Term
HSV 1 is most commonly trasmitted by
1.
2.
HSV 2 is transmitted by
3. |
|
Definition
1. mucous membranes
2. external skin
3. sexuall |
|
|
Term
| Honey colored crusted lesions common in kids |
|
Definition
|
|
Term
| The most common cause of herpetic keratitis in neonates is Type __ |
|
Definition
|
|
Term
T/F
90% adults obtain HSV 1 from a primary infection as a child |
|
Definition
|
|
Term
| HSV will hide within this area of the CNS after an initial infection and reoccur at any time |
|
Definition
Trigeminal ganglion
Reoccurs with stress, sun exposure, hormone changes, fever, trauma, immunosuppression |
|
|
Term
| Ocular complications of HSV |
|
Definition
dendritic keratitis
disciform keratitis
uveitis
blepharoconjunctivitis |
|
|
Term
| This ocular complication in HSV can quickly decrease vision due to stromal scarring |
|
Definition
|
|
Term
| There is a ___ % chance of recurring HSV, which almost doubles in terms of risk for a recurrence after the 2nd episode |
|
Definition
25%
becomes 40-45% after 2nd episode |
|
|
Term
yellow, elevated plaque lesions that happen bilaterally at medial portion of eyelids.
Often in older females with high cholesterol |
|
Definition
Xanthelasma
Tx with surgical excision, carbon dioxide laser tx, chemical cauterization |
|
|
Term
| Viris that causes Molluscum Contagiosum |
|
Definition
DNA pox virus
Multiple nodules may indicate HIV (immunocompromised..our bodies cam usually fight these off!) |
|
|
Term
|
Definition
dome-shaped nodules on face that mimic squamous cell carcinoma
spontaneously remiss over several months |
|
|
Term
| Your 35 YO male pt presents with crusty plaque-like lesions that look "stuck on" adnexal skin. He says they were mentioned by his PCP in the past, but no tx was needed because "they weren't big enough to be worrisome". What are these? |
|
Definition
Seborrheic Keratosis lesions
- common in males over 30, not commonly treated unless larger lesions (which require complete surgical excision) |
|
|
Term
| Allergic contact dermatitis is what type of hypersensitivity ? |
|
Definition
Type 4!
Delayed hypersensitivity |
|
|
Term
| HZV initially presents as ___ and lays dormant in dermatomes as a latent virus |
|
Definition
|
|
Term
| Your 20 YO male patient presents with eye irritation and a red eye, which you diagnose as uveitis. You also notice a rash located on the side of his nose with similar looking vesicles on the superior lid margin. You advice your patient that he should seek a medical evaluation for.... |
|
Definition
Immunodeficiency
(AIDs!!)
Think of KMK Jordan who evaluated his young male patient without gloves and thought he caught his AIDs :( |
|
|
Term
| This inflammatory disease causes mutlisystem complications including recurrent oral ulcers and genital ulcers, eye lesions, skin lesions and is common in Asian/Middle East young adults |
|
Definition
|
|
Term
| Most common cancer of young women |
|
Definition
Malignant melanoma
Depth of invasion is biggest prognostic factor (cancer wants to kill, wants to break the skin to reach blood supply so it can continue to feed and take over!)
|
|
|
Term
| Most common variant of melanoma (70% cases) |
|
Definition
superficial spreading melanoma
rapid growth and classically on non-exposed skin (upper back, anterior tibia) |
|
|
Term
Shiny firm pearly nodules with superficial telangiectasia.
Treat with 5-FU or biopsy |
|
Definition
Basal Cell Carcinoma
Can progress to rodent ulcers (central ulceration- look for any changes like bleeding, scabbing) |
|
|
Term
| Squamous cell carcinoma is malignancy of what layer of tissue? |
|
Definition
Stratum Spinosum layer of epidermis
It is non-healing and appears as erythematous plaque |
|
|
Term
| Squamous cell carcinoma arises from pre-cancerous lesions called |
|
Definition
|
|
Term
Port wine stains are facial capillary malformations that characterize this condition
Neuro SE of this condition?
Ocular SE? |
|
Definition
Sturge- Weber
Neuro: Seizures, focal neuro deficits, mental retardation
Ocular: glaucoma, VF defects, vascular malformation of conj/episclera/choroid/retina, iris heterochromia |
|
|
Term
Genetic condition with benign tumors growing in brain & other organs.
SE include hypopigmented macules (ash leaf spots), shagreen skin patches, angiofibromas, and a distinct brown fibrous plaque on the forehead |
|
Definition
|
|
Term
| Ocular signs of Tuberous Sclerosis |
|
Definition
retinal lesions (astocyte hamartomas)
chorioretinal depigmentation (punched out areas)
colobomas
eyelid angiofibromas
papilledema |
|
|
Term
extra 21st chromosome
(these pts are at increased risk for keratoconus) |
|
Definition
|
|
Term
|
Definition
XXY
most common cause of male primary hypogonadism
testicular atrophy, long extremities, gynecomastia, female hair distribution |
|
|
Term
An absent X chromosome leads to females with short stature, dysgenesis, webbed neck, coarctation of aorta.
What are associated ocular findings? |
|
Definition
Turner's Syndrome
associated with strab, amblyopia, CI, reduced accommodation |
|
|
Term
T or F
Aut recessive conditions typically present after puberty |
|
Definition
False- present during childhood! Only seen in 1 generation (typically)
Aut dominant conditions present after puberty |
|
|
Term
Neurofibromatosis type 1:
Classic triad of signs |
|
Definition
1. cafe au lait spots
2. neurofibromas (tumors at nerve cells)
3. Lisch nodules on iris |
|
|
Term
| Neurofibromatosis is common to form at these 3 locations: |
|
Definition
optic nerve
eye lid
auditory nerve
(I think thats what this means? written in the side margin of my kmk book on page 384....) |
|
|
Term
Marfan's Syndrome:
Ocular SE
Cardiovascular SE |
|
Definition
This CT disorder results in lens subluxation and retinal detachments
Cardiovasc: aortic aneurysms (aneurysms in general) , floppy mitral valves |
|
|
Term
| This autosomal dominant disorder is characterized by spastic uncontolled movements and dementia with 30-50 YO clinical onset, and only 15-20 year survival rate after that :( |
|
Definition
Huntington's Chorea
Spastic movements...think spastic muscles everywhere (including EOMS) for delayed pursuits/saccades/refixations |
|
|
Term
| This autosomal recessive condition results in crescent shaped RBCs that cause blocking in arteriole vessels and can lead to organ failure |
|
Definition
|
|
Term
| The most common form of sickle cell is by a single base pair mutation where ___ is substituted for ___ in the beta globin gene |
|
Definition
| Valine is exchanged for Glutamic Acid |
|
|
Term
| Sea fan retinopathy is a result of …. |
|
Definition
| sickle cells occluding retinal arterioles that lead to ischemia and thus, neovascularization grows in this "sea fan" shape |
|
|
Term
| Caused by mutations in phenylalanine hydroxyls (converts phenylalanine to tyrosine) & can lead to mental retardation if not treated |
|
Definition
|
|
Term
|
Definition
| Diet low in phenylalanine is initiated (milk, aspartame, meat, chicken) |
|
|
Term
| Tay Sachs is progressive destruction of the nervous system that leads to ocular signs of : |
|
Definition
Cherry red spot (retina- CRAO), atrophy of optic nerve
(these pts pass away early in life) |
|
|
Term
| Only systemic diasease that causes whorl keratopathy |
|
Definition
|
|
Term
| Lipid deposits in BV walls throughout body allow lipids to build up to harmful levels in eyes, kidneys, autonomic NS, and cardiovascular system |
|
Definition
|
|
Term
| Osteogenesis Imperfecta ocular SE |
|
Definition
| Blue sclera, keratoconus, megalocornea |
|
|
Term
Systemic conditions that cause blue sclera
One medication that causes blue sclera |
|
Definition
Ehler Danlos, PXE
Minocycline (tx for acne vulgaris) |
|
|
Term
| Condition transmitted only through mothers |
|
Definition
Leber's Hereditary Optic Neuropathy
(progressive loss of central vision in men in 20s-30s)
My Mother Leber Lost My Eyes |
|
|
Term
| more than 50% anemias are in this category |
|
Definition
|
|
Term
| Different causes of iron deficiency anemia |
|
Definition
1. GI blood loss from PUD, colon cancer, etc
2. malabsorption or decreased intake of iron (increased need with pregnancy or in childhood)
**Treat with oral iron supplements** |
|
|
Term
| Aplastic anemia is caused by which meds? What are other causes? |
|
Definition
OCT (Oral CAIs, Chloremphenicol, Trimethoprim) ..& chemo drugs
Also caused by infection, radiation |
|
|
Term
| Explain how kidney disease can lead to anemia |
|
Definition
Damaged kidneys synthesize inadequate amounts of erythropoeitin (which stimulates RBC production in bone marrow)
Low RBC production = low RBCs ! |
|
|
Term
| What is pernicious anemia? |
|
Definition
Abs against parietal cells in stomach = decreased intrinsic factor (needed for VitB12 absorption)
Leads to VitB12 deficiency |
|
|
Term
| This drug is used to treat rheumatoid arthritis and may also cause folic acid deficiency |
|
Definition
|
|
Term
| Folic acid deficiency during pregnancy increases risk for this |
|
Definition
| Spina Bifida (neural tube defects in general) |
|
|
Term
| Leading cause of folic acid deficiency is ___ , especially in this group of people |
|
Definition
| Dietary! Especially for alcoholics |
|
|
Term
Proliferation of malignant clone of plasma cells in bone marrow.
Leads to bone destruction, hypercalcemia, renal failure |
|
Definition
Multiple Myeloma
(multiples of a malignant bone killer) |
|
|
Term
Hodgkins Lymphoma is NOT associated with
a) age groups 15-30 and over 50
b) 50% associated VZV (Varicella Zoster)
c) Bad prognosis, with 15-20 year survival rate following dx
d) Enlarged lymph nodes |
|
Definition
B & C
- 50% associated with Epstein Barr Virus (EBV)
- good prognosis if caught early |
|
|
Term
| 60% of lymphomas are Hodkins or Non-Hodgkins? |
|
Definition
Non-Hodgkins Lymphoma
(big lymph nodes & GI tumors found by determining T or B cells through bone marrow biopsy) |
|
|
Term
| Predominate cell type in acute leukemia |
|
Definition
Blast cells aka immature cells
(>30% of marrow cells are blast cells) |
|
|
Term
| Auer rods are found in the blood with this condition |
|
Definition
Acute Myeloblastic Leukemia
(normal WBC with excess myeloblasts) |
|
|
Term
| peak age of this condition is 2-10 yrs. WBC is normal but lymphoblasts are excess! |
|
Definition
Acute Lymphoblastic Leukemia
(75% kids are disease free >5 yrs with tx) |
|
|
Term
| Roth spots are indicative of which conditions |
|
Definition
| Leukemia and endocarditis |
|
|
Term
Chronic Myelocytic Leukemia has ___ year survival rate
Chronic Lymphocytic Leukemia has __ year survival rate |
|
Definition
3 years, (25-60 YO)
5-10 years, (in older than 50 YO) |
|
|
Term
| Swelling of the legs with subcutaneous edema and possibly shortness of breath can be due to |
|
Definition
pulmonary edema
(tx with diuretics and compression stockings) |
|
|
Term
| These cells surround retinal blood vessels and damage to these can allow leakage and cause edema |
|
Definition
|
|
Term
| diabetic macular edema is caused by ... |
|
Definition
| microaneurysms or capillary wall dilation |
|
|
Term
| most common place for thrombosis |
|
Definition
deep venous system in the legs
(low pressure area, pulling blood increases risk for thrombosis) |
|
|
Term
|
Definition
Theory delineating cause of venous thromboembolism
VTE results from altered blood flow (stasis), vascular endothelial injury, alterations in constituents of blood through inherited/acquired hyper coagulable state |
|
|
Term
| Acquired causes of hypercoagulation |
|
Definition
birth control
smoking
vasculitis (temporal arteritis)
stasis (immobilization or pregnancy) |
|
|
Term
| inherited hypercoagulation |
|
Definition
Factor V Leiden
prothrombin gene mutation
protein C & S deficiency |
|
|
Term
| A thrombosis in deep leg veins are likely to embolize in what part of the body? |
|
Definition
heart or lungs
(can be immediately fatal) |
|
|
Term
| arterial thrombosis commonly form from what conditions? |
|
Definition
atherosclerosis or MI
These embolize to brain, kidneys, spleen |
|
|
Term
| What is more common: venous or arterial thrombosis? |
|
Definition
Venous
higher pressure in arteries means thrombus here is less likely (blood flow will cause it to move, aka it's an embolus) |
|
|
Term
| ocular conditions that most commonly result from thrombus formation |
|
Definition
|
|
Term
| What are the 6 types of emboli |
|
Definition
1. fat (long bone fractures, liposuction)
2. air (chest wall injury_
3. thrombus (#1 cause of emboli)
4/5. bacterial/tumor (tissue destruction, muscle pain)
6. amniotic fluid (lead to clotting) |
|
|
Term
|
Definition
| abnormal dilation of a vessel, enclosed by complete arterial wall components |
|
|
Term
| The most common aneurysms occur where? |
|
Definition
abdominal aorta
iliac
other larger arteries |
|
|
Term
| pupil involving CN 3 palsies are likely a result of.. |
|
Definition
aneurysms
pupil-sparing fibers are located on outside of CN 3, located close to surrounding arteries (posterior communicating artery) |
|
|
Term
| Aneurysms are basically stretching of vessel walls to cause bulging. You should associate this with which systemic condition? |
|
Definition
|
|
Term
| What are two main symptoms experienced by a patient with atherosclerosis? Are these experienced early or later in the disease? |
|
Definition
SOB and chest pain
patients can be asymptomatic for decades before experiencing this |
|
|
Term
| Biggest risk factor of atherosclerosis |
|
Definition
| age (especially greater than 50) |
|
|
Term
| Lab results for atherosclerosis |
|
Definition
increased total cholesterol
decreased HDL
increased LDL
increased CRP |
|
|
Term
| first line therapy for atherosclerosis |
|
Definition
statin medications
(followed by diet and exercise, then artery stents for those showing CAD symptoms) |
|
|
Term
| Most commonly encountered peripheral corneal opacity |
|
Definition
Arcus Senilus
(sign of present or past high cholesterol that DOES NOT affect vision)
** refer if seen in pt under 40 YO |
|
|
Term
Normal Cholesterol Values
Total:
LDL:
HDL:
TG |
|
Definition
Total: below 200
LDL: under 100
HDL: over 40
Triglycerides: under 150 |
|
|
Term
| Characterized by atherosclerosis within the coronary arteries supplying blood to the heart. Patients may have chest pain and dyspnea. |
|
Definition
Coronary Artery Disease
(can lead to an MI) |
|
|
Term
| If a pt experiences an MI, this treatment should be given immediately |
|
Definition
|
|
Term
Critical performance standards for CPR:
maintain rate of at least ___ compressions/min. Compress the chest at least ___ with each down stroke (complete recoil in between). The compression- ventilation ratio should be ___ until an advanced airway is put in place. Deliver ___ ventilations per minute. |
|
Definition
Maintain rate of 100 compressions/min
Compress 5 cm (2 inches)
Compression-ventilation ratio of 30 comp: 2 ventilations
Deliver 8 ventilations per minute |
|
|
Term
| 25% strokes are due to what? |
|
Definition
| Build up of plaque causing stenosis of carotid arteries (CAD) |
|
|
Term
| Visual/Neuro symptoms of CAD |
|
Definition
sensory loss, dizziness, amaurosis fugax, LV in ipsilateral eye
(motor symptoms are contralateral, visual symptoms are ipsilateral) |
|
|
Term
| You are listening for a bruit over the carotid artery but you hear nothing. This can indicate what? |
|
Definition
1. There is no occlusion
2. The artery is 90% occluded (too much blockage for blood flow to actually MAKE a sound) |
|
|
Term
| The most common primary diagnosis in America |
|
Definition
|
|
Term
| Percentage of 60-69 YO and percentage of those over 70 YO affected by HTN |
|
Definition
50% of 60-69 YO
75% over 70 YO |
|
|
Term
T or F
The rise in diastolic BP continues through life, but systolic pressure will level off by age 50. |
|
Definition
False
Systolic continues to rise
Diastolic is stable by 50 YO |
|
|
Term
| Goal of HTN for a patient with DM or renal diseases |
|
Definition
|
|
Term
|
Definition
| 120-139 systolic / 80-89 diastolic |
|
|
Term
|
Definition
age!!
(other risks are family hx, obesity, DM, smoking, excess sodium intake. African Americans have highest risk!!) |
|
|
Term
| At what stage of hypertensive retinopathy is optic disc edema found? |
|
Definition
|
|
Term
| Hypertensive retinopathy is manifested by what? |
|
Definition
narrowing of retinal arterioles
Injury to vasculature can cause occlusion or leakage which is seen as NFL infarcts, edema, intraretinal hemorrhages, macroaneursyms. |
|
|
Term
| Findings of hypertensive choroidopathy |
|
Definition
| Elschnig spots, Siegreist streaks |
|
|
Term
| Hypertensive retinopathy is directly linked to what factor? |
|
Definition
|
|
Term
| most common cause of left sided heart failure |
|
Definition
| ischemic cardiomyopathy (from CAD) |
|
|
Term
| most common cause of right sided heart failure |
|
Definition
left-sided CHF
(other causes: pulmonary HTN, COPD, right side MI) |
|
|
Term
| What is rheumatic fever? Who does it typically affect? |
|
Definition
An infection of strep pyogenes that alters shape of heart valves (75-80% cases attack the mitral valve) and valve replacement often needed.
Often in pts age 5-15 YO |
|
|
Term
| Common signs and symptoms of rheumatic fever |
|
Definition
| Elevated ESR, red-hot joints, endocarditis |
|
|
Term
| Condition where bacteria infects inner lining of heart and an echocardiogram shows "vegetations" which are mix of bacteria and thrombus |
|
Definition
|
|
Term
| Premature Ventricular Contractions |
|
Definition
| The most common heart palpitation |
|
|
Term
| TIAs typically last how long? |
|
Definition
| less than 24 hours, often less than 15 minutes |
|
|
Term
|
Definition
| inadequate perfusion, often caused an embolism |
|
|
Term
|
Definition
1. Carotid Artery (contralateral hand/arm weakness and ipsilateral VL)
2. Vertebrobasilar: diplopia, ataxia, vertigo, dysarthria, unilateral or bilateral VL |
|
|
Term
Which of the following about Hollenhorst plaques is true?
a) found at bifurcations of vasculature
b) larger in size than the actual vessel
c) transient & not always found at the same spot
d) if found, refer ASAP due to probability of TIAs |
|
Definition
|
|
Term
| Main risk factor for stroke |
|
Definition
HTN
(auscultate subclavian and carotid arteries for bruit as clue to early diagnosis for stroke) |
|
|
Term
| Test used to determine size and location of stroke |
|
Definition
|
|
Term
| This Vf defect is due to stroke at occipital lobe affecting EITHER the middle cerebral or posterior cerebral artery (not both) |
|
Definition
Macular sparing homonymous hemianopsia
(dual blood supply to macula) |
|
|
Term
| VF defect when tumor has compressed both blood supplies to macular cortex |
|
Definition
macula only homonymous hemianopsia
(A stroke would NEVER hit both of these arteries at once!) |
|
|
Term
| Accounts for 80% of all strokes, rusting from occlusion of an artery leading to the brain. |
|
Definition
Ischemic strokes
(embolism of atherosclerotic plaque is most common cause) |
|
|
Term
| The most common type of hemorrhagic stroke |
|
Definition
|
|
Term
| Explain how a subarachnoid hemorrhage leads to a pupil-involving CN 3 palsy |
|
Definition
| As blood increases in the subarachnoid space, pressure increases as well (think more fluid contributing to volume of CSF in this space) so as pressure increases, CN 3 is compressed. Pupil fibers located outside CN 3 are quick to be affected by any compression |
|
|
Term
| CN 3 palsies from subarachnoid hemorrhages are usually from insult at what area of the brain? |
|
Definition
Circle of Willis
(the meeting loop for basilar, internal carotids, anterior and posterior communicating arteries) |
|
|
Term
| The anterior cerebral artery is located where and supplies what? |
|
Definition
Location: extension that goes up and forward from the internal carotid
Supplies frontal lobe (logical thought, personality, voluntary movement) |
|
|
Term
Last and largest branch of the internal carotid is ___
It supplies ____ |
|
Definition
Middle cerebral artery (Think MEGA for large)
Supplies frontal lobe, lateral surfaces of temp/parietal lobe (control primary motor and sensory of face, throat, hand, arm, areas for speech) |
|
|
Term
This artery stems from the basilar artery.
It supplies temporal & occipital loves |
|
Definition
| posterior cerebral artery |
|
|
Term
| strokes involving this vessel cause contralateral hemiplegia, color blindness, verbal dyslexia, and VF defects |
|
Definition
posterior communicating artery
(feeds into occipital lobe) |
|
|
Term
| Difference between seizures and epilepsy? |
|
Definition
Seizures are a single event
Epilepsy is recurrent seizures. Status Epilepticus is a prolonged seizure (more than 5 minutes) |
|
|
Term
4 treatment drugs for epilepsy
1 drug for absence seizures |
|
Definition
Pheytoin, Phenobarbital, Carbamazepine, Valproic Acid
Klonopin (aka Clonazepam) |
|
|
Term
| What the hell is an absence seizure? |
|
Definition
aka petit mal seizures
a brief lapse of consciousness that quickly returns without lethargy following afterwards |
|
|
Term
Your 40 YO male patient presents for a CVE with red eyes and a stuffy nose. Upon examination you find a grade 1 ptosis OD, mitotic pupil OD (more prominent in your dark exam room).
Your patient reports he's been tired lately from lack of sleep due to extreme headaches during the night that he believes may be due to the fact that he recently quit smoking and drinking, habits he's been dealing with for the past 15 years.
Possible diagnosis? |
|
Definition
Cluster headaches
Look for 30-50 YO smoker/alcoholic males
headaches are often orbital/temporal (unilateral) and wake pts at night. Expect 1-2 attacks/day with each lasting ~1 hour.
Can present with red eyes, stuffy nose, transient or permanent ipsilateral Horner's Syndrome.
(Side note: this HA is known to begin more posterior and travel forward via the track of the trigeminal nerve) |
|
|
Term
| Describe the typical patient experiencing tension headaches |
|
Definition
Females (of all ages) that may be stressed & tense (think tense neck muscles).
HAs are in band-like distribution (hat band) |
|
|
Term
Migraine headaches are…
1. more common in men or women?
2. present with or without what symptoms?
3. typically last how long? |
|
Definition
1. women (typically start at 20-30 YO)
2. aura, nausea, photosensitivity
3. 4- 72 hours |
|
|
Term
| Big presenting signs that should make you think of brain tumors as possible diagnosis? |
|
Definition
1. Interruption of sleep
2. increasing severity over time (tumor HA typically worse in morning)
3. in kids- 1 or more physical/ neuro deficit in addition to the headaches |
|
|
Term
Your 75 YO female patient complains about jaw claudication, transient VL, scalp tenderness, and recent neck pain.
What's your plan of action? |
|
Definition
Order and ESR and CRP immediately!
Start patient of prednisone treatment!
The gold std for GCA is a temporal artery biopsy, but it can be performed following the above. The first two are more important so we can confirm diagnosis and initiate treatment ASAP |
|
|
Term
| Inflammation of the meninges is often preceded by what? |
|
Definition
upper respiratory infection
(other causes include virus, TB, fungi, chemical agents |
|
|
Term
T or F
Viral meningitis is a fairly rare disease with various treatment options available |
|
Definition
False
This form is both common AND very hard to treat |
|
|
Term
| Classic triad of meningitis |
|
Definition
fever, headache, neck stiffness
(look for papilledema) |
|
|
Term
| The most common primary malignant brain tumor typically found in the cerebral hemispheres that can cross the corpus callosum |
|
Definition
Glioblastoma Multiforme
prognosis is less than 1 year life expectancy |
|
|
Term
| The most common brain cancer in adults is due to metastasis that begins in which primary tumor sites? |
|
Definition
|
|
Term
| This is often localized to CN 8 and causes gradual onset of painless, progressive proptosis |
|
Definition
Schwannomas
Referred to as acoustic schwannoma if CN 8 localized |
|
|
Term
| The most common functional pituitary adenoma is ___ and causes what kind of VF defect? |
|
Definition
Prolactin-secreting tumor
Causes a bi-temporal hemianopsia as it sits directly below the optic chiasm |
|
|
Term
Hormones secreted by Posterior Pituitary Gland:
Hormones secreted by Anterior Pituitary Gland: |
|
Definition
Posterior: AHD, Oxytosin
Anterior: everything else
(LH, TSH, Prolactin, GF, ACTH) |
|
|
Term
| Diagnosis of MS requires what? |
|
Definition
| TWO separate CNS lesions on TWO or more occasions (two separate scans). lesions MUST involve white matter (periventricular) |
|
|
Term
| The most common presenting symptom of MS |
|
Definition
optic neuritis!!
found in 25% of cases |
|
|
Term
|
Definition
| Optic Neuritis, pain on EOM movements, APD, INO, diplopia |
|
|
Term
This patient presents to you with a CC of sudden non-progressive loss of vision OS that began yesterday. She also noticed blurry vision after taking a hot shower this morning.
Refer for further testing to rule out what? |
|
Definition
MS!!
Uhtoff's Phenomenon: decreased VA after increase in body temp |
|
|
Term
This condition is characterized by inflammation and demyelination of peripheral nerves and ventral root motor fibers.
Think symmetric ascending muscle weakness that starts in distal lower extremities |
|
Definition
|
|
Term
| Ocular findings of Guillian Barre Syndrome |
|
Definition
| Adies tonic pupil, diplopia, papilledema ( due to elevated CSF protein) |
|
|
Term
| This disease may be called "Hugh Heifner disease" because it affects younger women and older men ;) |
|
Definition
|
|
Term
| Myasthenia Gravis systemic symptoms |
|
Definition
| Respiratory weakness, jaw muscle weakness |
|
|
Term
| Pathologic process of myasthenia gravis |
|
Definition
| Neuromuscular signals are blocked by Abs at the Ach receptors. |
|
|
Term
| Diseases that MG is associated with |
|
Definition
| thymomas, rheumatoid arthritis, SLE |
|
|
Term
|
Definition
Ptosis and diplopia
(symptoms typically worse at end of the day) |
|
|
Term
| This common form of dementia is characterized by beta amyloid plaques and disorganized protein fibers (neurofibrillary tangles) in brain cells. |
|
Definition
|
|
Term
| Aricept, a medication that inhibits AchE, is used to treat what? |
|
Definition
Alzheimer's Disease
(There is no CURE but this med can help slow progression) |
|
|
Term
| Patients with vascular dementia have damaged brain tissue secondary to... |
|
Definition
| reduced cerebral flood flow from blood clots or fatty deposits (cerebral micro infarcts) |
|
|
Term
| Parkinson's is a deficiency of ___ in the striatum due to degenerated neurons in the ___ |
|
Definition
|
|
Term
|
Definition
Tremor
Rigidity
Akinesia
Postural Reflexes
(symptoms of Parkinsons) |
|
|
Term
| Typical first sign of Parkinson's |
|
Definition
slowness of movement
(along with cogwheel rigidity, pill-rolling tremor) |
|
|
Term
| This artery is often responsible for epidural hematomas |
|
Definition
|
|
Term
| Symptoms to look for with head trauma |
|
Definition
pupillary size changes (blown pupil signals impending uncial herniation)
nausea, vomiting
loss of consciousness |
|
|
Term
| Horner's Syndrome can be associated with these systemic diseases |
|
Definition
cluster headaches
Pancoast tumor (at lung apex) |
|
|
Term
| Which fibers are affected in Pancoast Tumor |
|
Definition
| sympathetic pre-ganglionic fibers |
|
|
Term
| Sympathetic fibers like to MOOCH! What places do these fibers mooch off of? |
|
Definition
Internal carotid artery
CN 3 to Muller's
CN 5 to Dilator |
|
|
Term
| Bell's Palsy is characterized by a deficit at what location? |
|
Definition
| lower motor neurons in CN VII |
|
|
Term
| Biggest ocular concern with a Bell's Palsy patient |
|
Definition
Exposure keratitis
Consider patching eye that can't completely close to prevent corneal dryness . Also consider ointment Rx and ATs |
|
|
Term
| Complete lack of insulin from beta cell production can lead to this condition in (typically) younger people |
|
Definition
|
|
Term
|
Definition
| Insulin injections, along with careful glucose and diet monitoring |
|
|
Term
| What is diabetic ketoacidosis and which type is it more associated with? |
|
Definition
Glucose that is not utilized is stored by fat and muscles for energy as ketone bodies (cause fruity breath)
More common in Type 1 |
|
|
Term
| Insulin resistance or abnormal beta cell secretion of insulin is commonly associated with which type of diabetes? |
|
Definition
|
|
Term
| Obestiy is associated with what % of DM 2 patients? |
|
Definition
|
|
Term
| Appropriate lab tests for diabetics |
|
Definition
Fasting glucose level
Hemoglobin A1C |
|
|
Term
| What is A1C and what is a normal level? |
|
Definition
State of glycemia over last 90-120 days
Should be less than 7% |
|
|
Term
| Abnormal fasting glucose level |
|
Definition
|
|
Term
| What type of DM is more associated with a genetic predisposition? |
|
Definition
|
|
Term
| When should diabetic pts come in for a DFE? |
|
Definition
DM 1 within 5 years
DM 2 upon diagnosis |
|
|
Term
| extreme thirst and polyuria resulting from lack of ADH |
|
Definition
Diabetes Insipidus
(remember, without ADH we constantly lose water) |
|
|
Term
| Lab values typical of hypothyroidism |
|
Definition
Low T3, T4
High TSH
(structural or functional abnormality hinders thyroid production) |
|
|
Term
| Most common cause of hypothyroidism in iodine-sufficient areas of the world |
|
Definition
Hashimotos Thyroiditis
This autoimmune-mediated condition affects females much more than men. |
|
|
Term
| How many hyperthyroid cases are caused by Grave's ? |
|
Definition
|
|
Term
| Pathologic process of Grave's |
|
Definition
| TSH Auto-Abs (TSH pretenders) that constantly stimulate the thyroid to excessively produce T3 and T4 |
|
|
Term
| Hyperthyroidism mostly affects what people? |
|
Definition
| middle aged females (8:1) |
|
|
Term
| In what order are EOMs affected in Thyroid Eye Disease? |
|
Definition
IM SLO
(inferior rectus commonly affected first) |
|
|
Term
| Most common ocular signs of Grave's |
|
Definition
proptosis
upper lid retraction
(also look for SLK) |
|
|
Term
| An eye affected by TED will commonly develop what kind of tropia? |
|
Definition
Hypotropia
(IR fibrosis makes the IR like a tight rope, pulling eye in the downward position. **Can result in falsely measured high IOP measurements**) |
|
|
Term
| Hyperparathyroidism is marked by ... |
|
Definition
|
|
Term
| Adrenocortical deficiency that results from autoimmune atrophy of the adrenals |
|
Definition
Addison's Disease
(gotta add more!) |
|
|
Term
| Symptoms of Addison's Disease |
|
Definition
weakness, fatigue, anorexia, weight loss, nausea/vomiting, diarrhea, muscle & joint pain, amenhorrhea
(treat with replacement corticoids) |
|
|
Term
| Majority of Cushing's syndrome cases result from what? |
|
Definition
chronic, prescribed corticosteroid meds
(living on a cushion of steroids) |
|
|
Term
| Typical Cushing's Syndrome patient looks like what? |
|
Definition
| Central obesity, moon face, buffalo hump |
|
|
Term
| Condition caused by tumors secreting excess NE and epinephrine. These tumors commonly located on one or both adrenal glands |
|
Definition
|
|
Term
| Symptoms of pheochromocytoma |
|
Definition
HTN, papilledema, severe HA, perspiration, palpitations, and anxiety with impending doom
(the 4 P's: pain, palpitations, pallor, perspiration) |
|
|
Term
| Lab test results common in renal failure |
|
Definition
GFR is decreased (glomerular filtration rate)
Creatinine is increased
BUN is increased |
|
|
Term
| Main causes of chronic renal failure |
|
Definition
| Diabetes (most common) and HTN |
|
|
Term
| When more than 3.5g of protein found in the urine, this indicates what condition? |
|
Definition
Nephrotic Syndrome
(type of inflammation of the kidney glomerulus) |
|
|
Term
| Post strep glomerulonephritis commonly affects 5-15 YO at what point of infection? |
|
Definition
| Occurs 7-21 days after a respiratory or skin infection |
|
|
Term
| Renal cell carcinomas are typically asymptomatic. But if they do have symptoms, what is the classic triad? |
|
Definition
flank pain, hematuria, abdominal renal mass
(1st diagnostic test is abdominal ultrasound) |
|
|
Term
| most common bacterial sexually transmitted disease in the US |
|
Definition
|
|
Term
| Chlamydia commonly causes inclusion conjunctivitis which presents in what way? |
|
Definition
| It's a chronic infection with large inferior palpebral conjunctival follicles |
|
|
Term
| Drugs that treat chlamydia |
|
Definition
|
|
Term
|
Definition
single dose of Ceftriaxone 125 mg IM
AND Doxycycline 100mg p.o. BID x 7 days (this covers for possible chlamydia) |
|
|
Term
| How are the two types of HSV diagnosed? |
|
Definition
| multinucleate giant cells on a Wright-Gram stain |
|
|
Term
|
Definition
Acyclovir or Famciclovir
(no cure but tx is prophylactic for breakouts) |
|
|
Term
| An STD caused by the spirochete Treponema pallidum |
|
Definition
|
|
Term
| Clinical findings of syphilis in each phase |
|
Definition
Primary: chancre (painless genital ulcer)
Secondary: eye, kidney, mucous membranes, skin, CNS, liver
Tertiary: nervous system & ophthalmic lesions (Argyll Robertson) |
|
|
Term
| Salt and pepper fundus is seen in which systemic conditions? |
|
Definition
congenital syphilis
congenital rubella |
|
|
Term
|
Definition
|
|
Term
| Screening tests for syphilis |
|
Definition
RPR (rapid plasma reagin)
VDRL (venereal disease research lab)
EIA (enzyme immune assay) |
|
|
Term
| Diagnostic tests for syphilis |
|
Definition
| FTA-ABS , TPPA , MHA- TP, dark field microscopy |
|
|
Term
| Which test can determine a currently active case of syphilis and which can determine a latent case? |
|
Definition
RPR for active (+ 4-6 weeks after infection)
FTA-ABS for latent (+ for life) |
|
|
Term
| An elderly male with complaints of increased urinary frequency, urgency, nocturne, a weak stream, dribbling, probably has what? |
|
Definition
| Benign Prostatic Hypertrophy |
|
|
Term
| 2nd most common cause of cancer death in males |
|
Definition
Prostate cancer
(elevated PSA test indicates prostate cancer) |
|
|
Term
| The most common causes of cancer death in women (in order) |
|
Definition
|
|
Term
| The most severe neural tube defect that is 100% fatal |
|
Definition
| Anencephaly: absence of normal bone & cranial bone tissue |
|
|
Term
| the number one cause of congenital malformation? |
|
Definition
|
|
Term
| This condition is transferred from mother to fetus and its ocular effects often include microphthalmia and glaucoma. It is screened for early in pregnancy |
|
Definition
|
|
Term
Name these common GI conditions:
a) gastroesophageal junction incompetence allows gastric juice into the esophagus for heartburn.
b) H. Pylori leads to ulcers (duodenal and gastric) that can lead to extreme pain after eating, the middle of the night when acid secretion is greatest.
c) esophagus lining is replaced by metaplastic columnar cells, can lead to esophageal adenocarcinoma |
|
Definition
a) GERD
b) PUD
c) Barrett's Esophagus |
|
|
Term
| Two main inflammatory bowel diseases |
|
Definition
| Crohn's and Ulcerative Colitis |
|
|
Term
| Affected location in Crohn's Disease |
|
Definition
any portion of GI tract.
Usually at terminal ileum, small intestine, colon.
(SKIP lesions) |
|
|
Term
| An autoimmune disease affecting the colon, along with rectal involvement and a 5-10% chance of nongranulomatous uveitis |
|
Definition
|
|
Term
| contributing factors to colon cancer |
|
Definition
low fiber, high fat diets, exposure to toxins
Primarily screened for with colonoscopy |
|
|
Term
| copper accumulation in the liver, brain, and cornea with sunflower cataracts. Can also cause liver cirrhosis, basal ganglia degeneration, dementia |
|
Definition
|
|
Term
|
Definition
| chelating agent used in Wilson's because it binds copper. Many patients stop taking because of SE (Ocular MG, ocular pemphigoid, optic neuritis) |
|
|
Term
| Types of Hepatitis: vaccine available? route spread? |
|
Definition
A- yes, focal oral route
B- yes, blood, IV, sex
C- no, blood, IV, sex (chronic)
D- no, carried with Hep B as superinfection
E- no, fecal oral route |
|
|
Term
Blood through liver is hindered due to fibrosis, leading to enlargement and formation of firm nodules, then liver shrinkage.
Leads to portal HTN, GI hemorrhaging, liver failure (and death). |
|
Definition
|
|
Term
| How does jaundice occur and what obvious signs are seen? |
|
Definition
The conversion of bilirubin or heme to urobilinogen is disrupted in liver or bilirubin can't be excreted
(either way- bilirubin builds up in bloodstream)
Skin and conjunctiva turn yellow |
|
|
Term
| Cholecystitis, caused by inflamed gall bladder lining, is most common in what group? |
|
Definition
| overweight females of childbearing age |
|
|
Term
| Acute pancreatitis is often secondary to what? |
|
Definition
| alcohol abuse or gallstones in 70-80% cases. |
|
|
Term
| most common form of hearing loss |
|
Definition
| loss of conduction, usually a result of cerumen impaction or trauma |
|
|
Term
Sensory hearing loss is due to ___
Neural hear loss is due to ___ |
|
Definition
Sensory: damage to cochlea
Neural: damage to CN VIII
(differentiate the two with Weber and Rinne tests) |
|
|
Term
| Otitis media is very common in infants and children and is due to what infectious agents? |
|
Definition
| Step Pneumoniae and H. Influenza |
|
|
Term
| Vertigo is often caused by what disease? |
|
Definition
| Meniere's Disease, a disease associated with episodic and severe vertigo, hearing loss, tinnitus |
|
|
Term
| Acute bacterial sialadenitis is often located where? |
|
Definition
the parotid or submandibular gland
(remember CN VII goes through the parotid gland) |
|
|
Term
| 80% of salivary gland tumors involve what gland? |
|
Definition
the parotid gland
(only 50-60% are benign) |
|
|
Term
|
Definition
|
|
Term
| Describe the signs of both types of COPD |
|
Definition
Emphysema: pink puffers with SOB, decreased breathing sounds, tachycardia
(decreased recoiling means a total exhalation would cause alveolar walls to collapse. So pink puffers only partially exhale)
Chronic bronchitis: blue bloaters with productive cough for 3 consecutive months in 2 or more years with cyanosis of fingers/toes and wheezing/crackling lung sounds. |
|
|
Term
| The pathophysiology of asthma |
|
Definition
Acute reversible bronchoconstriction (triggered and causes coughing, wheezing, dyspnea, tachycardia)
Chronic inflammation of airways |
|
|
Term
Which of the following can be considered as a form of pneumoconiosis?
a) asbestosis
b) silicosis
c) berylliosis |
|
Definition
All of them!
This disease is secondary to occupational inhalation of dust or other particles inhaled. They cause SOB, decreased lung volume/compliance. Order a chest x-ray to show a ground glass appearance from diffuse infiltrates. |
|
|
Term
| Systemic symptoms of TB? Which is the most common? |
|
Definition
Fever, cough, night sweats
Night sweats are most common |
|
|
Term
| All patients thought to have TB need to have what test done? |
|
Definition
|
|
Term
|
Definition
bilateral anterior granulomatous uveitis
CME
Less common: keratitis, phlyctenules, conjunctival granulomas, scleritis |
|
|
Term
| Two of the most common etiologies of chronic, bilateral anterior granulomatous uveitis |
|
Definition
|
|
Term
| A positive PPD test for TB is indicated by what amount of induration? |
|
Definition
At least 15 mm of induration in healthy/normal immune system patients
10mm for a health-care worker or someone in contact with active TB patients
5mm for immunocompromised pts (HIV, bone marrow suppression) |
|
|
Term
| The most common cause of bacterial pneumonia |
|
Definition
|
|
Term
| the MAIN cause of death from cancer in both men and women |
|
Definition
lung cancer
(adenocarcinoma is the most common lung cancer) |
|
|
Term
| the 4 classifications of neoplasms |
|
Definition
1. behavior
2. degree of differentiation
3. embyologic origin
4. gross appearance |
|
|
Term
| Carcinomas arise from what kind of cells? |
|
Definition
|
|
Term
| Sarcomas arise from what type of tissue? |
|
Definition
|
|
Term
| connective tissue cancer that causes bone destruction and is the most common primary orbital malignancy |
|
Definition
|
|
Term
| The second most common form of skin cancer |
|
Definition
Squamous cell carcinoma
(Basal cell carcinoma is #1, by a long shot) |
|
|
Term
| To be diagnosed with Bulimia Nervosa, a patient must suffer from how many episodes of binge eating over what period of time? |
|
Definition
| 2 times per week for at least 3 months |
|
|
Term
| A patient with this condition may appear malnourished with a very swollen belly due to protein malnutrition. |
|
Definition
|
|
Term
| % of patients that suffer from major depression? |
|
Definition
|
|
Term
| This condition is due to increased dopamine keels in the mesolimbic region causing a massive disruption of behavior, mood, and thinking for at least 6 months |
|
Definition
|
|
Term
|
Definition
| hypopyon, vitritis, chemosis, lid edema, reduced red reflex |
|
|
Term
| This presents within a week to a month post-op. Vision loss is insidious, with pain present that worsens. |
|
Definition
|
|
Term
| lens subluxation is caused by what conditions |
|
Definition
MEWTH
Marfan's, Ehlers Danlos, Weill-Marchesani, trauma, Homocysturinuria, |
|
|
Term
| Ehlers Danlos and Osteogenesis imperfecta cause similar ocular SE like ... |
|
Definition
KC, blue sclera, megalocornea
Difference between the two?
Ehlers Danlos causes lens subluxation… |
|
|
Term
| Most common and most serious SE of Marfan's |
|
Definition
|
|
Term
| This is the most common post-op complication following cataract surgery! |
|
Definition
Posterior capsular opacification
(treat with a yag laser) |
|
|
Term
| Elschnig pearls are a type of what? |
|
Definition
posterior capsular opacification
epithelial cell proliferation resulting in clouding of posterior capsule (often 2-6 months after surgery) |
|
|
Term
| This happens in OPL and is most commonly why decreased acuity occurs after cataract surgery |
|
Definition
CME (Irvine-Gass)
often 6-10 weeks after surgery but will likely evolve in 6 months |
|
|
Term
| What conditions cause CME ? |
|
Definition
surgery, diabetic retinopathy, vein occlusions, uveitis, RP, ARMD, retinal vasculitis, Coats Disease
(think anything caused by inflammation?) |
|
|
Term
| Choroidal nevi will (disappear or still be visible) with a red-free filter? |
|
Definition
| These will disappear. Remember that retina is soaking up all this green light, so everything below is going to disappear (aka choroid) |
|
|
Term
|
Definition
| age (approximates prevalence), myopia, DM, surgeries, inflammation, trauma |
|
|
Term
| Describe the pathophysiology of a PVD |
|
Definition
| As hyaluronic acid and collagen complex in vitreous breaks down, collagen clumps up. These clumps can contract and cause the posterior hyaloid to detach from retina. |
|
|
Term
| __ % of patients with an acute symptomatic PVD will have a retinal break |
|
Definition
10-15%
(look for Shafer's sign to aid diagnosis) |
|
|
Term
| Difference between a pre retinal and a vitreal hemorrhage? |
|
Definition
pre-retinal: between retina and an intact vitreous face
vitreal: anterior to posterior vitreous face (inside vitreous) |
|
|
Term
| Diabetic retinopathy is the most common cause of spontaneous vitreal hemorrhages. Tell the story (as Jordan would say) of how this happens |
|
Definition
| NV is pre retinal and these new vessels lack endothelial tight junctions, making them super leaky. This creates a situation where vitreal triton can cause sheering of the vessel = hemorrhage |
|
|
Term
| CRVOs result from a compressed artery on a vein that leads to turbulent blood flow, venous vessel wall damage and thrombus formation. Where to thrombi usually form? |
|
Definition
at or near lamina cribs
This leads to ischemia and release of VEGF |
|
|
Term
|
Definition
| sudden unilateral painless vision loss in elderly patients (most are over 50 YO) |
|
|
Term
| This is the most commonly associated ocular condition with CRVOs |
|
Definition
glaucoma
the optic nerve supports the CRV and CRA so in glaucoma, as nerve fibers are being lost, the vasculature can begin to kink and blood flow order can decrease and turbulence increases |
|
|
Term
|
Definition
hemorrhaging in all 4 quadrants (blood and thunder)
vision is threatened because of macular disease (ischemia and edema) and NV complications
If a young pt presents with this, ask about oral contraceptives! |
|
|
Term
| What are collateral veins? |
|
Definition
| They often form over weeks to months after a CRVO at the disc to permit flow between retina and choroid circulations to accelerate draining excess fluid (retinal edema) into choroid circulation after CRVO |
|
|
Term
| Definition of ischemic CRVO |
|
Definition
10 disc diameters or more of non perfusion on FA , likely with 20/200 VA's and a poor prognosis
(Luckily most cases are non-ischemic..67% to be exact) |
|
|
Term
| 90-day glaucoma often happens with what condition |
|
Definition
CRVO
60% of ischemic CRVOs develop iris NV while 30% develop glaucoma |
|
|
Term
| by far the most common retinal vascular occlusive disease |
|
Definition
BRVOs
(present with sudden, painless VF loss, blurred vision or no symptoms…if macula is spared)
BRVO is blood in ONE quadrant! |
|
|
Term
|
Definition
| hemorrhaging in 1 quadrant from obstruction of one branch of CRV, typically at AV crossings. the superior temporal quadrant is most likely location |
|
|
Term
| What is it about AV crossings that leads to veinous occlusions ? |
|
Definition
| retinal arteries and veins share a common adventitia at the crossings so a thickened artery can compress a vein |
|
|
Term
| Whats more common: CRAO or BRAO? |
|
Definition
| CRAO; if in young then ask about IV drugs or birth control |
|
|
Term
| With suspected CRAO, ask about the following: |
|
Definition
| visual blackouts and/or blur (amaurosis fugax) |
|
|
Term
| This often presents with an APD, cherry red spot, superficial whitening of inner retinal layers (returns to normal color later), narrow arterial vasculature, Hollenhorst plaques |
|
Definition
| Central Retinal Artery occlusion |
|
|
Term
| Emboli that leads to CRAOs are commonly from where? |
|
Definition
| Carotid artery (cholesterol) or the heart (calcified) |
|
|
Term
| Describe the signs of a BRAO |
|
Definition
| Edema and white infarction that distributes in the area of the affected BV (mostly temporal). The edema disappears within weeks and a permanent VF defect will present. |
|
|
Term
| Leading cause of new cases of blindness in the US for ages 20-74 |
|
Definition
diabetic retinopathy
(DURATION is the biggest risk factor) |
|
|
Term
| The most important signs of diabetic retinopathy because they are threats to vision include: |
|
Definition
| macular disease (edema is the most common DR-related cause of blindness) , NV |
|
|
Term
| CSME can happen at any stage of retinopathy. It's based on what criteria? |
|
Definition
1. retinal thickening within 500 micrometers (1/3 DD) of fovea center
2. Hard exudate in 500 micrometers of foveal center with adjacent thickening
3. retinal thickening that is 1 DD in size within 1 DD of fovea center. |
|
|
Term
Describe each stage of NPDR:
Mild:
Moderate:
Severe:
Very Severe |
|
Definition
Mild: MAs only, 5% risk to progress to PDR
Mod: 15% risk to PDR, anything that is in between…
Severe: 52% risk; follow the 4-2-1 rule
Very Severe: 75% risk, pt meets two or more criteria of 4-2-1 |
|
|
Term
|
Definition
4 quadrants with severe retinal hemorrhages
2 quadrants with venous beading
1 quadrant with IRMA |
|
|
Term
| 5% of DR patients progress to proliferative, which can lead to devastating visual outcomes. These patents are at most risk for High Risk Characteristics which are….. |
|
Definition
NV of the disc (greater than 1/4 DD)
Any NVD or NVE with a vitreous or pre retinal hemorrhage |
|
|
Term
| With hypertensive retinopathy, vision is typically unaffected unless vascular changes cause the following... |
|
Definition
| macular edema, serous retinal detachments, VEIN OCCLUSIONs |
|
|
Term
| Stages of hypertensive retinopathy |
|
Definition
1- arterial narrowing
2- …and AV nicking
3- ..AND hemorrhages, CWS, HE, edema
4- …and papilledema (hospitalize ASAP) |
|
|
Term
| Venous stasis retinopathy is the precursor to what ocular condition? It often results from blockage at which artery, secondary to which systemic condition? |
|
Definition
This is the precursor to ocular ischemic syndrome (which is posterior/anterior findings AND symptoms) which often occurs at the carotid artery (or ophthalmic…less common) and is secondary to atherosclerosis.
Look for dot/blots at mid-peripheral retina, dilated veins, and NVD. |
|
|
Term
| Venous Stasis Retinopathy is the precursor to OIS, which is often a result of which 3 systemic conditions? |
|
Definition
HTN, DM, cardiac disease
(latter of which is most common cause of 5 year mortality in 40% of these patients). Refer for Carotid Doppler and RTC 3 months to monitor for 90-Day NV |
|
|
Term
| most common cause of amaurosis fugax |
|
Definition
|
|
Term
| This idiopathic retinal disease often presents in males (many under the age of 10) and progresses rapidly if found in boys under age 4. What the the main symptoms associated with this disease? |
|
Definition
Coat's Disease
Strab & Leukocoria (unilateral in most cases…may simulate a retinoblastoma). Progresses with hard exudates and a total exudative RD if left untreated |
|
|
Term
| Factors that contribute to development of ROP |
|
Definition
birth less than 36 weeks
birth weight less than 2,000 g
had received oxygen therapy |
|
|
Term
|
Definition
Leukocoria and strab
Since anterior temporal section of retina is last to develop, look for tractional RDs in this region caused by damaged vasculature and NV |
|
|
Term
T or F
95% of retinoblastoma cases are diagnosed within the first 2 years of life |
|
Definition
Fales:
by age 5
Look for leukocoria and strab (may have decreased vision depending on size and location of tumor)
If bilateral, then DEFINITELY heritable. Which means there's a 50% chance that this kid will pass it on to HIS kid! |
|
|
Term
| Non-heritable retinoblastomas make up how many unilateral cases? |
|
Definition
85%
This will not get passed on to affected patient's kids |
|
|
Term
|
Definition
Coat's Disease
Retinoblastoma
ROP
Toxocariosis |
|
|
Term
| A choroidal nevus isn't a huge deal to us, except if it grows to this size and is located where? |
|
Definition
| 4DD in size and in close proximity to the optic nerve |
|
|
Term
| Symptoms and signs of Dry AMD |
|
Definition
Most dry AMD cases will not have vision loss though a few can report gradual loss, metamorphosis, blurry vision. Look for drusen and RPE mottling.
Only 12% have severe VL (more than 6 lines loss) and it's likely due to geographic atrophy |
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Term
| Macular Photocoagulation Study Group established 4 main risks that increase progression from dry to wet AMD. These are: |
|
Definition
soft drusen (confluent)
focal hyperpigmentation
HTN
smoking |
|
|
Term
| Characteristic findings of wet AMD (which accounts for 88% legal blindness AMD cases) |
|
Definition
| Drusen associated with sub-retinal fluid due to a choroidal neovascular membrane (CNVM) |
|
|
Term
| CNVM's can lead blood or plasma into these two potential places |
|
Definition
sub-RPE
sub retinal space |
|
|
Term
| earliest symptoms of histoplasmosis |
|
Definition
metamorphopsia
(often asymptomatic unless it causes maculopathy) |
|
|
Term
| Clinical triad of histoplasmosis |
|
Definition
peripapillary atrophy of the optic nerve
multifocal lesions in the periphery
maculopathy (including choroid NV…which is a late manifestation)
**remember vitreous is ALWAYS clear with histo** |
|
|
Term
| pathological myopia is axial lengthening greater than 26mm. lengthening in the anterior - posterior direction often leads to scleral thinning and choroid atrophy |
|
Definition
|
|
Term
| Hallmark of pathological myopia |
|
Definition
posterior staphyloma; bulging of weakened scleral posteriorly.
Also look for oblique optic disc insertion, Fuch's spots, CNVM, lacquer cracks (breaks in Bruch's), macular holes, PSC, PVD, lattice/snail track/ paving stone. |
|
|
Term
| Describe each stage of macular holes |
|
Definition
1: impending hole, low foveal depression with a yellow spot
2: round, small full thickness with pseudo-operculum
3: full thickness & large with operculum, + Watzke Allen (complete break in the middle of a thin light projected within the macular area)
4: Stage 3 AND a PVD |
|
|
Term
T or F:
Risk of developing a macular hole in the fellow eye is fairly high |
|
Definition
False:
It's less than 1% and there's virtually no risk if a PVD |
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