Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
91 Cards in this Set
- Front
- Back
|
what is the most common intraocular tumor of childhood?
what is the mean age |
RETINOBLASTOMA
mean age: 18 MONTHS |
|
|
what is the laterality of RETINOBLASTOMA
|
1. Unilateral is 75%
2. Bilateral is 25% |
|
|
what are the common signs for RETINOBLASTOMA
|
1. LEUKOCORIA
2. strabismus 3. ocular inflammation |
|
|
what test is of LITTLE VALUE when it comes to RETINOBLASTOMA
|
FLUORESCEIN ANGIOGRAPHY
|
|
|
the majority of the times patients with RETINOBLASTOMA will have to go under what procedure
|
Enucleation (eye removal)
|
|
|
what is the most common intraocular tumor of childhood?
what is the mean age |
RETINOBLASTOMA
mean age: 18 MONTHS |
|
|
what is the most common primary intraocular tumor in adults
what is the primary site of metastasis |
CHOROIDAL MELANOMA
primary site is liver |
|
|
what is the laterality of RETINOBLASTOMA
|
1. Unilateral is 75%
2. Bilateral is 25% |
|
|
what are differential diagnoses for CHOROIDAL MELANOMA
|
DDx:
1. Choriodal nevus 2. CHRPE |
|
|
what are the common signs for RETINOBLASTOMA
|
1. LEUKOCORIA
2. strabismus 3. ocular inflammation |
|
|
uveal melanoma:
tumor size is defined as... |
small: <8mm D and <3mm H
medium: 8-16mm D and 3-10mm H large: >16mm D and >10mm H |
|
|
what test is of LITTLE VALUE when it comes to RETINOBLASTOMA
|
FLUORESCEIN ANGIOGRAPHY
|
|
|
what is the best treatment option for a uveal melanoma
|
1. external beam irradiation
2. episceral plaque radiotherapy |
|
|
the majority of the times patients with RETINOBLASTOMA will have to go under what procedure
|
Enucleation (eye removal)
|
|
|
which is not a primary tumor:
A. retinoblastoma B. uveal melanoma C. metastatic carcinoma WHY? |
METASTATIC CARCINOMA
because it originates at another primary site 1. BREAST (WOMEN) 2. LUNG (MEN) |
|
|
what is the most common primary intraocular tumor in adults
what is the primary site of metastasis |
CHOROIDAL MELANOMA
primary site is liver |
|
|
what are differential diagnoses for CHOROIDAL MELANOMA
|
DDx:
1. Choriodal nevus 2. CHRPE |
|
|
uveal melanoma:
tumor size is defined as... |
small: <8mm D and <3mm H
medium: 8-16mm D and 3-10mm H large: >16mm D and >10mm H |
|
|
what is the best treatment option for a uveal melanoma
|
1. external beam irradiation
2. episceral plaque radiotherapy |
|
|
which is not a primary tumor:
A. retinoblastoma B. uveal melanoma C. metastatic carcinoma WHY? |
METASTATIC CARCINOMA
because it originates at another primary site 1. BREAST (WOMEN) 2. LUNG (MEN) |
|
|
overall what is the most common intraocular malignancy
|
CHOROIDAL METASTASIS
aka "metastatic carcinoma to the choroid" |
|
|
what is the best course of management of choroidal metastsis
|
PALLIATIVE
-since prognosis for life is exceedingly poor regardless of treatment, the least amount of intervention is probably the most humane course |
|
|
retinal capillary hemangioma is associated with...
|
1. Von Hippel-Lindau disease
2. intracranial/spinal cord hemangioblastoma |
|
|
what are the newer therapies in managing retinal capillary hemangioma
|
1. TTT
2. PDT 3. Avastin (anti-VEGF) |
|
|
what are the typical signs of cavernous hemangioma
|
1. white patient, average age: 23
2. UNILATERAL and ASYMPTOMATIC 3. grape shaped ophthalmic appearence |
|
|
what ancillary test must you do for CAVERNOUS HEMANGIOMA
|
IVFA demonstrates classic "plasma-erythrocyte sedimentation"
|
|
|
treatment for CAVERNOUS HEMANGIOMA
|
ONLY VASCULAR TUMOR THAT REQUIRES NO INTERVENTION!!!
|
|
|
Choroidal Hemangioma may be associated with...
|
Sturge-Weber Syndrome
(port wine stain) |
|
|
management of Choroidal Hemangioma
|
1. laser photocoagulation
2. external beam irradiation 3. episcleral plaque radiotherapy to induce regression |
|
|
choroidal osteoma is composed of...
|
mature bone
|
|
|
what is the usual presentation of choroidal osteoma
|
1. unilateral
2. FOUND ON OR NEAR OPTIC DISC 3. asymptomatic |
|
|
what is the usual presentation of MELANOCYTOMA
|
1. **more common in dark skinned individuals**
2. unilateral 3. usually inferior aspect of optic disc 4. asymptomatic but... 25% BVA less than 20/30 VF defect **APD (~30%)** |
|
|
astrocytic hamartoma is associated with...
|
1. tuberous sclerosis
2. neurofibromatosis |
|
|
what is the most common cause of pre-retinal hemorrhages
|
1. retinal neovascularization
2. pre-retinal hemorrhages are CONFLUENT and will BLOCK all underlying retinal detail |
|
|
flame shaped (NFL) hemorrhages are most associated with...
|
1. retinal vein occlusions
2. HTN retinopathy |
|
|
dot and blot hemorrhages are most associated with...
|
1. diabetic retinopathy
2. ocular ischemic syndrome |
|
|
what do you do if a healthy patient comes in and you find a SINGLE, ISOLATED, BLOT HEMORRHAGE...
|
NOTHING
-a healthy patient can have that without having to undergo an intensive medical eval. |
|
|
how can you diagnosis the location of sub-retinal hemorrhage
|
sub-retinal hemorrhages are identified by your ability to see distinct retinal vessels overlying the hemorrhaging area
|
|
|
what happens if you see a cotton wool spot
|
INTENSIVE MEDICAL EVALUATION for...
1. Hypertension (diastolic greater than 110mmHg) 2. Diabetes 3. HIV/AIDS 4. Lupus 5. Leukemia |
|
|
what is a cotton wool spot
|
1. focal retinal ischemia
2. indicates hypoxia DIABETES IS MOST COMMON SYSTEMIC ASSOCIATION |
|
|
1. what is the INNER BLOOD-RETINA BARRIER
2. what is the OUT BLOOD-RETINAL BARRIER |
1. inner blood-retina barrier:
-Retinal Capillary Beds 2. inner blood-retina barrier: -Retinal Pigment Epithelium -prevent blood from choriocapillaris from invading retina |
|
|
what is a Roth's Spot
|
1. superficial hemorrhage with inner infarcted area
2. associated with ANEMIA and BLOOD DYSCRASIA |
|
|
what causes a dot/blot hemorrhage
|
1. retinal compression and confinement of blood
2. vascular congestion 3. subjective differential (blot is larger than dot) |
|
|
what are hard exudates
|
1. waxy yellow lesion at level of OPL
2. lipid laden macrophages 3. serum lipoproteins 4. associated with CIRCINATE RETINOPATHY |
|
|
what is the difference between collateral vessels and neovascularization
|
collateral vessels:
1. NON FENESTRATED and NON LEAKING 2. beneficial Neovascularization: 1. FENESTRATED and LEAKING 2. attempts to be beneficial but very destructive BOTH INDICATIVE OF VASCULAR OCCLUSION or ISCHEMIA |
|
|
white without pressure is most commonly seen in...
|
1. BLACKS most common
2. ASIAN next most common NOT COMMON IN WHITES |
|
|
what if you see white without pressure in caucasians
|
if you think you see white without pressure in a Caucasian pt. you are likely seeing a PROMINENT VITREOUS BASE
|
|
|
where are prominent vitreal base and white without pressure located
|
PARALLEL TO THE ORA SERRATA
|
|
|
what is diagnostic for RPE Hypertrophy
associated with... |
LACUNAE
-which will enlarge and multiply over time associated with colorectal carcinoma (gardner's syndrome) |
|
|
RPE hypertrophy is also known as...
|
congenital hypertrophy of the retinal pigment epithelium (CHRPE)
|
|
|
what is the difference between RPE hypertrophy and hyperplasia...in terms of pathology
|
1. hypertrophic lesions themselves are totally benign
2. hyperplasia represents RPE cells invading sensory retina in response to injury, retinal tears, RD, lattice degeneration, etc. 3. RPE hyperplasia does not progress but will cause vision/field loss |
|
|
what other ocular manifestation is associated with RPE HYPERPLASIA
|
Chorioretinal Scar
|
|
|
color alterations in respects to location
|
1. lesions in the CHOROID tend to have their outlines and true coloration altered due to the fact that they are beneath the RPE, which is pigmented
2. changes in the RPE such as HYPERTROPHY and HYPERPLASIA typically are dark and well circumscribed because the RPE is under the retina, which is clear |
|
|
what is chorioretinal atrophy?
common seen in...? |
1. cobblestone degeneration
2. commonly seen in blonde fundi 3. atrophy of RPE and outer retinal layers 4. inner retinal layers intact |
|
|
which vein do you inject the NaFl into?
what is the second choice? |
first choice:
-ANTECUBITAL VEIN second choice: -vein at back of hand |
|
|
giant cell arteritis presentation in FA
|
1. patchy and delayed choroidal filling (normal ~10seconds)
2. DIAGNOSTIC |
|
|
what is autofluorescence or pseudofluorescence
|
1. fluorescence seen in the eye prior to fluorescein injection
2. ONH drusen can cause this, this is why photos are taken with filters in place prior to injection. |
|
|
what is transition time
|
1. circulation time (arm to retina time)
2. 5-10 secs depending on cardiac and vascular status |
|
|
what is choroidal flush in FA
|
1. ~1 sec after posterior ciliary arteries fill
2. ~1 sec prior to retinal arterial phase 3. PCA fill and flow leads to choroicapillaris, which is fenestrated and leaky |
|
|
what are causes of hyperfluorescence in FA
|
1. leaks
2. pools 3. stains 4. transmission defects 5. abnormal vessels |
|
|
what are causes of hypofluorescences in FA
|
1. optical barriers (pigment, exudates, etc)
2. filling defects (closures and occlusions) |
|
|
how is ICG better than FA
|
1. occult choroidal neovascular membranes (borders are more easily located)
2. CNVM associated with serous detachment of the retina (can better identify CNVM under fluid) |
|
|
what are the limitations of ICG
|
1. requires extensive imaging system
2. quality of image is poor 3. detailed capillaries are difficult to identify 4. not commonly used in most practices |
|
|
general properties of ICG
|
1. absorbed and emitted near the IR range
2. allows for a better penetration of the melanin pigment 3. better penetration of nuclear cataracts, vitreous hemorrhage and sub-retinal blood and fluid 4. 98% bound to protein, less leakage form choroicapillaris 5. iodinated, should not be used in pt with allergies to contrast dyes or shellfish 6. excreted via liver, should not be used in pt with liver disease |
|
|
what is the time sequence of FA
|
1. PCA fill
2. choroidal flush 3. retinal arterial stage 4. capillary transition stage 5. early venous stage 6. venous stage 7. late venous stage 8. retrofluorescence |
|
|
contraindications to FA
|
1. allergy to dye, iodine, shellfish
2. previous anaphylaxis to FA 3. first trimester preg. (relative) 4. severe renal impairment 5. CVA, MI, unstable angina |
|
|
what is the #1 cause of blindness between 20-74
|
DIABETIC RETINOPATHY
|
|
|
what are differential diagnoses for diabetic retinopathy
|
1. HTN retinopathy
2. retinal vein occlusion 3. ocular ischemic syndrome 4. radiation retinopathy 5. retinal telangiectasis 6. sarcoid retinopathy 7. sickle cell retinopathy |
|
|
what are risk factors for diabetic retinopathy
|
1. level of control
2. duration of disease (MOST IMPORTANT) 3. years of diabetes before puberty not a consideration 4. concurrent HTN 5. pregnancy increases progression |
|
|
testing diabetes and evaluating level of control...what should you consider
|
1. HbA1C is the MAIN FACTOR
2. info on glucose level over the preceding week rather than snapshot |
|
|
what is the pathophysiology of diabetic retinopathy
|
1. thickening if capillary membrane
2. decrease in pericyte (maintenance of BBB) 3. increase leakages 4. focal loss of capillaries and microaneurysm formation 5. dot/blot and flame hemorrhages 6. MACULAR EDEMA (MOST COMMON) 7. fluid leaks and lipid accumulation-exudates 8. capillary closures (HYPOXIA) |
|
|
what is a ring of hard exudates?
what does this indicate? |
1. CIRCINATE RETINOPATHY
2. indicates leaking microaneurysms (or choroidal neovascular membrane) within the center |
|
|
what is the most common systemic association of cotton wool spots
|
DIABETES!!
|
|
|
what is the only treatable form of diabetic maculopathy
|
clinically significant macular edema (CSME)
|
|
|
what are the causes that will determine GOOD or BAD prognosis for diabetic maculopathy
|
Poor Prognosis:
1. hard exudates in fovea 2. poor initial acuity 3. longstanding duration 4. broken perifoveal capillary net GOOD prognosis: 1. exudates are away from foveal avascular zone 2. good acuity 3. short duration 4. intact perifoveal net |
|
|
visual acuity in respect to CSME
|
1. visual acuity is NOT part of the definition for CSME
2. a pt can be 20/20 with CSME 3. CSME occurs at any stage of diabetic retinopathy independent of other findings |
|
|
what is CSME
|
1. retinal edema at or within 1/3 DD of the macula
2. hard exudates associated with adjacent retinal edema within 1/3 DD of the center of the macula 3. retinal edema 1 DD within 1 DD of the center of the macula |
|
|
macular edema treatment in respect to the ETDRS
|
1. FA to identify leakage
2. Argon Laser treatement (treat CSME only) 3. moderate vision loss 4. treat all leaking microaneurysms more than 500 microns from fovea (photocoagulation) 5. vitreal injection of steroids for edema 6. intravitral injection of AVASTIN and LUCENTIS |
|
|
what is the goal of laser photocoagulation for CSME
|
1. to prevent further vision loss
2. NOT TO IMPROVE EXISTING VISION |
|
|
what are components of proliferative diabetic retinopathy
|
1. neovascularization of the disc and elsewhere (NVD and NVE)
2. fibrotic proliferation 3. vitreous hemorrhage 4. tractional retinal detachment |
|
|
lab testing:
what are the important findings in IRON DEFICIENCY ANEMIA |
most common type of anemia
1. serum iron decreased 2. decreased serum ferritin levels (DIAGNOSTIC) |
|
|
what is the major cause of Pernicious Anemia
|
Vitamin B12 Deficiency
|
|
|
hypoxia in respects to sickle cell
|
1. hypoxia can transform sickle cell trait into a condition resembling sickle cell disease and lead to ocular complications
2. increased risk of sickle cell retinopathy due to blockage |
|
|
what is characteristic of sickle cell retinopathy
|
1. sea fan neovascularization
2. associated with release of VEGF and PEDF |
|
|
general anemic retinopathy treatment in respects to anemia
|
anemica retinopathy is always reversible with the correction of the anemia
|
|
|
what are the FIVE STAGES of proliferative sickle retinopathy
|
1. peripheral arteriolar occlusion
2. peripheral arteriovenous anastomoses 3. neovascular and fibrous proliferations (sea fan formation) 4. vitreous hemorrhage 5. retinal detachment |
|
|
what is the most common type of leukemia in young children?
adults? |
Children:
Acute Lymphocyte Leukemia (ALL) Adults: Chronic Lymphocytic Leukemia (CLL) |
|
|
what is the main treatment for all proliferative retinopathies
|
PAN RETINAL PHOTOCOAGULATION
|
|
|
what type of diabetic retinopathy requires a retinal specialist referral
|
1. NPDR with CSME (3months F/U)
2. PDR (1-2months F/U) in diabetes, CSME, vitreous hemorrhages, and PDR are not emergencies. referral needed but not same day. |
|
|
what are the TWO most serious sequelae of neovascularization
|
1. vitreous hemorrhage
2 tractional retinal detachments |
|
|
cataract surgery in respects to diabetic retinopathy
|
1. cataract extraction may worsen diabetic retinopathy
2. if there is no retinopathy, cataract extraction has GOOD prognosis 3. if patient has NPDR WITH MACULAR EDEMA, POOR PROGNOSIS 4. CSME must be treated before cataract surgery |
