
- B.
Sup/nasal
- C.
Inf/nasal
- D.
Sup/temporal
- E.
Inf/temporal
Correct Answer
E. Inf/temporalExplanation
- Bilateral
- absolute VFD
- hole in outer layer is worse than inner layer bc inner layer already detachedRate this question:
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- 36.
A basement membrane disorder of multiple organs in the body describes which condition?
- A.
Pseudoexfoliation Syndrome
- B.
Pigment Dispersion Syndrome
- C.
Progressive Outer Retinal Necrosis
- D.
Charles Bonnet Syndrome
Correct Answer
A. Pseudoexfoliation SyndromeExplanation
- Demo: older scandanavian women
- True Ex Syn = glassblowers, lens capsule chips off
- Exfol mat'l on anterior lens capsule, pupillary ruff
- Transilumination defects around pupillary ruff
- Narrow AC w/ IRREGULAR pigmentation in TM
- Foward movement of lens due to weak zonules
- Mitotic pupil
- GLC cupping (50% get GLC in 10 years)
- Bull's Eye pattern (3 ring)Rate this question:
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- 37.
What percentage of the population has ONH drusen?
- A.
1%
- B.
2%
- C.
4%
- D.
5%
Correct Answer
A. 1%Explanation
The correct answer is 1%. This suggests that only 1% of the population has ONH drusen. Drusen are tiny yellow or white deposits that accumulate under the retina, and ONH (optic nerve head) drusen refers to the presence of these deposits at the optic nerve head. This condition is relatively rare, affecting a small percentage of the population.Rate this question:
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- 38.
ONH drusen cause what type of VF defect?
- A.
Inferior
- B.
Superior
- C.
Nasal step
- D.
Temporal wedge
Correct Answer
A. InferiorExplanation
May look like GLC, but monitor and check for progression (GLC)
- VA good
- Can cause Pseudopapilledema (elevated but not edematous) --> DDX w/ OCT
- Anomalous branching of BV
- HemesRate this question:
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- 39.
ONH drusen is best detected with a ______.
Correct Answer
B scanExplanation
Turn down sensitivity --> calcified drusen show up
Use Red-Free filterRate this question:
- 40.
A CN III palsy will result in an eye turn that is down & in
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
- Complete CN III palsy: down + out + complete ptosis
- Incomplete CN III palsy: developing aneurysm/mass/compression lesion
- Aberrant regeneration leads to pseudo-Von Graffe --> usually due to mass, trauma, anerysm, NOT an ischemic eventRate this question:
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- 41.
Pts with Charles Bonnet Syndrome have good intellect, good cognitive ability, no psychiatric disorders, and good vision
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Visual impairment but have vivid/clear/colorful hallucinations
Gnomes are creepyRate this question:
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