Ocular Disease II: Acquired Maculopathies, Retinal Vascular

1. Match the A/V changes with its proper name for Arteriosclerotic retinopathy:

Deflection of veins at A/V crossing

Right angle deflections

Venous banking with dilation distal to crossing

Submit

2. Match the Grading of Arteriosclerotic retinopathy: (assume the previous grade is included)

Broadened Arteriosclerotic light reflex and simple vein concealment (arteriole crossing over venule)

Deflection of veins at A/V crossing. "SALUS SIGN"

Copper wire appearances of the artioles and marked A/V changes

Silver wire arterioles+ SEVERE A/V crossing changes, associated with BRVO

*BRVO can occurs at any grade, but is most likely to occurs at grade 4

Explanation

*BRVO can occurs at any grade, but is most likely to occurs at grade 4

Submit

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

True

False

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.

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.

4. 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?

Wet ARMD

Diabetic ret

Central Serous retinopathy

Macular hole

CSR are the #1 MOST ACQUIRED Maculopathy

Explanation

CSR are the #1 MOST ACQUIRED Maculopathy

5. 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

True

False

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.

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.

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

True

False

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

Explanation

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

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

Stage 1A: Macular Cyst

Stage 2: Lamellar Hole (partial Thickness)

Stage 3: Full thickness

Stage 4: Full thickness

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.

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.

8. 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

True

False

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.

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.

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

Hollenhorst Plaques

Hyperviscosity Plaques

Fibrinoplatetes Plaques

Calcific Plaques

not-available-via-ai

Explanation

not-available-via-ai

Submit

10. 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

True

False

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.

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.

11. 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

True

False

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.

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.

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

Stage 1A: Macular Cyst

Stage 2: Lamellar Hole (partial Thickness)

Stage 3: Full thickness

Stage 4: Full thickness

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.

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.

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

True

False

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

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

True

False

TRUE, because there is no traction in that area

Explanation

TRUE, because there is no traction in that area

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

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

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

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

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.

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.

Submit

16. Select the FALSE statement for ARMD:

Usually BILATERAL

#1 cause of blindness in UA over age 65

White is affected more than Black

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

Myopia is 25x higher risk due to less pigment

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

HYPEROPIA (>0.75) is 25x higher risk due to less pigment

Explanation

HYPEROPIA (>0.75) is 25x higher risk due to less pigment

17. T/F It is WORSE to have a SUPERIOR BRVO because it can move to macula due to gravity, compared to an inferior BRVO

True

False

Inferior BRVO usually go away in 1 month f/up, bc it isn't affecting macula or vision, if good systemic dz control.

Explanation

Inferior BRVO usually go away in 1 month f/up, bc it isn't affecting macula or vision, if good systemic dz control.

18. 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?

Plaquenil Retinopathy

Thoridazine (Mellaril) Retinopathy

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.

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.

19. 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

True

False

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.

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.

20. 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!

Stage 1A: Macular Cyst

Stage 2: Lamellar Hole (partial Thickness)

Stage 3: Full thickness

Stage 4: Full thickness

Stage 3: Full thickness
-PARTIAL vitreomacular separation (>400um)
-Edges are NOT elevated around hole

Explanation

Stage 3: Full thickness
-PARTIAL vitreomacular separation (>400um)
-Edges are NOT elevated around hole

21. Select the FALSE CME clinical findings:

Loss of foveal reflex

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

Blurring of chorodial pattern due to sensory retina thickening

Weiss Ring

FA: you will see "flower petal" appearance

Slight elevated macula

Weiss Ring is seen in the stage 4 of macular hole (full thickness)

Explanation

Weiss Ring is seen in the stage 4 of macular hole (full thickness)

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

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.

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.

Submit

23. T/F If BRVO is not in a significant visual area, then refer to PCP and f/up in 1 month. But if it is, then refer to retinal specialist

True

False

If BRVO (Branch Retinal Vein Occlusion) is not in a significant visual area, it is recommended to refer the patient to their primary care physician (PCP) and follow up in one month. However, if BRVO is in a significant visual area, it is advised to refer the patient to a retinal specialist. Therefore, the statement "True" indicates that the given explanation accurately reflects the correct answer.

Explanation

If BRVO (Branch Retinal Vein Occlusion) is not in a significant visual area, it is recommended to refer the patient to their primary care physician (PCP) and follow up in one month. However, if BRVO is in a significant visual area, it is advised to refer the patient to a retinal specialist. Therefore, the statement "True" indicates that the given explanation accurately reflects the correct answer.

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

True

False

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

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

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

Central Retinal Venous Occlusion (CRVO)

Arteriosclerotic Retinal Occlusion (ARO)

Hemi-Central Retinal Vein Occlusion (Hemi-CRVO)

Branch Retinal Vein Obstruction (BRVO)

Central Retinal Artery Occlusion (CRAO)

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).

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).

Submit

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

Venous Stasis Retinopathy (Incomplete CRVO)

Hemorrhagic Retinopathy (Ischemic)

Anticoagulant Retinopathy

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.

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.

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

Sent out for Argon laser ASAP

Do an OCT or FA to rule out an CNVM

Start him on a Photodynamic therapy (TDT)

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

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

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

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

True

False

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

Explanation

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

29. Select the FALSE statement about Drusen:

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

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

All are true

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.

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.

30. T/F BRAVO study shows that there is significant improvement with LUCENTIS INJECTION (anti-VegF), rather than observation. But LASER is still most helpful in BRVO

True

False

The explanation for the given correct answer is that the BRAVO study demonstrated that there is a significant improvement with LUCENTIS INJECTION (anti-VegF) compared to observation in treating BRVO (branch retinal vein occlusion). However, LASER treatment is still considered the most helpful approach in managing BRVO.

Explanation

The explanation for the given correct answer is that the BRAVO study demonstrated that there is a significant improvement with LUCENTIS INJECTION (anti-VegF) compared to observation in treating BRVO (branch retinal vein occlusion). However, LASER treatment is still considered the most helpful approach in managing BRVO.

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

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

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

All are true

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.

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.

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

True

False

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.

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.

33. Check all TRUE statements when it comes to ATHerosclerotic plaques:

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

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

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

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

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

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

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

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

-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 :)

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 :)

Submit

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

Triamcinolone/Kenalog vitreous injection reduce inflammation and vascular permeability

May be used in conjunction with Photodynamic therapy

Helpful for DM macular edema and other vascular occlusive dz

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

Reduce swelling which last for UP TO 3-4MONTHS

ADE of Triamcinolone/Kenalog injection is enhanced, compared to Oral Triamcinolone/Kenalog

Explanation

ADE of Triamcinolone/Kenalog injection is enhanced, compared to Oral Triamcinolone/Kenalog

35. T/F Rubeosis iridis (along with NV of retin) is VERY RARE complication in BRVO, compared to CRVO, because much less retina is affected

True

False

Rubeosis iridis, which refers to the abnormal growth of blood vessels in the iris, is indeed a very rare complication in BRVO (Branch Retinal Vein Occlusion) compared to CRVO (Central Retinal Vein Occlusion). This is because in BRVO, only a smaller portion of the retina is affected by the occlusion of a branch retinal vein, while in CRVO, the occlusion occurs in the central retinal vein, affecting a larger area of the retina. Therefore, the likelihood of developing rubeosis iridis is higher in CRVO cases.

Explanation

Rubeosis iridis, which refers to the abnormal growth of blood vessels in the iris, is indeed a very rare complication in BRVO (Branch Retinal Vein Occlusion) compared to CRVO (Central Retinal Vein Occlusion). This is because in BRVO, only a smaller portion of the retina is affected by the occlusion of a branch retinal vein, while in CRVO, the occlusion occurs in the central retinal vein, affecting a larger area of the retina. Therefore, the likelihood of developing rubeosis iridis is higher in CRVO cases.

36. Select the FALSE clinical finding statement of Macular Hole:

Unilateral (usually)

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

FA: HYPOfluorenscence in late stages (cyst)

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

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

Affect Female MORE

FA: HYPERfluorenscence in late stages (cyst)

Explanation

FA: HYPERfluorenscence in late stages (cyst)

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

Dry ARMD accounts for 90% of all ARMD

There is a DECREASED in VA

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

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

Coalescing drusen DO indicate progression to WET ARMD (aka Disciform type)

Explanation

Coalescing drusen DO indicate progression to WET ARMD (aka Disciform type)

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

Vasoconstriction can lead to CWS and NFL infarcts

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

Swelling of optic disc is common and not that serious

Macular star can occurs due to abnormal vascular permeability

KNOW! Swelling of optic disc is very serious because it is HALLMARK sign for MALIGNANT phase of HTN ret.

Explanation

KNOW! Swelling of optic disc is very serious because it is HALLMARK sign for MALIGNANT phase of HTN ret.

Submit

39. Check all the Treatment/management for Dry ARMD:

Home Amsler grid

Low vision devices if decreased VA

Anti-VegF injection

UV protection

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

Anti-VegF injection are for WET ARMD

Explanation

Anti-VegF injection are for WET ARMD

Submit

40. T/F SCORE study shows NO DIFFERENCE between laser and steroid tx for Retinal Vein occlusion.

True

False

The explanation for the given correct answer is that the SCORE study, which is a research study, has found no difference in the effectiveness of laser treatment and steroid treatment for Retinal Vein occlusion. This means that both treatments have similar outcomes in treating this condition.

Explanation

The explanation for the given correct answer is that the SCORE study, which is a research study, has found no difference in the effectiveness of laser treatment and steroid treatment for Retinal Vein occlusion. This means that both treatments have similar outcomes in treating this condition.

41. 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?

Prostaglandins Force

High Refractive error

Tractional Forces

Vascular

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

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

42. Which is NOT a cause for Macular Hole?

Idiopathic

CME

Diabetes

Trauma

Myopia

PVD

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

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

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

True

False

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

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

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

Monitor

Consult with retina specialist

Retinal consult for vitrectomy

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.

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.

45. 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?

BIO to check for Bull's eye macula

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

Fundus photos to look for degenerative changes

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

Consult with PCP about prescribed medication

- You want to Run a VF CENTRAL theshold 10-2 to determine changes in sensitivity, with foveal sensitivity

Explanation

- You want to Run a VF CENTRAL theshold 10-2 to determine changes in sensitivity, with foveal sensitivity

46. NAME that Keith Wagner stage (assume answers includes stage before it)

Disc Edema

NFL infarcts, retinal edema , HEMORRHAGES (blot/dots/flame)+ Macular Star

Arteriosclerotic vessel changes (esp small branches)

Narrowing and focal constriction (subtle changes in vessel width along a constricted vessel). Hard Exudates may form

**Stage 4: usually indicate poor prognosis and severe health issues

Explanation

**Stage 4: usually indicate poor prognosis and severe health issues

Submit

47. What would you do to treat your HT ret patient?

High BP but no disc edema and no HT Ret

(+) HT ret but low BP, and pt is NOT taking any HT meds

(+) disc edema

Macular edema or Hypoxia occurs

Submit

48. SELECT ALL the true statements about Fresh CRAO vs Old CRAO

Both will have (+) APD

Cherry red spot at macula seen in OLD CRAO

Fresh will have diffuse, hazy, WHITE edematous retina

Cherry red spot at macula seen in FRESH CRAO

Explanation

Cherry red spot at macula seen in FRESH CRAO

Submit

49. Which is NOT a typically cause of CRAO? ......EXTRA: Which one is the MOST COMMON?

Calcific plaques

Fibronplatelet

Giant Cell Arteritis (cause inflammation, not plaques)

Hollenhorst plaques

Migrane

Emoli (drug, self-injected)

Birth control pills (although rare)

Hollenhorst plaques rarely cause CRAO because they are so soft! =)

Calcific plaques= MOST COMMON CAUSE

Explanation

Hollenhorst plaques rarely cause CRAO because they are so soft! =)

Calcific plaques= MOST COMMON CAUSE

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

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

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

VA are NOT reduced in Solar Ret

VA are BOTH reduced in Solar Ret and macular holes

Explanation

VA are BOTH reduced in Solar Ret and macular holes

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

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

HR tends to affect more YOUNG, while VSR affect OLDER

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

You see SIGNIFICANT Optic disc edema in VSR

There are more CWS seen in HR

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

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

-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

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

Submit

52. Select all TRUE STATEMENTS about Epi-Retinal Membrane:

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

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

Caused by unknown or retinal vascular dz

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

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

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)

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)

Submit

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

Vitamin C

Vitamin E

Omega-3 FA

Xanthelutein

Zinc Oxide

Copper (prevents copper deficiency anemia from zinc intake)

Beta Carotene

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 -_-

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 -_-

54. SELECT ALL TRUE STATEMENT about Central Retinal Artery Occlusion (CRAO):

Affect MALES MORE

Affect EITHER OD or OS equally

Acute, painless, UNILATERAL VA loss (occurs over seconds)

Patient typically have SIGNIFICANT vascular dz

-Affect MALES and FEMALE equally

Explanation

-Affect MALES and FEMALE equally

Submit

55. SELECT all TRUE statement about Hemi-Central Retinal Vein Occlusion (Hemi-CRVO):

It is a localized altitudinal branch retinal vein occlusion, where 2 large venules as it branches are affected

Occlusion occurs at structure of veins, as it passes through LAMINA

You will NOT see a disc edema

Even if there is hemorrhaging going toward the macula, there is NO TENDENCY for macular edema development

Hypoxia in 1/2 of retina, will lead to NVI and neo of the retina

Can be ischemic or non-ischemic

Treat/manage the SAME way as CRVO :)

- You will see a disc edema
-If here is hemorrhaging going toward the macula, there is a STRONG TENDENCY for macular edema development

Explanation

- You will see a disc edema
-If here is hemorrhaging going toward the macula, there is a STRONG TENDENCY for macular edema development

Submit

56. So you decide to do Fundus on this BRVO kid, what do you expect to see? SELECT the correct answers

Collection of flame hemes in one quadrant, with some dot/blots

Abnormal A/V crossing

Retinal Edema, which is a MAJOR COMPLICATION for the breakdown of blood-retinal barrier

Very little CWS

Thickening of retinal layer

-ALOT OF CWS, since it is hypoxia

Explanation

-ALOT OF CWS, since it is hypoxia

Submit

57. Select all TRUE STATEMENTS about Branch Retinal Vein Obstruction (BRVO):

Most common vascular dz, which is similar to CRVO except it only involve ONE quadrant (typically INFERIOR/NASAL)

HTN is the Main cause of BRVO, seen in 3/4 of all cases

MOA: hardened arteries pinches on venules, which impede venous flow

BRVO occurs because there is DELAYED expression of PedF (pigment epithelial derived factor)

The LESS CWS= the MORE chronic= INCREASE NEO

-Most common vascular dz, which is similar to CRVO except it only involve ONE quadrant (typically SUPERIOR/TEMPORAL)

-The MORE CWS= the MORE chronic= INCREASE NEO

**PedF (pigment epithelial derived factor) is the MOST potent inhibitor of VEGF

Explanation

-Most common vascular dz, which is similar to CRVO except it only involve ONE quadrant (typically SUPERIOR/TEMPORAL)

-The MORE CWS= the MORE chronic= INCREASE NEO

**PedF (pigment epithelial derived factor) is the MOST potent inhibitor of VEGF

Submit

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

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

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

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

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

You can use proparacaine to anethestize topically

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

Avastin is FDA-approved and is used most commonly

-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

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

Submit

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

BILATERAL

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

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

After-images are seen due to fluid disruption with photoreceptors

(+) photostress test

Foveal reflex will still be present

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

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

-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)

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)

Submit

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

Pred-forte QIDx 4 weeks

Ketorolac Tromethaamine (Acular) or Voltaren drops

NSAID (Indomethacin)

Triamcinolone Injection

Focal or grid laser

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)

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)

61. Check all the etiologies that CME is secondary to:

Diabetes/ DM ret

Retinal Vein Obstruction

Steroid toxicity

Hypertension

Irvine-Gass Syndrome (Post cataract extraction)

Anterior Uveitis

High Cholesterol

Glaucoma Tx

Retinitis pigmentosa

Macular Pucker

*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

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

Submit

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

Order Complete blood count

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

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

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

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

ILM peeling or Anti-VEGF to decrease fluid/neo

Ketoralac (Acular) QID

-Retinal consult for possible PRP, ONLY if neo is seen
-Ketoralac (Acular) QID is used to decrease Prostaglandins for CME, post-cataract surgery

Explanation

-Retinal consult for possible PRP, ONLY if neo is seen
-Ketoralac (Acular) QID is used to decrease Prostaglandins for CME, post-cataract surgery

Submit

63. Select ALL TRUE statements about Presumed Ocular Histoplasmosis:

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

Associated with moisture, common in Ohio/Mississippi

Caused by bacterial infection

Ocular presentation is around 30 y/o

You will often seen a PPA

Histo spots around macula will appear

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

Patient is ASYMPTOMATIC until active macular involvement

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

If you see CNVM, anti-VEGF is best option

Typical TX: Retinal consult+ PhotoDynamicTherapy

-Caused by FUNGAL infection
-Chorododial neovascularization (CNVM) is seen AFTER (up to 30 yrs) the initial infection

Explanation

-Caused by FUNGAL infection
-Chorododial neovascularization (CNVM) is seen AFTER (up to 30 yrs) the initial infection

Submit

64. Select ALL TRUE statements about Central Retinal Venous Occlusion:

Peak incidence is 6th decade of life

MALE is more affected

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

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

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

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

(+) Macular edema because the fluid is accumulating

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

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

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

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

Submit

65. SELECT all TRUE statements about Geographic Helicoid Peripapillary Atrophy:

Age onset= 45-50 yrs

Non-Hereditary

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

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

VA is ALWAYS POOR

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

You treat it the SAME WAY as Macular degeneration

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

Corticosteroids is the BEST form of treatment

Low vision devices are very helpful

1) Hereditary
2) VA loss varies depending on lesion location
3) Corticosteroids is very controversial

Explanation

1) Hereditary
2) VA loss varies depending on lesion location
3) Corticosteroids is very controversial

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