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OD3 (S1&2) > DIS - Basic Pathology: Vascular II - Week 9 > Flashcards

DIS - Basic Pathology: Vascular II - Week 9 Flashcards

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1
Q

Where does CRVO tend to occur and at what age?

A

Usually behind the lamina cribrosa, typically >65yoa

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2
Q

List the three types of CRAO blockages that can occur.

A

Cholesterol
Fibrin platelets
Calcium

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3
Q

Where do cholesterol emboli tend to occur? Do they generally cause occlusion?

A

At bifurcations
Rarely cause occlusion

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4
Q

What is the loss of vision like with CRAO? Is pain involved? Is it acute or chronic?

A

Acute, severe, painless

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5
Q

What may CRAO precede (2)?

A

TIA / amaurosis fugax

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6
Q

Is RAPD present with CRAO?

A

Yes

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7
Q

What magnitude of vision lodd can occur with CRAO?

A

NLP

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8
Q

What is the ERG like with CRAO?

A

Normal a wave
Diminished/absent b wave

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9
Q

List 6 fundus findings you would expect with CRAO.

A

Superficial retinal whitening
Cherry red macula spot
Attenuated retinal arterioles
Retinal embolus visible
Segmentation of arterial blood column
Possible sector of normal retinal colour if ciliomacular artery is present

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10
Q

What happens to retinal filling in angiography with CRAO?

A

Delay

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11
Q

List two differential diagnoses for CRAO.

A

Tay sachs disease
Ophthalmic artery occlusion

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12
Q

How should CRAO be referred (2)? How urgent is it?

A

Ophthalmologist - urgent if <48h
GP - evaluation of risk factors

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13
Q

List 5 possible interventions for CRAO. Explain each.

A

Ocular massage - gonio lens 10s on, 5s off
Isosorbide - dilates peripheral vessels
Diamox - reduces IOP
Paracentesis - rapid IOP lowering
IV streptokinase - dissolves fibrin clots

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14
Q

What is the prognosis of CRAO like? What about if it is caused by calcific emboli or GCA?

A

Poor, especially with calcific thrombi or GCA

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15
Q

List four things that happen over the weeks with CRAO.

A

Retinal whitening fades
Attenuated arteries remain
Optic atrophy
Risk of NVG

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16
Q

What is the mebolus size like in BRAO compared to CRAO? Where does the blockage usually occur? At what age typically?

A

Smaller
Usually at arterial bifurcation
-further up the arterial tree
-typically >65yoa

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17
Q

Is RAPD present or absent with BRAO?

A

May or may not be
-will be if retinal loss is large enough

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18
Q

What is the prognosis of BRAO like (2)?

A

Poor unless the embolus dislodges

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19
Q

List four signs of BRAO.

A

Retinal clouding
Embolus (look at other branches)
Attenuated arteries
Segmentation

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20
Q

List three differential diagnoses for retinal whitening due to inflammation (BRAO).

A

Lymphoma
Toxoplasmosis chorioretinitis
CMV retinitis

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21
Q

List a differential diagnosis for non-inflammatory retinal whitening (BRAO).

A

Medullated nerve fibres

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22
Q

How should BRAO be managed?

A

As per CRAO

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23
Q

What is meant by combined CRAO/CRVO? How common is it? What is vision loss like and what onset?

A

Blockage of both the CRA and CRV
Very rare presentation
Very poor vision with acute onset

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24
Q

How does the retina appear with combined CRAO/CRVO (4)?

A

Retinal whitening
Extensive retinal haemorrhage
Macular oedema
Dilated vessels

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25
What is the management like for combined CRAO/CRVO and what is there a risk of?
As per CRAO with systemic workup as per CRAO Risk of NVG
26
What is ocular ischaemic syndrome?
Marked carotid/ophthalmic artery obstruction
27
What is required for ocular ischaemic syndrome? Describe in terms of percentages (2).
Requires significant decrease in flow/arterial hypoperfusion -no symptoms without 70% reduction
28
what percentage obstruction to the carotid/ophthalmic artery will cause a 50% decrease in CRA flow?
90%
29
List four causes/associations of ocular ischaemic syndrome.
Atherosclerosis Giant cell arteritis Diabetes Previous stroke/CVA
30
What happens to vision with ocular ischaemic syndrome? What happens with light exposure?
There is a slow decline Slow recovery in vision after light exposure
31
Is pain involved with ocular ischaemic syndrome?
Peri-orbital pain (angina-like)
32
List 5 anterior ocular signs of ocular ischaemic syndrome.
Corneal oedema Pupil mid-dilated/slow Cells in AC Iris neovascularisation Cataract
33
List 5 posterior ocular signs of ocular ischaemic syndrome.
Slightly dilated veins Microaneurysms Dot/blot haemorrhages Retinal whitening Spontaneous arterial pulsation
34
Should ocular ischaemic syndrome be referred? Is it urgent?
Yes, with some urgency
35
How many short posterior ciliary arteries do normal eyes have and what do they supply?
2-3 supplying the ONH
36
What is the cause of arteritic anterior ischaemic optic neuropathy? What disease can cause it? What artery is generally occluded?
Inflammatory narrowing of the lumen -giant cell arteritis -short posterior ciliary artery
37
List 7 things that can cause non-arteritic anterior ischaemic optic neuropathy.
Hypertension Hypercholesterolaemia Hypotensive events Carotid artery disease Diabetes Collagen vascular disease Nocturnal hypotension
38
How does arteritic anterior ischaemic optic neuropathy affect vision? How does it affect C reactive protein levels in blood and what blood test important for diagnosing this? Is pain involved?
Poor vision Elevated CRP Elevated ESR Neck pain and jaw claudication
39
What kind of visual field defec is present with arteritic anterior ischaemic optic neuropathy?
Altitudinal - other VF defects are available
40
Does arteritic anterior ischaemic optic neuropathy cause diplopia?
It may or may not
41
How does the ONH look with arteritic anterior ischaemic optic neuropathy?
Pale and oedematous
42
Is RAPD present with arteritic anterior ischaemic optic neuropathy?
Yesd
43
What does arteritic anterior ischaemic optic neuropathy resolve into?
Optic atrophy
44
Is arteritic anterior ischaemic optic neuropathy bilateral? What is this known as?
Yes -pseudo-foster-kennedy syndrome
45
How quickly is vision affected with non-arteritic anterior ischaemic optic neuropathy?
Acute
46
When does non-arteritic anterior ischaemic optic neuropathy generally result in visual loss?
Often on waking
47
Is there any pain involved with non-arteritic anterior ischaemic optic neuropathy?
Nol
48
What does non-arteritic anterior ischaemic optic neuropathy resolve into?
Optic atrophy
49
How urgent is arteritic anterior ischaemic optic neuropathy? What about non-arteritic?
Both urgent
50
Is there risk to the fellow eye with arteritic anterior ischaemic optic neuropathy?
Yees
51
What is the treatment for arteritic anterior ischaemic optic neuropathy (2)?
Prompt steroids -IV methyl prednisolone -oral prednisolone -taper
52
What prospects are there of visual recovery following non-arteritic anterior ischaemic optic neuropathy?
Little prospect -depends on the extent of ischaemia
53
What are retinal macroaneurysms? Do they have any association with microaneurysms? what are they similar to? are they related to intracranial berry aneurysms?
Aquired dilations of retinal arterioles Similar to aortic aneurysms Unrelated to intracranial berry aneurysms
54
Which 2 retinal arteries is there a predilection for retinal macroaneurysms (sectorally)?
Superior or inferior temporal arterioles
55
Which demographic is there a predilection for retinal macroaneurysms?
Elerdy female
56
What are retinal macroaneurysms strongly associated with?
Hypertension
57
What three things cause the visual symptoms of retinal macroaneurysms?
Exudation Sub-retinal Vitreous/sub-hyaloid haemorrhage
58
Should retinal macroaneurysms be referred? List four management options.
Refer Observation Laser around lesion Manage vitreous haemorrhage Manage underlying systemic disease
59
Is spontaenous resolution of retinal macroaneurysms common or rare?
Common
60
List four differential diagnoses for retinal macroaneurysms.
Disciform degeneration Other causes of vitreous/pre-retinal haemorrhage BRVO Coats disease
61
What is a retinal nerve fibre layer infarct? What causes it? Are they transient? How long do they take to resolve?
Cotton wool spot Acute blockage of terminal retinal arteriole Transient - resolves in 6 to 8 weeks
62
List 5 common causes of cotton wool spots.
Embolus Hypertension Inflammation Diabetes Coagulopathies
63
What are the notable symptoms of cotton wool spots?
Has few symptoms
64
Is RAPD present with cotton wool spots?
No RAP from cotton wool spots alone
65
Can cotton wool spots cause permanent NFL loss?
Yes
66
How do cotton wool spots affect vision?
No measurable loss of vision
67
List three differential diagnoses for cotton wool spots.
Medullated nerve fibres Inflammatory white dot syndromes Intra-retinal lipid
68
What kind of ischaemia does neovascular glaucoma cause? What does this result in?
Severe diffuse retinal ischaemia Results in rubeosis -iris neovascularisation
69
Desribe how retinal ischaemia can result in glaucoma.
The retina is ischaemic and releases VEGF, which diffuses anteriorly In the anterior chamber, VEGF causes the growth of new vessels on the iris and in the angle, blocking it Results in glaucoma
70
List three diseases that can cause neovascular glaucoma. List an additional 5 lesser causes.
Ischaemic CRVO Diabetic retinopathy Carotid occlusive disease -ocular ischaemic syndrome Also: CRAO BRVO Intraocular tumours Longstanding retinal detachment Chronic inflammation
71
List the three stages of neovascular glaucoma.
Rubeosis Open angle glaucoma phase Angle closure glaucoma phase
72
What happens during the rubeosis stage of neovascular glaucoma (2)?
Dilated capillary tufts form at the pupil Grow radially into the angle
73
What happens during the open angle glaucoma stage of neovascular glaucoma (2)?
Vessels arborise in the angle Fibrovascular membrane forms, blocking outflow
74
What happens during the angle closure glaucoma stage of neovascular glaucoma (1)?
Fibrovascular membrane contracts, angle zips up
75
List 7 signs and symptoms of neovascular glaucoma.
Pain Congestion Corneal oedema Elevated IOP Distorted pupil Synaechial closure Aqueous flare
76
List four treatment options for neovascular glaucoma.
Prevention -treat ischaemia, monitor at risk cases Prompt recognition of rubeosis - refer Retinal ablation Tube shunt

OD3 (S1&2) (114 decks)

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