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NBEO Part 2 > Diagnostic Testing > Flashcards

Diagnostic Testing Flashcards

1
Q

What are the 5 phases of Fluorescein angiography?

A
  1. Choroidal (pre-arterial)
  2. Arterial (early)
  3. Arteriovenous (capillary, early)
  4. Venous
  5. Recirculation (late)
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2
Q

FA interpretation: blood
Hypo or hyperfluorescence?

A

Hypo
* obstruction/ blockage

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3
Q

FA interpretation: vascular occlusion
Hypo or hyperfl?

A

Hypo
* inadequate perfusion of tissue (filling defect)

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4
Q

On FA, types of hyper-fluorescence (4)

A
  • pooling
  • leakage
  • staining
  • window defect
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5
Q

Pooling on FA indicates a breakdown of?

A

outer blood retinal barrier
* abnormal choroidal neovasc is leaky and dye will escape, accumulation of fl into distinct space

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6
Q

What supplies the outer one-third of the retina?

A

The choriocapillaris

The choriocapillaris is fenestrated, allowing fluorescein to readily diffuse through these vessels.

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7
Q

What is the primary blood supply for the inner two-thirds of the retina?

A

Central retinal artery
*supplies inner retina

These vessels possess tight endothelial junctions, forming the inner blood-retinal barrier.

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8
Q

What should not allow for leakage of fluorescein in a normal retina?

A

The inner blood-retinal barrier

This barrier is formed by tight endothelial junctions of retinal blood vessels.

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9
Q

What happens to endothelial junctions in diabetes cases?

A

They become destroyed

This leads to leakage of fluorescein from retinal vessels.

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10
Q

What effect do dot/blot hemorrhages have on fluorescence?

A

They block fluorescence locally

This is due to leakage of the retinal vasculature.

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11
Q

What appears as areas of hypofluorescence?

A

Capillary nonperfusion

This indicates regions where blood flow has been compromised.

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12
Q

What do leaky vessels appear as in fluorescein angiography?

A

Hyperfluorescent

This indicates excessive leakage of fluorescein from the vessels.

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13
Q

What are microaneurysms and areas of retinal edema characterized by in fluorescein angiography?

A

Hyperfluorescence

This suggests increased permeability or leakage in these areas.

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14
Q

What appearance do cotton wool spots have in fluorescein angiography?

A

Hypofluorescent

This indicates areas of localized ischemia or blockage in the retina.

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15
Q

What do areas of neovascularization appear as in fluorescein angiography?

A

Hyperfluorescent

This shows the presence of new, abnormal blood vessel growth.

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16
Q

Normal ESR for men

A
  • age/2

Example: Male age 30
30/2 = 15 mm/hour

Male age 50
50/2 = 25 mm/hour

Under 50 years old = ESR 0-15 mm/hour
Over 59 years old = ESR 0-20 mm/hour

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17
Q

Normal ESR for women

A

(Age + 10)/ 2

Under 50 = ESR 0-20 mm/hour
Over 50 = ESR 0-30 mm/hour

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18
Q

What is edrophonium commonly used for?

A

Diagnosis of myasthenia gravis

Edrophonium is also known by its trade names Tensilon and Enlon.

19
Q

What type of agent is edrophonium?

A

Anticholinesterase agent
*diagnostic testing for myasthenia gravis

20
Q

How does edrophonium work?

A

Inactivates the acetylcholinesterase enzyme, allowing accumulation of acetylcholine (ACh) in the neuromuscular junction

21
Q

What is the onset time for edrophonium?

A

30-60 seconds

22
Q

What is the duration of action for edrophonium?

A

10 minutes

23
Q

How is edrophonium administered?

A

Injected intravenously

24
Q

What are the risks associated with edrophonium in certain patients?

A

Can be very dangerous in patients with cardiac or respiratory diseases

25
What is another important diagnostic test for myasthenia gravis?
Evaluation of electromyographic responses to nerve stimulation at the neuromuscular junction
26
What do electromyographic measurements commonly reveal in myasthenia gravis?
Single-fiber atrophy
27
What will serum testing in myasthenia gravis patients reveal?
Significant levels of circulating antibodies to acetylcholine receptors
28
What is the positive ice-pack test used for?
To aid in the diagnosis of myasthenia gravis
29
What does improvement in eyelid position after ice application indicate?
Improved neuromuscular transmission at lower temperatures
30
What diagnostic testing should be performed for patients with unilateral myasthenia symptoms?
MRI or CT of the brain
31
What does an amelanotic choroidal melanoma look on B-scan?
Dome/mushroom shaped tumor Choroidal excavation Orbital shadowing Attenuation of signals Steep angle kappa
32
What would familial drusen look like on OCT Mac?
Thickening of RPE-bruch’s membrane complex with intact photoreceptors layer * familial drusen smaller, more numerous and evenly distributed throughout the posterior pole * monitor for progression, give at home Amsler
33
ERG and dark adaptation test rests for familial drusen
Normal ERG and normal dark adaptation test
34
Diagnostic testing for patient taking plaquenil long term
* OCT Mac * mfERG * FAF * 10-2 VF Also need: Check color vision Daily amsler grid ##footnote Baseline testing within 1st year of drug initiation Testing after 5 years of therapy unless high risk If high risk (elderly, kidney/liver disease, increased BMI) Most see pts on an annual basis
35
True or false A red-free filter will cause a lesion in the RPE to be darker and more defined
TRUE * while choroidal pigmentation will be harder to see/invisible
36
True or false ERG is normal in RP
FALSE ERG is abnormal in RP
37
Is ERG and EOG normal and/or abnormal in Best disease?
Normal ERG Abnormal EOG
38
Is ERG and EOG normal and/or abnormal in Stargardt?
Normal ERG Normal EOG
39
Is ERG and EOG normal and/or abnormal in choroideremia?
Abnormal ERG Abnormal EOG
40
Which imaging technique is best to evaluate polypoidal choroidal vasculopathy?
Indocyanine Green angiography *highlight choroidal vasculature
41
(+) FTA-ABS and (-) VDRL or (-) RPR means?
History of syphilis infection, but no current/active infection
42
What blood works needs to be positive in order to confirm active infection of syphilis?
(+) FTA-ABS and (+) VDRL [or (+) RPR]
43
What is MRD measuring?
Marginal reflex distance (distance between upper eyelid margin and corneal light reflex) MRD1 Normal is 4.5 mm MRD 2 normal is 5mm MRD1 + MRD 2 = PF PF: palpebral fissure Normal ~10mm

NBEO Part 2 (23 decks)

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