Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neo Pathophys 2 > ROP > Flashcards

ROP Flashcards

1
Q

What was the old name of ROP of the 1940’s

A

Retrolental Fibroplasia (RLF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What caused the 1st epidemic of ROP?

How many babies were blind?

A

O2 piped into the isolette for survival from HMD

12,000 worldwide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What was the set point of FiO2 after the RCT study that showed much less ROP if FiO2 was <50%.
Did it work?

A

< 40%

No, for ever 1 baby whose sight was saved, 16 babies died. Many more had CP.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the current FiO2 recommendation based on evidence?

A

Keep SpO2’s >90% in <28 wk preemies

although still depends on HgbF/A in baby so not always accurate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When you target 1 organ, you must think of….?

A

All the other organ systems you may be neglecting (or affecting).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What were the 2 types of Retinal Ablative Tx (in 1990)?

A

Cryotherapy

Laser therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The second Epidemic of ROP was in what decade?

A

1970’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The third epidemic of ROP was when?
Mostly where?
Why?
Are the babies bigger or smaller than US babies who get ROP?

A

Current
Middle-income nations (India, S. America)
Don’t have the equipment or specialists needed.
Much bigger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

The Sclera is the _______ connective tissue that __________ the Retina with O2 and nutrition

A

Vascular

Nourishes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

The Retina accepts _____ waves and _______ information to the optic nerve.

A

Light waves

Transmits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

The ______ is the pit in the Macula where precise central vision is.
We always want to preserve the _______

A

Fovea

Macula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Vessels grow from the _____ _____ of the Optic Nerve in a spray outward.

A

Optic Disk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

The _______ ____ secretes ______ _______ that cause the vessels to grow toward the Avascular Area

A

Avascular Area

Growth Factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does VEGF stand for?

A

Vascular Endothelial Growth Factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does IGF-1 stand for?

A

Insulin-Like Growth Factor 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

VEGF is secreted by the ________ ____

and production is regulated by _______

A

Avascular Retina

Oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

In Hypoxic state, Increased/Decreased VEGF is secreted?

A

Inreased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

In Hyperoxic state, Increased/Decreased VEGF is secreted?

A

Decreased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Normal Uterine environment is?

A

Hypoxic
Best pO2 25-30mmHg
SpO2~60-70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does IGF-1 do to VEGF?

A

ACTIVATES it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When does IGF-1 increase in utero?

Where is it located in large amounts?

A

3rd Tri

Amniotic Fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Where does IGF-1 come from postnatally?

A

Nutrition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What does VEGF do to the vessels?

A

Draws the vessels toward the Avascular area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

There are ____ phases of ROP

A

2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

During the 1st phase of ROP after premature birth, the Retinal Development ____ _____ leading to decreased _____ & ______

A

Shuts down
VEGF & IGF-1
(because of increased oxygen state vs. in utero)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Once hit with O2, the vessels that have begun to grow literally “_____”

A

“cringe” or shrink back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When does the 2nd phase of ROP happen?

A

4 wks after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What happens in the 2nd phase of ROP?

What happens if IGF-1 levels remain low due to inadequate nutrition?

A

Avascular Retina increases it’s Metabolic Needs by becoming ischemic/hypoxic—>VEGF Production (again).

If IGF-1 levels remain low, VEGF accumulates awaiting IGF-1 to reach threashold levels for revascularization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What happens if IGF-1 levels reach threashold early and VEGF levels are NOT excessive?

A

ROP will NOT develop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What happens if IGF-1 levels reach threashold late–(VEGF levels will be excessive)?

A

ROP WILL occur

So-nutrition is SUPER important

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What does excessive VEGF cause?

A

Out-of-control Angiogenesis at the demarcation of Vascular and Avascular Retina.

  • Ridge (360 deg. w/tissue tufts that hook into vitreous)
  • AV shunts
  • Vessels leak proteins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

The Retina is like ___ _____ on the eyeball.

With extensive scarring, what can happen?

A

Wall Paper

Retinal Detachment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What 3 things put infants at risk for ROP?

A
  1. Prematurity
  2. Severity of Illness
  3. Number of Complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Are the classifications of ROP accepted worldwide?

A

Yes, by zones and clock hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

The zones are circles that move outward from numbers __-__ from the ____ ____

A

1 - 3

from Optic Disk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Zone 1 is where ____% of central vision is located

A

80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

The stages of ROP are based on?

A

Over-production of vessels at the border of the Vascularized and Avascularized Retina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How is the location of ROP described?

A

In clock hours 1-12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the number of stags of ROP?

Which is the worst?

A

1-5

5

40
Q

W/Stage 1 ROP you would see?

A

A distinct line (flat/thin) between the Vascular and Avascular Retina

41
Q

W/Stage 2 ROP you would see?

A

The line between Vascular and Avascular Retina has become a ridge with a little depth (inward) & height

42
Q

W/Stage 3 ROP you would see?

A

Vessels extend beyond Retina (over the Ridge) into the Vitreous itself (the liquid in the eyeball)

43
Q

W/Stage 4 ROP you would see?
4a?
4b?

A

Partial Retinal Detachment
4a-Macula is Spared (Not covered by Retinal Detachment)
4b-Macula is Involved (Covered by Retinal Detachment)

44
Q

W/Stage 5 ROP you would see?

A

Complete Retinal Detachment (blind)

45
Q

What is PLUS Dz?

If a child has PLUS Dz, what does it indicate?

A

Important clinical marker in ROP Screening

Need Laser Tx

46
Q

True/False: Current studies say WITHOUT PLUS Dz , it’s always better to Tx w/Laser right away.

A

False, it’s better to do nothing-better outcome (WITHOUT Plus Dz).

47
Q

How is Plus Dz determined?

A

By the state of blood vessels in Zone 1 near Optic Disk-Posterior Pole

48
Q

What happens as ROP becomes more severe?

A

Veins become Dilated

Arteries become Tortuous

49
Q

True/False: W/PLUS Dz, it’s easier to Dilate pupils

A

False, it’s more difficult to dilate pupils (due to the blood flow)

50
Q

Is “pre-PLUS” Dz an accepted term?

How is it generally defined?

A

Controversial/Subjective.

Vascular abnormalities in the Posterior Pole, but less severe than true PLUS Dz.

51
Q

What are the protocol for screening babies for ROP?

A

< 30 wks at birth
< 1500 gm BW
Or difficult course or lots of O2 need.

52
Q

What does the term Incomplete mean?

Is it bad?

A

The vessels just haven’t grown yet.

No, just need to wait and watch.

53
Q

How long after ROP exam should the lighting be kept low?

A

4 hours.

Their eyes are dilated and they don’t know not to open them–>causes stress

54
Q

Retcam is a good screening tool for ____ areas.

A

Rural

55
Q

What is Optical Coherence Tomography?

Why might it be beneficial?

Why isn’t it used much

A

OCT-Visualization of the eye structure at a microscopic level. (macular edema-quantify PLUS dz)
May lead to earlier Dx and Tx
-no bright light in eye
-no need for eye clip or local anesthesia
-No direct contact of equipment to eye

Not used much d/t $

56
Q

When does ROP need TX?

A

W/PLUS Dz.

57
Q

What is the most dangerous type 1 ROP that needs tx?

When does tx need to happen?

A 
Zone 1 (central vision)
-Any Stage WITH PLUS Dz.
OR 
-Stage 3 WithOUT PLUS Dz 
(hooking into the vitreous)

Probably w/in 48 hrs (24 hr better, for sure by 72 hrs)

58
Q

When does Type 1 ROP in Zone 2 need Tx?

A

-any Stage 2 OR 3 WITH PLUS Dz.

59
Q

What is “RUSH dz”?

Why is it so devastating?

A

ROP in Zone 1 w/Severe PLUS Dz
(also known as Aggressive Posterior ROP or AP-ROP)
Can quickly lead to Retinal Detachment w/in 24-48 hrs.

60
Q

When we “wait and watch”?

Why?

A

Type 2 ROP, Zone 1/2; Stage 1,2,3 Without PLUS

May regress on own

61
Q

ROP in Zone 1, type 2 needs……?

A

To be watched VERY carefully

62
Q

What ROP seen initially has the Worst prognosis?

A

ROP in Zone 1

63
Q

What ROP seen initially has the Best prognosis?

A

ROP in Zone 3

is mild and recovers fully (usually)

64
Q

T/F, Do most infant’s with ROP undergo Regression?

What happens in Regression?

A

Yes

The ridge flattens and becomes faint line. The vessels have been able to cross the ridge.

65
Q

If regression occurs without distortion or detachment of the Retina, they will have _____.

A

Vision

Still may lose some peripheral vision

66
Q

Can people have problems from ROP later?

A

Yes

67
Q

A late complication of ROP is Retinal dragging and folds. What is the result of this?

A

Results in decreased vision, but not blindness. May have “ambulatory vision”.

68
Q

Name the Late Complications of ROP

A 
Retinal Dragging/Folding
Myopia (near-sightedness)
Strabismus (crossed-eyes)
Amblyopia (lazy-eye)
Glaucoma
Late onset Retinal Detachment
69
Q

What is the risk of Myopia (near-sightedness) for a preemie?

W/mild ROP?
W/treated ROP?

A

3 x’s that of a term infant (6%)

12 x’s that of term (24%)
70-80% that of term infant–the damage gets worse, does not stay where it was at correction.

70
Q

Can infant’s who never had signs of ROP develop it later in life?

A

Yes.

Just being born prematurely is a risk factor.

71
Q

Why do they patch the strong/predominant eye in a child w/Amblyopia?

A

To force the brain to use the weaker eye, other wise the brain will stop the connection to that eye and they will be blind in that eye.

72
Q

All infants meeting ROP criteria need F/U at what agees?

A

6 months
3 years
Yearly in adolescence/early adulthood

73
Q

What is the Purpose of laser treatment for ROP?

A

Eliminate abnormal vessels before they lay down enough scar tissue to produce Retinal Detachment

74
Q

What does Lasering do?

How?

A

Causes destruction of the remaining Avascular Retina—>No more VEGF production (and no more vessels)

Condensates protein material by controlled use of light rays
Only needs topical anesthesia and IV sedation (no General)

75
Q

Why don’t they Laser the ridge?

A

It can cause Vitreous Hemorrhage

76
Q

What is Cryotherapy?

How is it performed?

Is it still used?

A

Very cold probe placed on the sclera until ice balls form on Retina

Under General anesthesia, metal probe dipped in liquid nitrogen.

No, Laser is preferred method

77
Q

Laser spot is significantly Larger/Smaller than spot of Cryotherapy?

How many spots w/Laser can be done?
How many w/Cryo?

A

Smaller

600-1000
30-50

78
Q

Laser is done through the _____ or with Severe PLUS, could be done through the _____.

A

Pupil

Slcera (can’t get pupil dilated)

79
Q

What is Bevacizumab (Avastin)?

How long does it last systemically?

A

Anti-VEGF factor

2 wks

80
Q

When is Avastin indicated?

A

Vascular congestion precluding laser tx
Progression of ROP despite Laser (last option)
Primary Tx

81
Q

Is Avastin FDA approved?

A

No, not yet.

Dosing is not known

82
Q

How is Avastin given?

A

30 gu. needle (topical anesthetic & Fentanyl)

83
Q

What are the benefits of Avastin vs Laser?

What are the unknowns?

A

Less:
Cost, time, anesthesia, myopia
Systemic effects, optimal dosing/timing, may need prolonged F/U (one baby had recurrence ROP 5 mos out)

84
Q

True/False: A benefit of Avastin is the ridge and tufts will go away and the vessels can grow up all the way

A

True :-)

85
Q

When is Scleral buckling used?

Is it once and done?

A

4a & 4b Retinal Detachment

No, the band must be changed w/age/growth.

86
Q

What is a Vitrectomy?

When is it done?

A

Removes scar tissue (exchanges vitreous w/NS) to decrease traction on Retina.

Done w/Stage 5 ROP or Lg Vitreous Hemorrhage. Must be done prior to Laser-(they can’t see to do it).

87
Q

What is the success rate of Retinal Reattachment?

A

25-50%

88
Q

What vision is left after Retinal reattachment?

A

It can provide ambulatory vision, but only 1/4 will be able to reach out and grab an object.

89
Q

What are possible future Tx’s?

A

EPO (anti-EPO drug?-but would suppress RBC production)
Propanolol (beta-blocker: safety concern of bradycardia, hypotension)–working on topical solution
Omega-3 Long Chain Polyun. FA’s (need balance of omega 3 & 6 to prevent ROP)

90
Q

How can we Prevent ROP?
What are 2 predictors of highest risk ROP?
Protein intake ______’s IGF-1

A

Nutrition!
1. poor postatal wt gain 2. Low serum IGF-1
Increases it.

91
Q

Breastmilk Increases/Decreases incidence of ROP?

What about Donor BM?

A

Decreases incidence

No benefit w/Donor

92
Q

What maternal state is an Anti-angiogenic state?

What might this do for babies?
It Increases/Decreases any stage of ROP by 60%
It Increases/Decreases Severe ROP by 80%

A

Pre-Eclampsia

Mature Retinal vasculature preventing ROP
Decreases

Decreases

93
Q

Decreased Oxygen is helpful in the ____ phase of ROP.

Increased Oxygen is helpful in the ____ phase of ROP

A

First

Second

94
Q

Avoid hyPERoxia in the first/later wks life.

A

First

95
Q

Strict monitoring if O2 starts when?

A

In the DR

96
Q

Avoid HYPOxia in the first/later wks life

A

Later

Neo Pathophys 2 (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions