1.
Select the FALSE statement for ARMD:
Correct Answer
E. Myopia is 25x higher risk due to less pigment
Explanation
HYPEROPIA (>0.75) is 25x higher risk due to less pigment
2.
T/F Drusen which is collection of HYALINE DEPOSITs between RPE and Bruch's membrane is the #1 sign for ARMD
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.
3.
Select the FALSE statement about Drusen:
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.
4.
Select the FALSE statement about the general signs for DRY ARMD (aka Atrophic, or non-exudative)
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)
5.
Check all the Treatment/management for Dry ARMD:
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
6.
It is safe to prescribe Beta-carotene to chronic smokers who just quit 2 years ago.
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
7.
Which one is NOT a part of the AREDS formulation as an ADD-ON TX for dry ARMD to help slow down progression.
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 -_-
8.
Which patient is NOT at risk for developing CNVM (choroidal neovascular membrane or Macular degeneration in the good eye?
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.
9.
Your patient come in and you see an elevated, discolored lesion in the retina. What should do you do first?
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
10.
T/F Photodynamic Therapy (PDT) is a great 1st line treatment for Wet ARMD:
Correct Answer
B. False
Explanation
Photodynamic Therapy (PDT) "cold laser" can only be used in conjunction with Anti-VEGF injection.
11.
Select all the TRUE statements about Anti-VEGF injections as treatment for wet ARMD:
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
12.
Select the FALSE statement for Steroid injection of Triamcinolone/Kenalog for wet ARMD?
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
13.
T/F If there is overall defect in Bruch's membrane in wet AMD, there anti-VEGF injections will be helpful.
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
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
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
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?
Correct Answer
C. Central Serous retinopathy
Explanation
CSR are the #1 MOST ACQUIRED Maculopathy
16.
Select all the TRUE statements about CSR's clinical finding:
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)
17.
SELECT all the TRUE statements about Treatment/Managment of CSR:
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.
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?
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
19.
Check all the etiologies that CME is secondary to:
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
20.
Select the FALSE CME clinical findings:
Correct Answer
D. Weiss Ring
Explanation
Weiss Ring is seen in the stage 4 of macular hole (full thickness)
21.
If you see DM retinopathy in your CME patient, what would be the BEST treatment?
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)
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
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.
23.
Select the FALSE clinical finding statement of Macular Hole:
Correct Answer
C. FA: HYPOfluorenscence in late stages (cyst)
Explanation
FA: HYPERfluorenscence in late stages (cyst)
24.
Which is NOT a cause for Macular Hole?
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
25.
NAME THAT STAGE!
-Reduced VA
-Slight reddish hole
-No edema around hole
-OCT: show a depressed area
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.
26.
NAME THAT STAGE:
-Central yellow dot
-Loss of foveal reflex
-OCT: Small elevated space (not a hole yet)
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.
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!
Correct Answer
D. Stage 4: Full thickness
Explanation
Stage 3: Full thickness
-PARTIAL vitreomacular separation (>400um)
-Edges are NOT elevated around hole
28.
What would you do to treat Stage 3: Full thickness??
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.
29.
T/F PVD is a good indicator of stability because if present, there is no little risk of developing a TRUE macular hole
Correct Answer
A. True
Explanation
TRUE, because there is no traction in that area
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.
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.
31.
SELECT THE FALSE STATEMENT that you can DDX Solar Ret from Macular Hole?
Correct Answer
C. VA are NOT reduced in Solar Ret
Explanation
VA are BOTH reduced in Solar Ret and macular holes
32.
Select ALL TRUE statements about Presumed Ocular Histoplasmosis:
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
33.
SELECT all TRUE statements about Geographic Helicoid Peripapillary Atrophy:
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
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?
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.
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.
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?
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
37.
Select all TRUE STATEMENTS about Epi-Retinal Membrane:
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)
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
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.
39.
Select all TRUE STATEMENT abnout ACUTE DAMAGES signs in HT retinopathy:
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.
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
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.
41.
What are the 3 types of ATHEROsclerotic changes? (check 3)
Correct Answer(s)
A. Hollenhorst Plaques
C. Fibrinoplatetes Plaques
D. Calcific Plaques
42.
Check all TRUE statements when it comes to ATHerosclerotic plaques:
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 :)
43.
What are the 4 types of Retinal Vascular Occlusive dz that we learned about? (Select 4)
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).
44.
Select ALL TRUE statements about Central Retinal Venous Occlusion:
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
45.
What are the 2 types of CRVO? Select the wrong one
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.
46.
Select ALL TRUE STATEMENT for venous stasis ret (VSR) and Hemorrhagic Ret (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
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
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.
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
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.
49.
T/F Ozurdex (Dexametasone) implant will NOT REDUCE risk of further vision loss
Correct Answer
B. False
Explanation
Ozurdex (Dexametasone) implant will REDUCE risk of further vision loss. Similar effect as injections but with MUCH FEWER ADE
50.
So your patient presents with CRVO, what treatment options would you do??? SELECT ALL TRUE
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