Ocular Disease II Mt 3
- Acquired maculopathies
- Retinal vascular disease
- Management of GLC
Questions and Answers
- 1.
What is the hallmark presentation of ARMD?
- A.
Hard Exudates
- B.
CWS
- C.
Drusen
- D.
Flame hemes
Correct Answer
C. DrusenExplanation
Drusen: malfunctioning RPE deposits ECM; appear as small yellow/white lesions distributed across PPRate this question:
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- 2.
Hard drusen represent localized areas of RPE detachment
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Hard Drusen: small, well-defined yellow deposits deep in retina; overlying RPE appears depigmented
--> VA no reduced + Amsler normal
Soft Drusen: larger, fluffy, yellow deposits; localized zones of RPE detachment
--> VA reduced + Amsler abnormalRate this question:
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- 3.
If your pt has unilateral wet ARMD, what are the chances wet ARMD will appear in other eye?
- A.
2%
- B.
10%
- C.
50%
- D.
65%
Correct Answer
C. 50%Explanation
If a patient has unilateral wet age-related macular degeneration (ARMD), it means that only one eye is affected by this condition. The question asks about the chances of wet ARMD appearing in the other eye. Since wet ARMD can affect both eyes, the answer of 50% suggests that there is an equal likelihood of the condition appearing in the other eye. Therefore, there is a 50% chance of wet ARMD appearing in the other eye of a patient with unilateral wet ARMD.Rate this question:
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- 4.
Describe what FA & OCT would look like in Wet ARMD.
- 5.
What is the gold standard to treat wet ARMD?
- A.
Anti-VEGF intravitreal injections
- B.
Steroid intravitreal injections
- C.
Photocoagulation & Photodynamic therapy
- D.
Combo therapies
Correct Answer
A. Anti-VEGF intravitreal injectionsExplanation
Anti-VEGF: treats classic & occult CNVM (Macugen, Lucentis, Avastin)
Steroids: supportive tx for edema (Triamcinolone)
Photocoag & PDT: prior tx to destroy BVs & surrounding tissue / destroy only BVs that broke through Bruch's
Combo: PDT + VEGFRate this question:
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- 6.
The following signs/symptoms are associated with which disease? - Acute onset reduced vision - Scotoma - Metamorphopsia - Afterimages - Hyperopic shift - Prolonged photostress time
- A.
CSR
- B.
Epiretinal membrane
- C.
Wet ARMD
- D.
Macular holes
Correct Answer
A. CSRExplanation
The signs and symptoms listed are commonly associated with Central Serous Retinopathy (CSR). CSR is a condition where fluid accumulates under the retina, causing a sudden reduction in vision. Scotoma refers to a blind spot in the visual field, metamorphopsia is the distortion of vision, afterimages are persistent images seen after the original stimulus is removed, hyperopic shift is a shift towards farsightedness, and prolonged photostress time refers to a delay in recovery from bright light exposure. These symptoms are all characteristic of CSR.Rate this question:
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- 7.
Less than 10% of patients with CSR have permanent vision loss
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
CSR Prognosis:
- 80-90% spontaneously resolve w/in 1-6 mo (metamorphosias can remain up to 1 year after resolution)
- 40% have recurrence due to weaker bonds
- < 10% have permanent vision lossRate this question:
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- 8.
If a patient has CSR that does not get better after 4 monthes, experiences recurrent episodes, has secondary CNVM, what would be the recommended management?
- A.
Continue monthly f/u for 1 year
- B.
Anti-VEGF injections
- C.
Argon laser photocoagulation
- D.
PRP
Correct Answer
C. Argon laser photocoagulationExplanation
Argon laser photocoag for tx of CSR:
- purpose to seal leak
- decreases time course of resolvement
- does NOT improve prognosisRate this question:
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- 9.
Indicate which of the following retinal disease commonly presents as UNILATERAL (at least initially)
- A.
Macular holes
- B.
CME
- C.
CSR
- D.
Presumed ocular histoplasosis
- E.
CRVO
Correct Answer(s)
A. Macular holes
C. CSR
E. CRVOExplanation
Macular holes, CSR (central serous retinopathy), and CRVO (central retinal vein occlusion) are retinal diseases that commonly present as unilateral, at least initially. Macular holes are small breaks in the macula, the central part of the retina, which typically occur in one eye. CSR is characterized by fluid accumulation under the retina, causing vision loss in one eye. CRVO is a blockage of the central retinal vein, leading to sudden vision loss in one eye. These conditions usually affect only one eye initially, although they can progress to involve both eyes in some cases.Rate this question:
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- 10.
PVD increases the risk of developing a true macular hole
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
PVD reduces the risk of a true macular hole since there will be no vitreal traction pulling on the maculaRate this question:
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- 11.
BRVO is the most common retinal vascular occlusion
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
BRVO, which stands for branch retinal vein occlusion, is indeed the most common type of retinal vascular occlusion. Retinal vascular occlusion refers to the blockage of blood vessels that supply the retina, leading to impaired blood flow and potentially causing vision loss. BRVO specifically occurs when a branch of the retinal vein becomes blocked, usually due to a blood clot. This condition can result in various symptoms, such as blurry vision, visual field loss, and in severe cases, permanent vision loss. Therefore, the statement that BRVO is the most common retinal vascular occlusion is true.Rate this question:
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- 12.
Which of the following atherosclerotic changes to retinal vessels has the greatest risk for CRAO/BRVO?
- A.
Hollenhorst Plaque
- B.
Fibrinoplatelet Plaque
- C.
Calcific Plaque
- D.
Cholesterol Plaque
Correct Answer
C. Calcific PlaqueExplanation
Hollehorst: chl @ bifurcations; shiny/reflective --> rare risk for obstruction
Fibrinoplatelet: chl + platelet; whit plug --> greater risk for obstruction
Calcific: calcified emolus from heart/coronary arteries --> greatest risk for obstructionRate this question:
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- 13.
Rubeosis iridis is more common in hemorrhagic CRVO than venous stasis CRVO
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Hemorrhagic --> ischemic retinopathyRate this question:
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- 14.
Narrow angles are a risk factor for POAG
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Narrow angles are risk factor for ACG not POAGRate this question:
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- 15.
Which of the following undergo systemic crossover?
- A.
Beta Blockers
- B.
Prostaglandins
- C.
Miotics
- D.
Alpha-2 Adrenergic Agonsits
Correct Answer(s)
A. Beta Blockers
D. Alpha-2 Adrenergic AgonsitsExplanation
Beta blockers and alpha-2 adrenergic agonists undergo systemic crossover. Systemic crossover refers to the ability of a drug to cross the blood-brain barrier and exert its effects centrally in the brain. Beta blockers are commonly used to treat cardiovascular conditions and they can also cross the blood-brain barrier, leading to central effects such as reducing anxiety and tremors. Alpha-2 adrenergic agonists, on the other hand, can also cross the blood-brain barrier and act centrally to reduce sympathetic outflow, resulting in sedation and analgesia. Prostaglandins and miotics do not typically undergo systemic crossover as they primarily act locally in specific tissues or organs.Rate this question:
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- 16.
According to the OHTS, reducing IOP by 1 mmHg will reduce the risk of GLC progression by ____%
Correct Answer(s)
10Explanation
According to the OHTS (Ocular Hypertension Treatment Study), reducing intraocular pressure (IOP) by 1 mmHg will result in a 10% reduction in the risk of glaucoma progression. This suggests that even a small decrease in IOP can have a significant impact on preventing the progression of glaucoma.Rate this question:
- 17.
Indicate all the contraindications for use of Pilocarpine
- A.
Youth & Elderly
- B.
Corneal endothelial dysfunction
- C.
Axial PSC
- D.
CHF
Correct Answer(s)
A. Youth & Elderly
C. Axial PSCExplanation
Corneal endothelial dysfuncion --> avoid CAIs
CHF --> avoid beta blockersRate this question:
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- 18.
If you're seeing a pregnant patient with advanced GLC, what would be the best management for this pt?
- A.
Stop taking GLC meds for the duration of pregnancy and breast feeding
- B.
Betoptic S to avoid Beta1 stimulation
- C.
Alphagan P 0.1%
- D.
Any CAI
Correct Answer
C. Alphagan P 0.1%Explanation
Ideally a pregnant woman would not be taking any medications, however if they need GLC meds to preserve vision, as in the case of advanced GLC, alphagan P 0.1% is the best optionRate this question:
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- 19.
Which of the following is NOT a contraindication for beta blockers?
- A.
Heart block
- B.
Unstable DM
- C.
Low BP and/or pulse
- D.
Asthma
- E.
Anterior uveitis
Correct Answer
E. Anterior uveitisExplanation
anterior uveitis contras: miotics & prostaglandins (these increase inflammation)Rate this question:
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- 20.
Indicate which of the following meds dilate the pupils.
- A.
Beta blockers
- B.
Propine
- C.
Epinephrine
- D.
CAIs
- E.
Prostaglandins
Correct Answer(s)
A. Beta blockers
B. Propine
C. EpinephrineExplanation
Beta blockers, Propine, and Epinephrine are medications that can dilate the pupils. Beta blockers work by blocking the effects of adrenaline, which causes the pupils to dilate. Propine is a medication used to treat glaucoma and can also cause pupil dilation. Epinephrine, also known as adrenaline, is a natural hormone that can dilate the pupils when administered as a medication. CAIs (carbonic anhydrase inhibitors) and Prostaglandins are not known to have a direct effect on pupil dilation.Rate this question:
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- 21.
Which of the following GLC meds has the best IOP-lowering during the night time?
- A.
Beta blockers
- B.
CAIs
- C.
Alpha-2 agonists
Correct Answer
B. CAIsExplanation
beta blockers have on effect at night, alpha-2 has some effect at nightRate this question:
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- 22.
If IOP lowering is not effective using Travatan, switching to Lumigan may have better results
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Although Travatan & Lumigan are both prostaglandins, pts have variations of PG receptors and Lumigan has a slightly different mechanism that might prove more effective. However, it would not be advised to substitute between Travatan and Xalantan.Rate this question:
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- 23.
Beta blockers are commonly associated with ocular and systemic ADEs
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Beta blockers have many systemic ADEs, but ocular ADEs are relatively rare (dry eye, dec corneal sensitivity, burn/sting on instillation)Rate this question:
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- 24.
Which of the following beta blockers would be best for someone with elevated cholesterol levels?
- A.
Ocupress
- B.
Timolol XE
- C.
Betagan
- D.
Betimol
Correct Answer
A. OcupressExplanation
Ocupress advantages: does not lower HDLs (like timolol), less stinging, less CNS ADEsRate this question:
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- 25.
Which of the following GLC drugs is associated with reactivation of HSV keratitis?
- A.
Xalantan
- B.
Timolol
- C.
Trusopt
- D.
Travatan Z
Correct Answer
A. XalantanExplanation
Xalantan can cause pseudodendrites & reactivation of HSV keratitisRate this question:
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- 26.
BID dosing of prostaglandins has greater IOP lowering effects than q Day dosing
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
BID dosing actually has less effect than q day dosingRate this question:
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- 27.
Part of Lumigan's MOA is reducing aqueous production.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Lumigan actually increases aq production by 14%
But it increase TM outflow by 30% and US OF by 50% so overall lowers IOP
CAI MOA: reduce aqueous productionRate this question:
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- 28.
Which of the following prostaglandins has the fewest ocular & systemic side effects?
- A.
Zioptan
- B.
Travatan
- C.
Lumigan
- D.
Xalantan
Correct Answer
C. LumiganExplanation
Lumigan is the prostaglandin that has the fewest ocular and systemic side effects compared to the other options. This can be inferred from the question, which asks for the prostaglandin with the fewest side effects.Rate this question:
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- 29.
What would be the best option for a prostaglandin if someone is very sensitive to preservatives?
- A.
Xalantan
- B.
Lumigan
- C.
Zioptan
- D.
Travatan
Correct Answer
C. ZioptanExplanation
Zioptan & Travatan Z don't have BAKRate this question:
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- 30.
Metallic taste and stinging upon instillation are the most commonly associated signs/symptoms of Trusopt
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
The statement is true because metallic taste and stinging upon instillation are indeed the most commonly associated signs/symptoms of Trusopt. Trusopt is a medication used to treat glaucoma and ocular hypertension, and these side effects are commonly reported by patients who use this medication. The metallic taste can occur after using Trusopt eye drops, while stinging upon instillation refers to the temporary discomfort or burning sensation that may be experienced when the eye drops are applied.Rate this question:
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Current Version
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Sep 01, 2023Quiz Edited by
ProProfs Editorial Team -
Oct 09, 2012Quiz Created by
Tseemore
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