Ocular Disease II: Acquired Maculopathies, Retinal Vascular

65 Questions | Total Attempts: 62

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Disease Quizzes & Trivia

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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

  • 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

  • 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

  • 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)

  • 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

  • 6. 
    It is safe to prescribe Beta-carotene to chronic smokers who just quit 2 years ago. 
    • A. 

      True

    • B. 

      False

  • 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

  • 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

  • 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.

  • 10. 
    T/F Photodynamic Therapy (PDT) is a great 1st line treatment for Wet ARMD: 
    • A. 

      True

    • B. 

      False

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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.

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 24. 
    Which is NOT a cause for Macular Hole?
    • A. 

      Idiopathic

    • B. 

      CME

    • C. 

      Diabetes

    • D. 

      Trauma

    • E. 

      Myopia

    • F. 

      PVD

  • 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

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