Ohp II Mt 2 Cataracts

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Ohp II Mt 2 Cataracts - Quiz

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Questions and Answers
  • 1. 

    The most common type of senile cataract is _______.

    Explanation
    The LEAST common is PSC

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  • 2. 

    Infantile (congenital) catracts typically do NOT affect vision.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Infantile (congenital) cataracts typically do not affect vision because they are present from birth and the brain adapts to the cloudy lens, allowing the child to develop normal vision. In some cases, if the cataracts are severe or left untreated, they can cause visual impairment. However, in general, infantile cataracts do not have a significant impact on vision.

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  • 3. 

    Indicate which conditions can result due to anterior/posterior polar cataracts.

    • A.

      Uveitis

    • B.

      Myopic shift

    • C.

      Increased glare issues

    • D.

      Capsular rupture

    • E.

      Hyperopic shift

    Correct Answer(s)
    A. Uveitis
    D. Capsular rupture
    Explanation
    Anterior/Posterior Polar cataracts are a type of congenital cataract.
    These present as a dot on the anterior or posterior capsule and can be confused with PSC.
    The lens capsules are weaker in these pts and can cause capsular rupture + uveitis.
    Can also occur due to TRAUMA

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  • 4. 

    Zonular cataracts present as a region/zone of the lens that is opaque and is usually unilateral.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Zonular cataracts are usually BILATERAL

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  • 5. 

    Which of the following is the most common type of congenital cataract?

    • A.

      Fetal Nuclear

    • B.

      Lamellar

    • C.

      Blue Dot

    • D.

      Coronary

    Correct Answer
    B. Lamellar
    Explanation
    Lamellar has a SAND DOLLAR apperance (ring of opacity around nucleus)

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  • 6. 

    Fetal Nuclear Cataracts are limited to what area of the nucleus?

    • A.

      Embryonic nucleus

    • B.

      Fetal nucleus

    • C.

      Adult nucleus

    Correct Answer
    A. Embryonic nucleus
    Explanation
    Fetal Nuclear Cataracts are limited to the embryonic nucleus. This means that the cataracts only affect the nucleus of the lens during the fetal stage of development. It suggests that the condition does not extend to the adult nucleus, which is the central part of the lens in the eye that develops after birth. The answer implies that the occurrence of cataracts is specific to a particular stage of fetal development and does not persist into adulthood.

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  • 7. 

    Sutural cataracts can occur in both the anterior and posterior of the lens.  Anterior is more common.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Sutural cataracts can occur in both the anterior and posterior of the lens, but anterior cataracts are more common. This means that while cataracts can form in both parts of the lens, they are more likely to occur in the anterior portion.

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  • 8. 

    For sutural (stellate) cataracts, anterior sutures are inverted 'Y'-shaped and posterior sutures are 'Y'-shaped

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Anterior: Y
    Posterior: inverted Y

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  • 9. 

    Coronary and Blue Dot cataracts occur in the lens nucleus.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Both of these occurs in the CORTEX

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  • 10. 

    Down's Syndrome and Myotonic Dystrophy are associated with what type of congenital cataract?

    • A.

      Lamellar

    • B.

      Sutural

    • C.

      Coronary

    • D.

      Blue Dot

    Correct Answer
    C. Coronary
    Explanation
    Coronary: radial, club-shaped opacities in cortex (similar to cortical cataracts)

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  • 11. 

    What is the most common cause of Total Congenital cataract?

    • A.

      Rubella

    • B.

      Mumps

    • C.

      Hepatitis

    • D.

      Toxoplasmosis

    Correct Answer
    A. Rubella
    Explanation
    All of the above are causes, but RUBELLA is most common cause
    Rubella is assoc with ear/heart defects + salt/pepper fundus

    Mneumonic: "Salt&Pepa were such (ru)bellas, they went through my ear straight to my heart"

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  • 12. 

    Galactosemia causes what type of secondary cataract?

    • A.

      Polychromatic

    • B.

      Diabetic

    • C.

      Anterior Subcapsular

    • D.

      Oil Droplet

    Correct Answer
    D. Oil Droplet
    Explanation
    Galactosemia: no galactose metabolizing enzymes --> galactose b/u to toxic levels and damages tissue --> inc'd intracellular osmotic pressure + fluid influx --> oil-droplet apperance from zonular/nuclear opacity

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  • 13. 

    Indicate which type(s) of cataracts can cause a myopic shift.

    • A.

      Oil Droplet

    • B.

      Cortical

    • C.

      Diabetic

    • D.

      Traumatic

    • E.

      Morganian

    • F.

      NSC

    Correct Answer(s)
    A. Oil Droplet
    C. Diabetic
    F. NSC
    Explanation
    Cortical: hyperopic shift

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  • 14. 

    Indicate the potential causes of Polychromatic (christmas tree) cataracts.

    • A.

      Thermal radiation

    • B.

      Wilson's Disease

    • C.

      Myotonic dystrophy

    • D.

      Trauma

    • E.

      Cholesterol issues

    Correct Answer(s)
    C. Myotonic dystrophy
    E. Cholesterol issues
    Explanation
    thermal radiation: Glassblower's
    Wilson's disease: Sunflower

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  • 15. 

    A 'milky NSC' apperance is associated with what type of secondary cataract?

    • A.

      Sunflower

    • B.

      Diabetic

    • C.

      Posterior Subcapsular

    • D.

      Hypermature

    Correct Answer
    B. Diabetic
    Explanation
    Diabetic cataracts = osmotic cataract --> cause LARGE MYOPIC SHIFT

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  • 16. 

    Glassblower's cataract is also known as a pseudo-exfoliation cataract

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Glassblower's: TRUE exfoliation cataract (capsule splits/chips off and flakes stick to lens)
    Glaucoma: psuedo-exfoliation cataract

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  • 17. 

    Wilson's Disease involves copper accumulation from poor metabolism and is associated with a Keiser-Fleisher Ring

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    --> Sunflower cataract

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  • 18. 

    Drugs such as phenothiazines and miotics can cause what type of secondary cataract?

    • A.

      Polychromatic

    • B.

      Hypermature

    • C.

      Anterior Subcapsular

    • D.

      Mature

    Correct Answer
    C. Anterior Subcapsular
    Explanation
    Other causes of anterior subcapsular cataract: chronic iritis, trauma

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  • 19. 

    Posterior subcapsular is rarely visually devastating.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Posterior & Anterior Subcapsular cataracts are commonly associated with being VISUALLY DEVASTATING.

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  • 20. 

    A 'rosette (star of david) or vossius ring is associted with which type of cataract?

    • A.

      NSC

    • B.

      Cortical

    • C.

      Traumatic

    • D.

      Morganian

    Correct Answer
    C. Traumatic
    Explanation
    Vossius Ring: pigment ring on anterior capsule from iris

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  • 21. 

    A Mature cataract is one where there is liquefaction of lens contents and wrinkling of capsule; a Hypermature cataract is complete opacification of lens capsule, cortex and nucleus

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Mature: complete opacification of lens capsule, cortex and nucleus
    Hypermature: liquefaction of lens contents and wrinkling of capsule

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  • 22. 

    If you see nuclear contents that have sunken inferiorly, what type of cataract would you consider?

    • A.

      Diabetic

    • B.

      Hypermature

    • C.

      Morganian

    • D.

      Total Congenital

    Correct Answer
    C. Morganian
    Explanation
    Nuclear contents can break through capsule in Morganian cataract.

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  • 23. 

    What is the VA limit for Medicare to cover cataract extraction?

    • A.

      20/30

    • B.

      20/40

    • C.

      20/50

    • D.

      20/60

    Correct Answer
    C. 20/50
    Explanation
    Or significant impairment with glare...most other insurance policies will cover once 20/40

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  • 24. 

    Phacolytic glaucoma and lens particle glaucoma are very similar in that they both involve lens proteins that go into the AC and clog the TM.  Describe the 2 main differences between these two.

  • 25. 

    Inflammation due to lens proteins can clog up the TM and is associated with what tyepe of lens-associated glaucoma condtiion?

    • A.

      Lens particle

    • B.

      Closed angle (phacomorphic)

    • C.

      Phacoanaphylaxis

    Correct Answer
    C. Phacoanaphylaxis
    Explanation
    Inflammation due to lens proteins can lead to the blockage of the trabecular meshwork (TM), which is responsible for draining the fluid from the eye. This blockage can result in increased intraocular pressure, leading to a type of lens-associated glaucoma called phacoanaphylaxis.

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  • 26. 

    A phacomorphic lens can cause narrow angle glaucoma because with age the lens grows and can close off the angle.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    As a person ages, the lens in their eye can grow and become thicker, potentially causing a condition known as phacomorphic lens. This condition can lead to narrow angle glaucoma, where the angle between the iris and the cornea becomes blocked or closed off. This blockage can increase the pressure inside the eye, leading to symptoms such as eye pain, blurred vision, and even vision loss if left untreated. Therefore, the statement "A phacomorphic lens can cause narrow angle glaucoma because with age the lens grows and can close off the angle" is true.

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  • 27. 

    A diabetic lens is easier to 'break up' during cataract surgery because the swelling and de-swelling that has occured has already damaged the lens in most cases.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Diabetic lens is MORE DIFFICULT to break up

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  • 28. 

    Cataract surgery can proceed even if there is an active uveitis as long as necessary precaustions (antibiotics etc) are administered.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    The surgery itself will cause inflammation and therefore a uveitis must be treated 3-6 mo prior to sx

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  • 29. 

    What aspect of the cataract surgery is particularly important for a pt with COPD & Parkinson's?

    • A.

      Wide dilation

    • B.

      Antibiotics

    • C.

      Anesthesia

    • D.

      Steroids

    Correct Answer
    C. Anesthesia
    Explanation
    Since COPD pts have increased chances of coughing, its important to make sure they are under the proper anesthesia to reduce this potential. Parkinson's pts have increased change of shaking.

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  • 30. 

    If a patient is on Warfarin, what test must be taken before cataract sx?

    Correct Answer
    INR
    Explanation
    INR will tell us how much blood clots and how thin blood is
    Normal INR = 2-4
    If blood too thin --> inc'd risk of bleeding out/orbital hemorrhage

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  • 31. 

    When would a B-Scan be important for pre-cataract sx testing?

  • 32. 

    When performing the Maddox Rod test, if the patient cannot see the line then that indicates poor macular function

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Visible whole line = good macular fxn
    Broken/wavy line = leakage/hole in macula
    No visible line = need more testing (not a good indicator of poor macular fxn'ing)

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  • 33. 

    Absence of scleral spikes during A Scan indicates that the probe is oriented toward the ONH

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    The absence of scleral spikes during A Scan indicates that the probe is oriented toward the optic nerve head (ONH). This is because scleral spikes are reflections from the sclera, which is the white outer layer of the eye. When the probe is properly oriented towards the ONH, the scleral spikes are not visible because the sound waves are directed towards the optic nerve head instead of reflecting off the sclera. Therefore, the statement is true.

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  • 34. 

    The anterior lens spike is slighly shorter than the posterior lens spike

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    anterior lens spike > posterior lens spike

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  • 35. 

    Retinal spike sloping during A Scan will result in what? Choose all that apply.

    • A.

      Falsely long axial length

    • B.

      Falsely short axial length

    • C.

      Weaker IOL

    • D.

      Stronger IOL

    • E.

      - SRx needed

    • F.

      + SRx needed

    Correct Answer(s)
    A. Falsely long axial length
    C. Weaker IOL
    F. + SRx needed
    Explanation
    Retinal spike sloping: falsely long axial length = weaker IOL = hyperopia = + SRx needed
    AC depth inconsistency = corneal compression: falsely short axial length = stronger IOL = myopia = -Srx needed

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  • 36. 

    The average AC depth is 3.24 mm.  0.1 mm error in measurement is equal to what dioptric error?

    Correct Answer(s)
    0.25 D
    Explanation
    1 mm error = 0.25 D

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  • 37. 

    Indicate when an A Scan should be retaken.

    • A.

      Axial length less than 22 mm

    • B.

      Axial length greater than 23 mm

    • C.

      Axial length greater than 25 mm

    • D.

      Axial length difference of 0.4mm

    Correct Answer(s)
    A. Axial length less than 22 mm
    C. Axial length greater than 25 mm
    D. Axial length difference of 0.4mm
    Explanation
    Retake: < 22 mm, >25 mm, difference btw eyes > 0.3 mm, pt uncooperative

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  • 38. 

    Cataract sx can result in _____% loss of endothelial cells.

    • A.

      15%

    • B.

      25%

    • C.

      40%

    • D.

      60%

    Correct Answer
    D. 60%
    Explanation
    Cataract surgery can result in a significant loss of endothelial cells, specifically 60% of them. The endothelial cells are responsible for maintaining the clarity of the cornea by regulating the fluid balance. During cataract surgery, the natural lens of the eye is removed and replaced with an artificial lens. This surgical procedure can cause damage to the endothelial cells, leading to their loss. It is important to consider this potential loss when assessing the risks and benefits of cataract surgery.

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  • 39. 

    Which of the following endothelial cell counts should you NOT recommend for cataract sx?

    • A.

      < 800 cells/mm2

    • B.

      < 1200 cells/mm2

    • C.

      < 1500 cells/mm2

    Correct Answer
    A. < 800 cells/mm2
    Explanation
    < 800 = poor candidate
    1200-1400 = OK candiate (minimally acceptable range for sx)

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  • 40. 

    RAM is the most commonly used potential acuity meter in the ECC.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    97% accurate

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  • 41. 

    The endpoint or Interferometry is when the pt can only read 1 out of 4 presentations.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    endpoint = 2/4 presentations

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  • 42. 

    Interferometry has a more optimistitic prediction than PAM

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Interferometry: UNDERPREDICTS VA w/ dense cataracts & OVERPREDICTS VA w/ macular issues

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  • 43. 

    Indicate all of testing set-ups for interferometry.

    • A.

      Undilated

    • B.

      Moderate room illumination

    • C.

      8 deg field

    • D.

      Moderate setting

    • E.

      Dim room illumination

    • F.

      Dilated

    • G.

      18 deg field

    • H.

      High setting

    • I.

      Start at 20/60

    • J.

      Start at 20/80

    • K.

      Start with worse eye

    Correct Answer(s)
    B. Moderate room illumination
    C. 8 deg field
    F. Dilated
    H. High setting
    J. Start at 20/80
    Explanation
    start with better eye

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  • 44. 

    How would you interpret the results of a glare test if the VA improves?

    • A.

      No significant glare problem

    • B.

      Glare is a problem

    • C.

      Pinhole effect

    • D.

      Results cannot be determined

    Correct Answer
    C. Pinhole effect
    Explanation
    VA same = no significant glare problem
    VA reduced = glare is a problem
    VA improves = pinhole effect --> recheck Rx

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  • 45. 

    Glare testing is typically done with the patient dilated.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Glare testing is typically done with the patient undilated, not dilated. Dilating the eyes can affect the accuracy of the test results, as it changes the size of the pupil and can alter the perception of glare. Therefore, it is important for the patient to be undilated during glare testing to obtain accurate and reliable results.

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  • 46. 

    Topical NSAIDs are used pre-sx to maintain mydriasis and prevent post-op CME.  Choose the appropriate regimen.

    • A.

      1 gtt Acular q 30min, 2 hr before surgery

    • B.

      2 gtt Acular q 1 hr, 3 hr before surgery

    • C.

      1 gtt Acular q 30 min, 2 days before surgery

    • D.

      2 gtt Acular q 2 hr, 1 day before surgery

    Correct Answer
    A. 1 gtt Acular q 30min, 2 hr before surgery
    Explanation
    Topical NSAIDs are used pre-sx (pre-surgery) to maintain mydriasis (dilation of the pupil) and prevent post-op (post-operative) CME (cystoid macular edema). The appropriate regimen is to administer 1 drop of Acular every 30 minutes, starting 2 hours before surgery. This ensures that the medication is present in the eye at the time of surgery to maintain mydriasis and minimize the risk of post-operative complications.

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  • 47. 

    Oral glaucoma meds are used pre-sx to help control IOP.  It is best to switch the patient from using prostaglandins, however, in order to reduce the aggravation of inflammation.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    The statement is true. Oral glaucoma medications are indeed used before surgery to help control intraocular pressure (IOP). However, it is recommended to switch the patient from using prostaglandins because they can aggravate inflammation.

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  • 48. 

    Which anesthesia has the best pain control?

    • A.

      Local

    • B.

      Peribulbar

    • C.

      Retrobulbar

    • D.

      Intracameral

    • E.

      More than one of the above

    Correct Answer
    E. More than one of the above
    Explanation
    Pain Control:
    retrobulbar = peribulbar > local > topical

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  • 49. 

    Peribulbar block is riskier than than retrobulbar block

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Peribulbar is less risky than retrobulbar
    Retrobular is the most dangerous...you inject the needle as in peribulbar, but then you tilt upward to go into the muscle cone...this is risky bc you might hit the optic nerve

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  • 50. 

    The most common anesthsia for sx used is topical.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Most common = LOCAL
    However, topical is recently popular bc it reduces risk of complications, however pain control is not as good.

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