Ocular Disease II: Acquired Maculopathies, Retinal Vascular

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Ocular Disease II: Acquired Maculopathies, Retinal Vascular - Quiz


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Questions and Answers
  • 1. 

    Select the FALSE statement for ARMD:

    • A.

      Usually BILATERAL

    • B.

      #1 cause of blindness in UA over age 65

    • C.

      White is affected more than Black

    • D.

      Smoking is 3X the risk due to DECREASED circulation to the retina and choroid

    • E.

      Myopia is 25x higher risk due to less pigment

    • F.

      Circulatory diseases such as DM and HTN are a major factor for ARMD, due to circulation issues to retina

    Correct Answer
    E. Myopia is 25x higher risk due to less pigment
    Explanation
    HYPEROPIA (>0.75) is 25x higher risk due to less pigment

    Rate this question:

  • 2. 

    T/F Drusen which is collection of HYALINE DEPOSITs  between RPE and Bruch's membrane is the #1 sign for ARMD 

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Drusen, which are collections of hyaline deposits between the retinal pigment epithelium (RPE) and Bruch's membrane, are indeed considered the number one sign for age-related macular degeneration (ARMD). These deposits can be seen during an eye examination and are associated with the degeneration of the macula, leading to vision loss. Therefore, the statement "Drusen is the #1 sign for ARMD" is true.

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  • 3. 

    Select the FALSE statement about Drusen: 

    • A.

      Hard drusen are small, well-defined yellow deposits deep in retina while Soft drusen are LARGER and fluffy

    • B.

      Dursen will HYPERfluroresence, compared to Exudate which will HYPOfluorensce with Red-free Light. used to DDX

    • C.

      Hard dursen has low risk for Neo, compared to soft drusen which has a 7% risk of neo dye to more damage to sensory retina

    • D.

      VA will be still be 20/20 and will have a (-) amsler grid, if it is just soft or hard drusen by itself and not true ARMD.

    • E.

      All are true

    Correct Answer
    E. All are true
    Explanation
    All the statements provided in the question are true. Hard drusen are small, well-defined yellow deposits deep in the retina, while soft drusen are larger and fluffy. Drusen will hyperfluoresce, compared to exudate which will hypofluoresce with red-free light, which can be used to differentiate between them. Hard drusen have a lower risk for neovascularization compared to soft drusen, which have a 7% risk. If it is just soft or hard drusen by itself and not true age-related macular degeneration (ARMD), visual acuity will still be 20/20 and the Amsler grid will be negative.

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  • 4. 

    Select the FALSE statement about the general signs for DRY ARMD (aka Atrophic, or non-exudative) 

    • A.

      Dry ARMD accounts for 90% of all ARMD

    • B.

      There is a DECREASED in VA

    • C.

      Underlying choroidal vessels may become more PROMINANT as the disease progress. Retina look whiter

    • D.

      Coalescing drusen do NOT indicate progression to WET ARMD (aka Disciform type)

    Correct Answer
    D. Coalescing drusen do NOT indicate progression to WET ARMD (aka Disciform type)
    Explanation
    Coalescing drusen DO indicate progression to WET ARMD (aka Disciform type)

    Rate this question:

  • 5. 

    Check all the Treatment/management for Dry ARMD: 

    • A.

      Home Amsler grid

    • B.

      Low vision devices if decreased VA

    • C.

      Anti-VegF injection

    • D.

      UV protection

    • E.

      Vitamin C+E , beta-carotene (vitamin A), zinc

    Correct Answer(s)
    A. Home Amsler grid
    B. Low vision devices if decreased VA
    D. UV protection
    E. Vitamin C+E , beta-carotene (vitamin A), zinc
    Explanation
    Anti-VegF injection are for WET ARMD

    Rate this question:

  • 6. 

    It is safe to prescribe Beta-carotene to chronic smokers who just quit 2 years ago. 

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    It is still NOT safe to prescribe Beta-carotene to chronic smokers who just quit 2 years ago. Better to replace with a Lutein, according to AREDS forumation

    Rate this question:

  • 7. 

    Which one is NOT a part of the AREDS formulation as an ADD-ON TX for dry ARMD to help slow down progression. 

    • A.

      Vitamin C

    • B.

      Vitamin E

    • C.

      Omega-3 FA

    • D.

      Xanthelutein

    • E.

      Zinc Oxide

    • F.

      Copper (prevents copper deficiency anemia from zinc intake)

    • G.

      Beta Carotene

    Correct Answer
    D. Xanthelutein
    Explanation
    Omega-3 FA and Lutein will be added to the NEW AREDS formula.
    AREDS formulation should ONLY BE an ADD-ON TX for dry ARMD, never as a main tx

    There is no such thing as Xanthelutein -_-

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  • 8. 

    Which patient is NOT at risk for developing CNVM (choroidal neovascular membrane or Macular degeneration in the good eye? 

    • A.

      If a patient bilateral drusen, then he has a 2-4%of developing CNVM

    • B.

      If one eye have AMD, there is a 10% of the other eye developing AMD

    • C.

      If there is a wet AMD in one eye AND confluent dursen in the other eye= then there is 55% risk of eye with the drusen of developing WET AMD

    • D.

      Focal RPE changes in one eye and NEO in the other eye--> high risk of developing wet AMD in non-affected eye

    • E.

      All are true

    Correct Answer
    E. All are true
    Explanation
    The given answer states that all the statements provided in the question are true. This means that all the mentioned conditions (bilateral drusen, AMD in one eye, confluent drusen in one eye, focal RPE changes in one eye and NEO in the other eye) put the patient at some level of risk for developing CNVM or macular degeneration in the good eye.

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  • 9. 

    Your patient come in and you see an elevated, discolored lesion in the retina. What should do you do first?

    • A.

      Sent out for Argon laser ASAP

    • B.

      Do an OCT or FA to rule out an CNVM

    • C.

      Start him on a Photodynamic therapy (TDT)

    • D.

      Using your 90D and stereo to see if there is elevation.

    Correct Answer
    B. Do an OCT or FA to rule out an CNVM
    Explanation
    Do an OCT or FA to rule out an CNVM!

    Using your 90D and stereo to see if there is elevation. This is hard to detect with wet ARMD

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  • 10. 

    T/F Photodynamic Therapy (PDT) is a great 1st line treatment for Wet ARMD: 

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Photodynamic Therapy (PDT) "cold laser" can only be used in conjunction with Anti-VEGF injection.

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  • 11. 

    Select all the TRUE statements about Anti-VEGF injections as treatment for wet ARMD: 

    • A.

      #1 choice TX, which target ABNORMAL vessel/fast-growing tissue (NVM)

    • B.

      Macugen, Lucentis, Avastin are all form of the intravitreal injections

    • C.

      4th gen FQ are used prior to injection to decrease bacteria growth

    • D.

      Betadine is used in adjacent ocular area to create a sterile environment

    • E.

      You can use proparacaine to anethestize topically

    • F.

      Your goal is create a CLOUD cover of medication over the wet AMD and blood vessels.

    • G.

      Avastin is FDA-approved and is used most commonly

    Correct Answer(s)
    A. #1 choice TX, which target ABNORMAL vessel/fast-growing tissue (NVM)
    B. Macugen, Lucentis, Avastin are all form of the intravitreal injections
    C. 4th gen FQ are used prior to injection to decrease bacteria growth
    D. Betadine is used in adjacent ocular area to create a sterile environment
    F. Your goal is create a CLOUD cover of medication over the wet AMD and blood vessels.
    Explanation
    -You use NOVOCAINE to anethestize topically
    -ONLY Lucentis is FDA-approved. But Avastin is used more widely bc it is cheaper and used off-label

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  • 12. 

    Select the FALSE statement for Steroid injection of Triamcinolone/Kenalog for wet ARMD?

    • A.

      Triamcinolone/Kenalog vitreous injection reduce inflammation and vascular permeability

    • B.

      May be used in conjunction with Photodynamic therapy

    • C.

      Helpful for DM macular edema and other vascular occlusive dz

    • D.

      ADE of Triamcinolone/Kenalog injection is NOT enhanced, compared to Oral Triamcinolone/Kenalog

    • E.

      Reduce swelling which last for UP TO 3-4MONTHS

    Correct Answer
    D. ADE of Triamcinolone/Kenalog injection is NOT enhanced, compared to Oral Triamcinolone/Kenalog
    Explanation
    ADE of Triamcinolone/Kenalog injection is enhanced, compared to Oral Triamcinolone/Kenalog

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  • 13. 

    T/F If there is overall defect in Bruch's membrane in wet AMD, there anti-VEGF injections will be helpful. 

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Overall defect in Bruch's membrane in wet AMD, there anti-VEGF injections will be helpful.
    -eg) presumed ocular Hist, high myopia, angoid streaks, traumatic chorodial rupture

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  • 14. 

    T/F Photodynamic  therapy is ONLY used in combo with: 1) VEGF injection...OR  2) Steroid such as Triamcinolone...OR 3) AREDS multi-vitamins

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Photodynamic therapy is ONLY used in combo with:
    1) VEGF injection
    2) Steroid such as Triamcinolone

    AREDS multi-vitamins are used to slow down progression of dry AMD

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  • 15. 

    Your 40 y/o MALE patient walks in. He just got divorced by his wife and is complaining of a central distortion in his vision. What could he possible have? 

    • A.

      Wet ARMD

    • B.

      Diabetic ret

    • C.

      Central Serous retinopathy

    • D.

      Macular hole

    Correct Answer
    C. Central Serous retinopathy
    Explanation
    CSR are the #1 MOST ACQUIRED Maculopathy

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  • 16. 

    Select all the TRUE statements about CSR's clinical finding:

    • A.

      BILATERAL

    • B.

      Acute onset of reduced VA with a (+) relative scotoma and central metamorphosia

    • C.

      Although sometime the vision is 20/20, there might be a MYOPIC shift because sensory retina is elevated

    • D.

      After-images are seen due to fluid disruption with photoreceptors

    • E.

      (+) photostress test

    • F.

      Foveal reflex will still be present

    • G.

      You will see a dome-shaped elevation of retina, which can best viewed with stereo fundus lens.

    • H.

      OCT is great because it will should an optically empty gap (can't see fluid). Great for DDX between wet ARMD

    • I.

      FA will HYPOflurousence because SEROUS fluid (not blood) will fill the sub-retinal space--> Which lead to a "mushroom" cloud appearance with time.

    Correct Answer(s)
    B. Acute onset of reduced VA with a (+) relative scotoma and central metamorphosia
    D. After-images are seen due to fluid disruption with photoreceptors
    E. (+) photostress test
    G. You will see a dome-shaped elevation of retina, which can best viewed with stereo fundus lens.
    H. OCT is great because it will should an optically empty gap (can't see fluid). Great for DDX between wet ARMD
    Explanation
    -CSR is UNILATERAL
    -Although sometime the vision is 20/20, there might be a HYPEROPIC shift (>+0.75D) because sensory retina is elevated
    Foveal reflex will NOT BE present
    -FA will HYPERflurousence because SEROUS fluid (not blood) will fill the sub-retinal space--> Which lead to a "mushroom" cloud appearance with time.
    ---> This is due to a break in RPE (KNOW)

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  • 17. 

    SELECT all the TRUE statements about Treatment/Managment of CSR: 

    • A.

      80-90% will resolve spontaneously within 1-6 month, with increased VA. That's why we usually monitor monthly.

    • B.

      If symptoms are STILL PRESENT after 4 months, then refer out to LASER PHOTOCOAGULATION (usually argon).

    • C.

      Laser is effective and will IMPROVE vision outcome, thus is often used as an initial treatment

    Correct Answer(s)
    A. 80-90% will resolve spontaneously within 1-6 month, with increased VA. That's why we usually monitor monthly.
    B. If symptoms are STILL PRESENT after 4 months, then refer out to LASER PHOTOCOAGULATION (usually argon).
    Explanation
    Laser is effective but WILL NOT IMPROVE vision outcome. ALSO NOT used as an initial treatment

    -If present after 4months, usually indicate tissue having irreversible damage.

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  • 18. 

    Which is one is Cystoid Macular Edema (which is collection of fluid in the OUTER PLEXIFORM LAYER and INNER NUCLEAR LAYER of the sensory retina around macula) NOT SECONDARY to? 

    • A.

      Prostaglandins Force

    • B.

      High Refractive error

    • C.

      Tractional Forces

    • D.

      Vascular

    Correct Answer
    B. High Refractive error
    Explanation
    1) Prostaglandins Force= faclitates inflammation and CME if PG is around macula
    2) Tractional Forces
    3) Vascular= breakdown of capillaries

    ***KNOW That CME is when it is secondary to something that lead to a BREAKDOWN

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  • 19. 

    Check all the  etiologies that CME is secondary to: 

    • A.

      Diabetes/ DM ret

    • B.

      Retinal Vein Obstruction

    • C.

      Steroid toxicity

    • D.

      Hypertension

    • E.

      Irvine-Gass Syndrome (Post cataract extraction)

    • F.

      Anterior Uveitis

    • G.

      High Cholesterol

    • H.

      Glaucoma Tx

    • I.

      Retinitis pigmentosa

    • J.

      Macular Pucker

    Correct Answer(s)
    A. Diabetes/ DM ret
    B. Retinal Vein Obstruction
    D. Hypertension
    E. Irvine-Gass Syndrome (Post cataract extraction)
    F. Anterior Uveitis
    H. Glaucoma Tx
    I. Retinitis pigmentosa
    J. Macular Pucker
    Explanation
    *Diabetes/ DM ret: especially when blots/hemes/hard exudates are seen

    *Irvine-Gass Syndrome (Post cataract extraction)

    *Glaucoma Tx= because epinephrine and PG are released, which increase inflammation

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  • 20. 

    Select the FALSE CME clinical findings: 

    • A.

      Loss of foveal reflex

    • B.

      Multiple cystic spaces in sensory retina, where fluid accumulates and breaks up sensory retina

    • C.

      Blurring of chorodial pattern due to sensory retina thickening

    • D.

      Weiss Ring

    • E.

      FA: you will see "flower petal" appearance

    • F.

      Slight elevated macula

    Correct Answer
    D. Weiss Ring
    Explanation
    Weiss Ring is seen in the stage 4 of macular hole (full thickness)

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  • 21. 

    If you see DM retinopathy in your CME patient, what would be the BEST treatment? 

    • A.

      Pred-forte QIDx 4 weeks

    • B.

      Ketorolac Tromethaamine (Acular) or Voltaren drops

    • C.

      NSAID (Indomethacin)

    • D.

      Triamcinolone Injection

    • E.

      Focal or grid laser

    Correct Answer
    D. Triamcinolone Injection
    Explanation
    1) Pred-forte= inflammatory cause
    2) Ketorolac Tromethaamine (Acular) or Voltaren drops= if PG cause, used to reduce release
    3) NSAID (Indomethacin)

    ***Triamcinolone Injection= highly used TX, especially if DM ret
    -Will increase IOP so be careful!

    Focal or grid laser= can also be for any vascular etiology (DM or HTN)

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  • 22. 

    T/F Caution with glaucoma patients prior to cataract surgery, because we need to D/C glaucoma medications for ~1month because it may facilitate CME

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Prior to cataract surgery, caution is needed with glaucoma patients because discontinuing glaucoma medications for approximately one month may facilitate cystoid macular edema (CME). CME is a potential complication of cataract surgery, and glaucoma medications can help manage intraocular pressure and reduce the risk of CME. Therefore, stopping these medications prior to surgery may increase the likelihood of CME occurring.

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  • 23. 

    Select the FALSE clinical finding statement of Macular Hole: 

    • A.

      Unilateral (usually)

    • B.

      MOA: Vitreous get pulled on, which separate the retina--> create cysts--> Pull enough to get a hole ("punch out appearance")

    • C.

      FA: HYPOfluorenscence in late stages (cyst)

    • D.

      (+) amsler at fixation only (normal everywhere else)

    • E.

      Symptoms might be hard for patient to describe (usually blurred vision, metamophoropsia, missing areas)

    • F.

      Affect Female MORE

    Correct Answer
    C. FA: HYPOfluorenscence in late stages (cyst)
    Explanation
    FA: HYPERfluorenscence in late stages (cyst)

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  • 24. 

    Which is NOT a cause for Macular Hole?

    • A.

      Idiopathic

    • B.

      CME

    • C.

      Diabetes

    • D.

      Trauma

    • E.

      Myopia

    • F.

      PVD

    Correct Answer
    C. Diabetes
    Explanation
    5 Causes: MC-PIT
    1)Idiopathic
    2) CME= create a lamellar hole
    3) Trauma= cause vitreous traction and, which can lead to lamellar hole
    --Might need vitrectomy to collapse the hole
    4) Myopia= subtretinal fluid leading to detachment
    5) PVD

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  • 25. 

    NAME THAT STAGE! -Reduced VA -Slight reddish hole  -No edema around hole  -OCT: show a depressed area 

    • A.

      Stage 1A: Macular Cyst

    • B.

      Stage 2: Lamellar Hole (partial Thickness)

    • C.

      Stage 3: Full thickness

    • D.

      Stage 4: Full thickness

    Correct Answer
    B. Stage 2: Lamellar Hole (partial Thickness)
    Explanation
    The given description of the stage includes reduced VA, a slight reddish hole, no edema around the hole, and OCT showing a depressed area. Based on these characteristics, the correct answer is Stage 2: Lamellar Hole (partial Thickness). This stage is characterized by a partially-thickness hole in the macula, which can cause reduced visual acuity. The absence of edema around the hole suggests that it is not a full-thickness hole.

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  • 26. 

    NAME THAT STAGE: -Central yellow dot  -Loss of foveal reflex -OCT: Small elevated space (not a hole yet)

    • A.

      Stage 1A: Macular Cyst

    • B.

      Stage 2: Lamellar Hole (partial Thickness)

    • C.

      Stage 3: Full thickness

    • D.

      Stage 4: Full thickness

    Correct Answer
    A. Stage 1A: Macular Cyst
    Explanation
    The given description of the central yellow dot, loss of foveal reflex, and OCT findings of a small elevated space suggests that the correct answer is Stage 1A: Macular Cyst. In this stage, there is a collection of fluid within the macula, causing a cyst-like appearance. This stage is characterized by partial thickness involvement and is the earliest stage of macular hole formation.

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  • 27. 

    NAME THAT STAGE: -Complete separation of vitreous  -Central round defect -WEISS ring  -Grey elevated edges around hole (donut appearance)  *You see yellowish deposits at the floor of the hole form lipids! 

    • A.

      Stage 1A: Macular Cyst

    • B.

      Stage 2: Lamellar Hole (partial Thickness)

    • C.

      Stage 3: Full thickness

    • D.

      Stage 4: Full thickness

    Correct Answer
    D. Stage 4: Full thickness
    Explanation
    Stage 3: Full thickness
    -PARTIAL vitreomacular separation (>400um)
    -Edges are NOT elevated around hole

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  • 28. 

    What would you do to treat Stage 3: Full thickness??

    • A.

      Monitor

    • B.

      Consult with retina specialist

    • C.

      Retinal consult for vitrectomy

    Correct Answer
    C. Retinal consult for vitrectomy
    Explanation
    For Stage 3: Full thickness, the appropriate treatment option would be a retinal consult for vitrectomy. This procedure involves removing the vitreous gel from the eye and repairing any retinal tears or detachments. Monitoring alone would not be sufficient, and consulting with a retina specialist would not be enough to treat the condition. Therefore, the best course of action is to consult with a retinal specialist for a vitrectomy.

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  • 29. 

    T/F PVD is a good indicator of stability because if present, there is no little risk of developing a TRUE macular hole 

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    TRUE, because there is no traction in that area

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  • 30. 

    T/F Vitrectomy (gas bubble injection to keep macula in place, to keep hole smaller), will IMPROVE VA by 2x if initial poor VA. 

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Vitrectomy is a surgical procedure that involves injecting a gas bubble into the eye to keep the macula in place and prevent the hole from getting larger. This procedure can improve visual acuity (VA) by 2x if the initial VA is poor. By keeping the macula in place, the gas bubble helps to stabilize the hole and promote healing, which can lead to an improvement in vision. Therefore, the statement is true.

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  • 31. 

    SELECT THE FALSE STATEMENT that you can DDX Solar Ret from Macular Hole? 

    • A.

      Solar ret patient are usually mental disabled patient who like to stare at the sun. "sun-worshippers"

    • B.

      Solar ret are usually BILATERAL, compared to macular holes which are UNILATERAL

    • C.

      VA are NOT reduced in Solar Ret

    Correct Answer
    C. VA are NOT reduced in Solar Ret
    Explanation
    VA are BOTH reduced in Solar Ret and macular holes

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  • 32. 

    Select ALL TRUE statements about Presumed Ocular Histoplasmosis: 

    • A.

      It is due to a defect in the Bruch's, which allow a higher chance of CNVM to grow in

    • B.

      Associated with moisture, common in Ohio/Mississippi

    • C.

      Caused by bacterial infection

    • D.

      Ocular presentation is around 30 y/o

    • E.

      You will often seen a PPA

    • F.

      Histo spots around macula will appear

    • G.

      Chorododial neovascularization (CNVM) is seen at the SAME time as the initial infection

    • H.

      Patient is ASYMPTOMATIC until active macular involvement

    • I.

      If one eye is affected, the fellow eye will have 30% chance of getting it in 6-7 yrs

    • J.

      If you see CNVM, anti-VEGF is best option

    • K.

      Typical TX: Retinal consult+ PhotoDynamicTherapy

    Correct Answer(s)
    A. It is due to a defect in the Bruch's, which allow a higher chance of CNVM to grow in
    B. Associated with moisture, common in Ohio/Mississippi
    D. Ocular presentation is around 30 y/o
    E. You will often seen a PPA
    F. Histo spots around macula will appear
    H. Patient is ASYMPTOMATIC until active macular involvement
    I. If one eye is affected, the fellow eye will have 30% chance of getting it in 6-7 yrs
    J. If you see CNVM, anti-VEGF is best option
    K. Typical TX: Retinal consult+ PhotoDynamicTherapy
    Explanation
    -Caused by FUNGAL infection
    -Chorododial neovascularization (CNVM) is seen AFTER (up to 30 yrs) the initial infection

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  • 33. 

    SELECT all TRUE statements about Geographic Helicoid Peripapillary Atrophy: 

    • A.

      Age onset= 45-50 yrs

    • B.

      Non-Hereditary

    • C.

      Patient will see a sudden scotoma, as lesion encoaches to macualr

    • D.

      During BIO, you will see a whitish area (over a great area) due to poor circulation on chorioid

    • E.

      VA is ALWAYS POOR

    • F.

      During fundus, you might see subretinal scarring extending out from optic disc, in a PROPELLER-like pattern

    • G.

      You treat it the SAME WAY as Macular degeneration

    • H.

      If you see SRNVM, you might want to order FA and maybe anti-VEGF therapy

    • I.

      Corticosteroids is the BEST form of treatment

    • J.

      Low vision devices are very helpful

    Correct Answer(s)
    A. Age onset= 45-50 yrs
    C. Patient will see a sudden scotoma, as lesion encoaches to macualr
    D. During BIO, you will see a whitish area (over a great area) due to poor circulation on chorioid
    F. During fundus, you might see subretinal scarring extending out from optic disc, in a PROPELLER-like pattern
    G. You treat it the SAME WAY as Macular degeneration
    H. If you see SRNVM, you might want to order FA and maybe anti-VEGF therapy
    J. Low vision devices are very helpful
    Explanation
    1) Hereditary
    2) VA loss varies depending on lesion location
    3) Corticosteroids is very controversial

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  • 34. 

    Your patient started a new anti-psychotic medication and come in for an eye exam. Initially, you find fundus to be normal. Then he started to complain of: -Blurred VA -Central VA loss -BROWN discolored vision  What does he have?

    • A.

      Plaquenil Retinopathy

    • B.

      Thoridazine (Mellaril) Retinopathy

    Correct Answer
    B. Thoridazine (Mellaril) Retinopathy
    Explanation
    The patient is experiencing symptoms of Thoridazine (Mellaril) Retinopathy. Thoridazine is an anti-psychotic medication known to cause retinal toxicity. The symptoms of blurred vision, central vision loss, and brown discolored vision are consistent with this condition. Plaquenil Retinopathy is not the correct answer as it is associated with the use of a different medication called Plaquenil, which is used to treat autoimmune conditions.

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  • 35. 

    So you decided to look in the back of the eye, what would you see for Thoridazine Ret?

    Correct Answer
    Salt and Pepper
    Explanation
    If you were to look in the back of the eye for Thoridazine Ret, you would see salt and pepper. This could be referring to a specific pattern or appearance in the retina that is characteristic of Thoridazine Ret. Without further context, it is difficult to determine the exact meaning of "salt and pepper" in this context.

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  • 36. 

    A different patient is currently taking the same medication (Plaquenil) for their RA, Lupus, Erthematosus and Anti-psy conditions. You are like wow, this guy is a eff-ed. What would you NOT do next? 

    • A.

      BIO to check for Bull's eye macula

    • B.

      Run a VF theshold 30-2 to determine changes in sensitivity

    • C.

      Fundus photos to look for degenerative changes

    • D.

      Consider a EOG, ERG, FA (in central vision loss w/o signs)

    • E.

      Consult with PCP about prescribed medication

    Correct Answer
    B. Run a VF theshold 30-2 to determine changes in sensitivity
    Explanation
    - You want to Run a VF CENTRAL theshold 10-2 to determine changes in sensitivity, with foveal sensitivity

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  • 37. 

    Select all  TRUE STATEMENTS about Epi-Retinal Membrane: 

    • A.

      May be related to POST-PVD process, due to more glial cells proliferating on the surface on ILM

    • B.

      Causes localized areas of wrinkling in macula "Spider web appearance" (aka Macular pucker)

    • C.

      Caused by unknown or retinal vascular dz

    • D.

      OCT: will show ERM pulling up vitreous region--> slight elevation

    • E.

      We will usually do vitrectomy to peel ILM first, because ERM usually cause a severe VA loss

    Correct Answer(s)
    A. May be related to POST-PVD process, due to more glial cells proliferating on the surface on ILM
    B. Causes localized areas of wrinkling in macula "Spider web appearance" (aka Macular pucker)
    C. Caused by unknown or retinal vascular dz
    D. OCT: will show ERM pulling up vitreous region--> slight elevation
    Explanation
    We usually just MONITOR, and RTC in 6months. It is rare for severe VA loss in ERM.
    -If so, THEN we will do vitrectomy to peel ILM first (but rare)

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  • 38. 

    T/F If you see a FLAME heme in your Hypertensive ret patient, you need to check BP because it can lead to BRVO/BRAO

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    If a hypertensive retinopathy patient presents with a FLAME heme (which refers to a flame-shaped hemorrhage), it is necessary to check their blood pressure because it can potentially lead to branch retinal vein occlusion (BRVO) or branch retinal artery occlusion (BRAO). High blood pressure can cause damage to the blood vessels in the retina, leading to bleeding and blockages in the retinal veins or arteries. Therefore, monitoring and controlling blood pressure is crucial in managing hypertensive retinopathy and preventing further complications.

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  • 39. 

    Select all TRUE STATEMENT abnout ACUTE DAMAGES signs in HT retinopathy: 

    • A.

      Vasoconstriction can lead to CWS and NFL infarcts

    • B.

      Leakage can leading to flame hemes, hard exudates and possible BRAIN SWELLING

    • C.

      Swelling of optic disc is common and not that serious

    • D.

      Macular star can occurs due to abnormal vascular permeability

    Correct Answer(s)
    A. Vasoconstriction can lead to CWS and NFL infarcts
    B. Leakage can leading to flame hemes, hard exudates and possible BRAIN SWELLING
    D. Macular star can occurs due to abnormal vascular permeability
    Explanation
    KNOW! Swelling of optic disc is very serious because it is HALLMARK sign for MALIGNANT phase of HTN ret.

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  • 40. 

     T/F Arteriosclerotic retinopathy ("hardening of the arteries") alone DO NOT indicate the severity of the HTN, but it does show that the systemic HTN has been present for MANY year 

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Arteriosclerotic retinopathy, also known as "hardening of the arteries," refers to the narrowing and hardening of the blood vessels in the retina. While it does not indicate the severity of hypertension (high blood pressure), it does suggest that systemic hypertension has been present for many years. This is because the chronic high blood pressure can cause damage to the blood vessels in the retina over time, leading to arteriosclerotic retinopathy. Therefore, the statement that arteriosclerotic retinopathy alone does not indicate the severity of hypertension but does show that systemic hypertension has been present for many years is true.

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  • 41. 

    What are the 3 types of ATHEROsclerotic changes? (check 3) 

    • A.

      Hollenhorst Plaques

    • B.

      Hyperviscosity Plaques

    • C.

      Fibrinoplatetes Plaques

    • D.

      Calcific Plaques

    Correct Answer(s)
    A. Hollenhorst Plaques
    C. Fibrinoplatetes Plaques
    D. Calcific Plaques
  • 42. 

    Check all TRUE statements when it comes to ATHerosclerotic plaques: 

    • A.

      Calcific plaques are the MOST common, while Hollenhorst plaques are the least

    • B.

      Hollenhorst are made up of cholesterol and tends to rest at BIFURCATIONS

    • C.

      Hollenhorst looks very SHINY, while Calcific are NOT shiny (look matte white)

    • D.

      We don't need to do carotid bruit assessment when we see plaques

    • E.

      Calcific plaques are the GREATEST risk of CRAO/BRAO because it can cause the greatest occlusion

    • F.

      Calcific plaques come from heart valves or carotid arteries, which break off

    • G.

      Aspirin once a day, if there is no contraindications, is a good treatment

    • H.

      Due to its soft/mallable form, Hollenhorst plaques can OFTEN cause occlusion

    Correct Answer(s)
    B. Hollenhorst are made up of cholesterol and tends to rest at BIFURCATIONS
    C. Hollenhorst looks very SHINY, while Calcific are NOT shiny (look matte white)
    E. Calcific plaques are the GREATEST risk of CRAO/BRAO because it can cause the greatest occlusion
    F. Calcific plaques come from heart valves or carotid arteries, which break off
    G. Aspirin once a day, if there is no contraindications, is a good treatment
    Explanation
    -Calcific plaques are the LEAST common, while Hollenhorst plaques are the MOST
    -We DO need to do carotid bruit assessment when we see plaques
    -Due to its soft/mallable form, Hollenhorst plaques can LEAST cause occlusion
    --blood can flow over and under the plaque :)

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  • 43. 

    What are the 4 types of Retinal Vascular Occlusive dz that we learned about? (Select 4) 

    • A.

      Central Retinal Venous Occlusion (CRVO)

    • B.

      Arteriosclerotic Retinal Occlusion (ARO)

    • C.

      Hemi-Central Retinal Vein Occlusion (Hemi-CRVO)

    • D.

      Branch Retinal Vein Obstruction (BRVO)

    • E.

      Central Retinal Artery Occlusion (CRAO)

    Correct Answer(s)
    A. Central Retinal Venous Occlusion (CRVO)
    C. Hemi-Central Retinal Vein Occlusion (Hemi-CRVO)
    D. Branch Retinal Vein Obstruction (BRVO)
    E. Central Retinal Artery Occlusion (CRAO)
    Explanation
    The four types of retinal vascular occlusive diseases that were learned about are Central Retinal Venous Occlusion (CRVO), Hemi-Central Retinal Vein Occlusion (Hemi-CRVO), Branch Retinal Vein Obstruction (BRVO), and Central Retinal Artery Occlusion (CRAO).

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  • 44. 

    Select ALL TRUE statements about Central Retinal Venous Occlusion: 

    • A.

      Peak incidence is 6th decade of life

    • B.

      MALE is more affected

    • C.

      BINOCULAR, painless vision loss, which decrease VA over 24-48hrs

    • D.

      When you look in the back of the retina, you will see "Flower Petal appearance" around the Macula

    • E.

      If the ONH is swollen enough, you will see (-)SVP and (-) Central retinal venous

    • F.

      CWS (aka NFL infacts) are seen MORE in hemorrhagic types

    • G.

      (+) Macular edema because the fluid is accumulating

    • H.

      If NVI do occur, it will occurs between 11 to 3 o'clock along the pupillary margin, because VegF flows along the convection current

    • I.

      Rubeosis Iridis (or NVI) can result in NEOVASCULAR GLAUCOMA (within 90-100 days)

    • J.

      If there is a retinal heme, it is will most likely be a FLAME HEME

    Correct Answer(s)
    A. Peak incidence is 6th decade of life
    B. MALE is more affected
    E. If the ONH is swollen enough, you will see (-)SVP and (-) Central retinal venous
    F. CWS (aka NFL infacts) are seen MORE in hemorrhagic types
    G. (+) Macular edema because the fluid is accumulating
    I. Rubeosis Iridis (or NVI) can result in NEOVASCULAR GLAUCOMA (within 90-100 days)
    J. If there is a retinal heme, it is will most likely be a FLAME HEME
    Explanation
    1) MONOCULAR, painless vision loss, which decrease VA over 24-48hrs
    2) When you look in the back of the retina, you will see BLOOD AND THUNDER
    -Flower Petal appearance is seen in FA for CME due cystic spaces
    3) If NVI do occur, it will occurs between 10 to 2 o'clock along the pupillary margin, because VegF flows along the convection current

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  • 45. 

    What are the 2 types of CRVO? Select the wrong one

    • A.

      Venous Stasis Retinopathy (Incomplete CRVO)

    • B.

      Hemorrhagic Retinopathy (Ischemic)

    • C.

      Anticoagulant Retinopathy

    Correct Answer
    C. Anticoagulant Retinopathy
    Explanation
    The question asks for the wrong type of Central Retinal Vein Occlusion (CRVO). The correct answer is "Anticoagulant Retinopathy" because it is not a type of CRVO. CRVO is typically classified into two types: Incomplete CRVO, also known as Venous Stasis Retinopathy, and Ischemic CRVO, also known as Hemorrhagic Retinopathy.

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  • 46. 

    Select ALL TRUE STATEMENT for venous stasis ret (VSR) and Hemorrhagic Ret (HR) 

    • A.

      VSR is more associated with sludging of blood, caused by LEUKEMIA, SICKLE CELL, DM

    • B.

      HR tends to affect more YOUNG, while VSR affect OLDER

    • C.

      VA prognosis is very POOR for HR, compared to VSR (which have good VA prognosis)

    • D.

      You see SIGNIFICANT Optic disc edema in VSR

    • E.

      There are more CWS seen in HR

    • F.

      NVI is more common in HR, which can lead to neovascular glaucoma

    • G.

      It is harder to see the retina and fundus during BIO with HR

    Correct Answer(s)
    A. VSR is more associated with sludging of blood, caused by LEUKEMIA, SICKLE CELL, DM
    C. VA prognosis is very POOR for HR, compared to VSR (which have good VA prognosis)
    E. There are more CWS seen in HR
    F. NVI is more common in HR, which can lead to neovascular glaucoma
    G. It is harder to see the retina and fundus during BIO with HR
    Explanation
    -VSR tends to affect more YOUNG, while HR affect OLDER
    -You see SIGNIFICANT Optic disc edema in HR
    -You see SIGNIFICANT Optic disc edema in HR

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  • 47. 

    T/F According to the CRVO study, Pan-retinal photocoagulation (PRP) should only be reserved if NEO is present. Also the results show that it is EFFECTIVE in reducing edema but NO IMPROVEMENT in VISUAL OUTCOME 

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    According to the CRVO study, Pan-retinal photocoagulation (PRP) should only be reserved if NEO (neovascularization of the optic disc) is present. The study also shows that PRP is effective in reducing edema, but it does not lead to any improvement in visual outcome. Therefore, the statement that PRP should only be used if NEO is present and that it is effective in reducing edema but does not improve visual outcome is true.

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  • 48. 

    T/F According to the SCORE study, 1 mg injection of steroid will: 1) Improve VA 2) Decrease vascular permeality  3) Decrease inflammation *Overall, there is a definite improvement with steroid injection, in treating CRVO 

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    The statement is true because according to the SCORE study, a 1 mg injection of steroid will improve visual acuity, decrease vascular permeability, and decrease inflammation. This study specifically focused on the treatment of central retinal vein occlusion (CRVO) and found that steroid injections had a positive overall effect in improving the condition.

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  • 49. 

    T/F Ozurdex (Dexametasone) implant will NOT REDUCE risk of further vision loss 

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Ozurdex (Dexametasone) implant will REDUCE risk of further vision loss. Similar effect as injections but with MUCH FEWER ADE

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  • 50. 

    So your patient presents with CRVO, what treatment options would you do??? SELECT ALL TRUE 

    • A.

      Order Complete blood count

    • B.

      Retinal consult for possible PRP, even if neo is NOT seen

    • C.

      Anticoagulants (Herparin, Warfarin) to break up the thrombosis and increase circulation

    • D.

      Shit, I should really palpate the hell out of that carotid system

    • E.

      Serum protein electrophoresis in younger patient, to R/O HYPERVISCOSITY SYNDROME

    • F.

      ILM peeling or Anti-VEGF to decrease fluid/neo

    • G.

      Ketoralac (Acular) QID

    Correct Answer(s)
    A. Order Complete blood count
    C. Anticoagulants (Herparin, Warfarin) to break up the thrombosis and increase circulation
    D. Shit, I should really palpate the hell out of that carotid system
    E. Serum protein electrophoresis in younger patient, to R/O HYPERVISCOSITY SYNDROME
    F. ILM peeling or Anti-VEGF to decrease fluid/neo
    Explanation
    -Retinal consult for possible PRP, ONLY if neo is seen
    -Ketoralac (Acular) QID is used to decrease Prostaglandins for CME, post-cataract surgery

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Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Jan 31, 2024
    Quiz Edited by
    ProProfs Editorial Team
  • Oct 08, 2013
    Quiz Created by
    Dbui510
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