Posterior Segment

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Posterior Segment
2011-11-13 18:51:21
Posterior Segment

Posterior segment for board certification examination
Show Answers:

  1. What is the composition of asteroid hyalosis?
    Calcium phosphate soaps
  2. What is the composition of synchysis scintillans?
    Cholesterol crystals
  3. What are the most common causes of Synchysis Scintillans?
    • 1. Chronic uveitis
    • 2. Vitreous hemorrhage
    • 3. Trauma
  4. What is a Weiss ring?
    Vitreous opacity that occurs near the optic nerve with a posterior vitreous detachment
  5. What is the chance that a patient with an acute PVD will have a retinal detachment?
  6. What are the 3 sites of highest vitreal traction in the retina?
    • 1. Optic nerve
    • 2. Macula
    • 3. Ora Serrata
  7. What is the most common cause of spontaneous vitreous hemorrhage?
    Diabetic retinopathy
  8. What shape do pre-retinal hemorrhage usually resemble?
    Boat shaped
  9. What is the treatment of choice for a vitreous hemorrhage?
    Pars plana vitrectomy
  10. What is a common condition that occurs after a pars plana vitrectomy?
    Cataract formation
  11. What are the 2 main reasons to order a B scan?
    • 1. Blocked fundus
    • 2. Optic nerve head drusen
  12. What is the most serious form of dry ARMD?
    Geographic atrophy
  13. What are the 4 signs of wet ARMD?
    • 1. Subretinal hemorrhage
    • 2. Sub-RPE hemorrhage
    • 3. Subretinal detachent
    • 4. Sub-RPE detachment
  14. What is the likelihood of developing wet ARMD in the fellow eye if one eye is affected?
    28-36% during the first 2 years

    Note that it is 100% by 10 years
  15. What is the leading cause of blindness in the U.S. for patients over 50?
  16. Is hyperopia or myopia a risk factor for ARMD?
  17. What 4 factors increase the risk for progression from dry to wet ARMD?
    • 1. Multiple soft drusen
    • 2. Focal hyperpigmentation
    • 3. Hypertension
    • 4. Smoking
  18. What vitamin component should be avoided in patients that smoke?
    Beta carotene

    Increases the risk of lung cancer in smokers
  19. Which categories of ARMD patients should be treated with high does antioxidants?
    Categories 3 and 4

    Note that these are the advanced stages of the ARMD
  20. What was the absolute risk reduction in ARMD by taking vitamins, shown by the AREDS study?
  21. What is the AREDS formula?
    • 1. Vitamin C 500 mg
    • 2. Vitamin E 400 IU
    • 3. Beta-carotene 15 mg
    • 4. Zinc 80 mg
    • 5. Copper 2 mg
  22. Which type of ARMD is required for Visudyne treatment?
    Subfoveal, predominantly classic neovascularization
  23. What was the first anti-VEGF medication developed?

    Note that Macugen did not improve visual acuity with treatment
  24. What is histoplasmosis?
  25. What is the classic triad for Histoplasmosis?
    • 1. Multifocal lesions
    • 2. Peripapillary atrophy
    • 3. Maculopathy

    The maculopathy is the most concerning sign
  26. What are angiod streaks?
    Large breaks in Bruch's membrane that radiate from the disc
  27. What are the most common causes of angiod streaks?
    • 1. Pseudoxanthoma elasticum
    • 2. Ehlers-Danlos syndrome
    • 3. Paget's disease
    • 4. Sickle cell disease
    • 5. Idiopathic

    • Remember PEPSI
    • Note that 50% of the cases are idiopathic
  28. What is the most concerning ocular complication with Angiod Streaks?
    Choroidal neovascularization
  29. What are lacquer cracks?
    Breaks in bruch's membrane in the macula

    Ofent occurs in pathological myopia
  30. What is the most common fluorescein presentation in Central Serous Choroidopathy?
  31. What is the recurrence rate of Central Serous Choroidopathy?
  32. What causes an epiretinal membrane?
    Glial cells that escape due to a break in the internal limiting membrane
  33. What is a mild ERM called?
    Cellphane maculopathy
  34. What is severe ERM called?
    Macular pucker
  35. What is the treatment for an ERM?
    Pars plana vitrectomy with a membrane peel.

    Only done if the vision is 20/50 or worse
  36. What causes a macular hole?
    Significant posterior vitreous traction on the macula
  37. What does a positive Watzke Allen sign indicate?
    A stage 3 or worse macular hole
  38. What 2 factors affect the success of macular hole surgery?
    • 1. Onset
    • 2. Acuity (20/40-20/400)
  39. What is the risk of developing a macular hole in the fellow eye?

    Note that the risk is 0 if the patient has a PVD in that eye
  40. What is a normal finding on the macular photostress test?
    Recovery of one line less than best corrected visual acuity in less than 60 seconds
  41. What is the most common hereditary macular dystrophies?
    Stargardt's disease
  42. What is the progression of Stargardt's disease?
    • 1. Early--minimal fundus irregularities
    • 2. Middle--yellow flecks
    • 3. Late--beaten bronze

    May also see salt and pepper pigmentary changes in the periphery
  43. What is the classic presentation in Best's disease?
    Egg yolk lesion in the macula
  44. What is the key diagnostic sign for Best's disease?
    Abnormal EOG
  45. What are the most common causes of CRVO?
    • 1. Hypertension
    • 2. Diabetes
    • 3. Cardiovascular disease
    • 4. Open angle glaucoma
  46. What is the most common ocular disease associated with CRVO?
    Primary open angle glaucoma
  47. What is the leading cause of visual loss in both ischemic and non-ischemic CRVO?
    Macular edema
  48. What are the 5 most concerning ocular complications with a CRVO?
    • 1. Macular ischemia
    • 2. Macular edema
    • 3. Vitreous hemorrhage
    • 4. Neovascular glaucoma
    • 5. Tractional retinal detachment
  49. What is the definition for an ischemic CRVO?
    10 disc diameters or more of non-profusion

    These patients will also likely have vision of 20/200 or worse
  50. What percentage of patients with an ischemic CRVO develop glaucoma?

    Due to the release of VEGF causing neovascularization of the iris
  51. What study found that intravitreal steroids improved vision in a CRVO patients?
  52. What is the most common location for a BRVO?
    Superior temporal quadrant
  53. When is treatment indicated in a BRVO?
    20/40 or worse at 3 months

    Focal laser treatment is indicated
  54. What is the name given to a plaque from the carotid artery?
    Hollenhorst plaque
  55. What are the most common risk factors for a CRAO?
    • 1. Hypertension
    • 2. Diabetes
    • 3. Carotid occlusive disease
    • 4. Cardiac valve disease
  56. What are the most common caues of painless vision loss?
    • 1. Retinal artery occlusion
    • 2. Retinal vein occlusion
    • 3. Giant cell arteritis
    • 4. Vitreous hemorrhage
    • 5. Retinal detachment
    • 6. Optic neuritis
  57. What are the most common causes of painful vision loss?
    • 1. Acute angle closure glaucoma
    • 2. Optic neuritis
    • 3. Uveitis
    • 4. Corneal pathology
  58. What is the grading system for hypertensive retinopathy?
    • Grade 1--Retinal arterial narrowing
    • Grade 2--Retinal A/V nicking
    • Grade 3--Retinal hemorrhages, cotton wool spots, hard exudates
    • Grade 4--Grade 3 plu optic nerve swelling
  59. What are the two most concerning ocular signs with malignant hypertension?
    • 1. Papilledema
    • 2. Macular star
  60. What are Elschnig spots?
    Focal areas of choroidal atrophy that represent past episodes of acute hypertension
  61. What is the most important risk factor for developing diabetic retinopathy in a patient with insulin dependent diabetes?
    Duration of the disease
  62. Which study defined the high risk charactertistics for diabetic retinopathy?
    Diabetic Retinopathy Study (DRS)
  63. What are the high risk charcteristics for the treatment of diabetic retinopathy?
    • 1. Neovascularizatio of the disc greater than 1/4 DD
    • 2. Any NVD or NVE with a vitreous or preretinal hemorrhage
  64. Which study determined when to treat macular disease in diabetic retinopathy?
    The Early Treatment Diabetic Retinopathy Study (ETDRS)
  65. What are the 3 criteria for CSME?
    • 1. Retinal thickening within 500 microns (1/3 DD) of the foveal center
    • 2. Hard exudate within 500 microns of the foveal center with adjacent thickening
    • 3. Retinal thickening of at least 1 DD, within 1 DD of the foveal center

    Note that you only need to have 1 of the 3 criteria to have CSME
  66. What is the 4-2-1 rule for severe NPDR?
    • 1. 4 quadrants of hemorrhages or microaneurysms
    • 2. 2 quadrants of venous beading
    • 3. 1 quadrant of intraretinal microvascular abnormalities (IRMA)
  67. What is the cause of venous stasis retinopathy?
    High cholesterol

    Usually due to an internal carotid stenosis
  68. What is the most common cause of amaurosis fugax?
    Carotid artery embolus
  69. What characerterizes a premature infant?
    • 1. Gestation less than 36 weeks
    • 2. Birth weight less than 2,000 g
  70. Which part of the retina is affected in retinopathy of prematurity?

    Note that they have can neovascularization and a tractional retinal detachment in this area
  71. What is the most common intraocular malignancy?
  72. What are the two most common signs seen with retinoblastoma?
    • 1. Strabismus
    • 2. Leukocoria
  73. What is the main factor for determining mortality with Retinoblastoma?
    Optic nerve invasion
  74. What conditions can cause a bull's eye maculopathy?
    • 1. Stargardt's disease
    • 2. Progressive cone dystrophy
    • 3. Chloroquine toxicity
    • 4. Hydroxychloroquine toxicity
    • 5. Thioridazine toxicity
  75. What causes toxoplasmosis?
  76. What is the most common form of toxoplasmosis?

    Usually passed from the mother to fetus
  77. What is the most common cause of posterior uveitis in the U.S.?
  78. What is the preferred treatment for Toxoplasmosis?
    • 1. Systemic steroids
    • 2. Oral anti-toxoplasmosis agent (Bactrim, Pyrimethamine)
  79. What is the most common ocular presentation of Toxoplasmosis?
    A retinal lesion with an associated vitritis that appears as a headlight in the fog
  80. What syndrome is associated with multiple bilateral congenital hypertrophy of the RPE?
    Gardner's syndrome

    Patient is at high risk for colon cancer. Order a colonoscopy
  81. What characteristics indicate a risk factor that a choroidal nevus could transform to a malignant melanoma?
    • 1. Thickness > 2 mm
    • 2. Size > 5 mm
    • 3. Proximity to the optic nerve head
    • 4. Orange pigment on the surface of the lesion
    • 5. Irregular borders
    • 6. Presence of subretinal fluid
  82. What 3 conditions can cause night blindness?
    • 1. Retinitis pigmentosa
    • 2. Gyrate atrophy
    • 3. Choroideremia
  83. What to rhegmatogenous retinal detachment occur from?
    Retinal break

    Note that it can be either a hole or tear
  84. What is the most common location of a rhegmatogenous retinal detachment?
    Superior temporal
  85. What are the types of retinal tears?
    • 1. Flap tear
    • 2. Operculated tears
  86. What percentage of lattice patients have a retinal detachment?
  87. What percentage of the population have lattice degeneration?
  88. What percentage of lattice patients have atrophic holes?
  89. What are the most common risk factors for a retinal detachment?
    • 1. Previous ocular surgery
    • 2. Posterior vitreous detachment
    • 3. Trauma
    • 4. Family history
    • 5. Myopia
    • 6. Lattice degeneration
  90. What are the two types of non-rhegmatogenous retinal detachments?
    • 1. Exudative
    • 2. Tractional
  91. Vitreoretinal tufts occur in what percentage of the population?

    Note that they are the second most common peripheral retinal lesion. Lattice is the most common
  92. Which type of retinal tear always require treatment?
    Flap tears

    Due to traction still being present with the possibility of a larger detachment
  93. What are the possible side effects with a scleral buckle?
    • 1. Induced myopia
    • 2. Pain
    • 3. Hemorrhage
    • 4. Infection
    • 5. Diplopia
  94. What is a retinoschisis?
    Splitting of the outer plexiform layer
  95. What is the most common location for a retinoschisis?
    Inferior temporal
  96. What is Usher's syndrome?
    An autosomal recessive condition associated with retinitis pigmentosa and congenital hearing loss
  97. What is the classic triad for retinitis pigmentosa?
    • 1. Bone spicule pigmentation
    • 2. Arteriolar attenuation
    • 3. Waxy optic disc pallor
  98. What is the preferred treatment for retinitis pigmentosa?
    Vitammin A

    • Children=5,000 IU per day
    • Adults=15,000 IU per day
  99. What is the classic retinal sign in Coat's disease?
    Marked hard exudates
  100. What are the most common causes of leukocoria?
    • 1. Coat's disease
    • 2. Toxocariasis
    • 3. Retinoblastoma
    • 4. Retinopathy of prematurity
  101. What is the field of view for the Optos?
    200 degrees