Shared Flashcard Set

Details

Systemic Disease
KMK Systemic Disease Chapter 11
305
Pathology
Professional
02/24/2014

Additional Pathology Flashcards

 


 

Cards

Term

HSV 1 is most commonly trasmitted by 

1. 

2. 

 

HSV 2 is transmitted by 

3. 

Definition

1. mucous membranes 

2. external skin 

 

3. sexuall 

Term
Honey colored crusted lesions common in kids
Definition
Impetigo
Term
The most common cause of herpetic keratitis in neonates is Type __
Definition
2
Term

T/F

90% adults obtain HSV 1 from a primary infection as a child 

Definition
True
Term
HSV will hide within this area of the CNS after an initial infection and reoccur at any time
Definition

Trigeminal ganglion

 

Reoccurs with stress, sun exposure, hormone changes, fever, trauma, immunosuppression

Term
Ocular complications of HSV
Definition

dendritic keratitis 

disciform keratitis 

uveitis

blepharoconjunctivitis 

Term
This ocular complication in HSV can quickly decrease vision  due to stromal scarring
Definition
Disciform Keratitis
Term
There is a ___ % chance of recurring HSV, which almost doubles in terms of risk for a recurrence after the 2nd episode
Definition

25% 

 

becomes 40-45% after 2nd episode 

Term

yellow, elevated plaque lesions that happen bilaterally at medial portion of eyelids. 

 

Often in older females with high cholesterol 

Definition

Xanthelasma 

 

Tx with surgical excision, carbon dioxide laser tx, chemical cauterization 

Term
Viris that causes Molluscum Contagiosum
Definition

DNA pox virus 

 

Multiple nodules may indicate HIV (immunocompromised..our bodies cam usually fight these off!) 

Term
Keratoacanthoma
Definition

dome-shaped nodules on face that mimic squamous cell carcinoma

 

spontaneously remiss over several months 

Term
Your 35 YO male pt presents with crusty plaque-like lesions that look "stuck on" adnexal skin. He says they were mentioned by his PCP in the past, but no tx was needed because "they weren't big enough to be worrisome". What are these?
Definition

Seborrheic Keratosis lesions 

 

- common in males over 30, not commonly treated unless larger lesions (which require complete surgical excision) 

Term
Allergic contact dermatitis is what type of hypersensitivity ?
Definition

Type 4! 

 

Delayed hypersensitivity 

Term
HZV initially presents as ___ and lays dormant in dermatomes as a latent virus
Definition
Varicella Zoster Virus
Term
Your 20 YO male patient presents with eye irritation and a red eye, which you diagnose as uveitis. You also notice a rash located on the side of his nose with similar looking vesicles on the superior lid margin. You advice your patient that he should seek a medical evaluation for....
Definition

Immunodeficiency 

(AIDs!!) 

 

Think of KMK Jordan who evaluated his young male patient without gloves and thought he caught his AIDs :( 

Term
This inflammatory disease causes mutlisystem complications including recurrent oral ulcers and genital ulcers, eye lesions, skin lesions and is common in Asian/Middle East young adults
Definition

Behcets Disease 

 

(

Term
Most common cancer of young women
Definition

Malignant melanoma 

 

Depth of invasion is biggest prognostic factor (cancer wants to kill, wants to break the skin to reach blood supply so it can continue to feed and take over!) 

 

 

Term
Most common variant of melanoma (70% cases)
Definition

superficial spreading melanoma 

 

rapid growth and classically on non-exposed skin (upper back, anterior tibia)

Term

Shiny firm pearly nodules with superficial telangiectasia. 

 

Treat with 5-FU or biopsy 

Definition

Basal Cell Carcinoma 

 

Can progress to rodent ulcers (central ulceration- look for any changes like bleeding, scabbing) 

Term
Squamous cell carcinoma is malignancy of what layer of tissue?
Definition

Stratum Spinosum layer of epidermis 

 

It is non-healing and appears as erythematous plaque

Term
Squamous cell carcinoma arises from pre-cancerous lesions called
Definition
actinic keratosis
Term

Port wine stains are facial capillary malformations that characterize this condition

 

Neuro SE of this condition? 

 

Ocular SE? 

Definition

Sturge- Weber 

 

Neuro: Seizures, focal neuro deficits, mental retardation 

 

Ocular: glaucoma, VF defects, vascular malformation of conj/episclera/choroid/retina, iris heterochromia 

Term

Genetic condition with benign tumors growing in brain & other organs. 

SE include hypopigmented macules (ash leaf spots), shagreen skin patches, angiofibromas, and a distinct brown fibrous plaque on the forehead 

Definition
Tuberous Sclerosis
Term
Ocular signs of Tuberous Sclerosis
Definition

retinal lesions (astocyte hamartomas)

 

chorioretinal depigmentation (punched out areas) 

 

colobomas

 

eyelid angiofibromas

 

papilledema 

Term

extra 21st chromosome 

 

(these pts are at increased risk for keratoconus) 

Definition
Down's Syndrome
Term
Klinefelter's Syndrome
Definition

XXY 

 

most common cause of male primary hypogonadism 

 

testicular atrophy, long extremities, gynecomastia, female hair distribution 

Term

An absent X chromosome leads to females with short stature, dysgenesis, webbed neck, coarctation of aorta. 

 

What are associated ocular findings? 

Definition

Turner's Syndrome 

 

associated with strab, amblyopia, CI, reduced accommodation 

Term

T or F 

Aut recessive conditions typically present after puberty

Definition

False- present during childhood! Only seen in 1 generation (typically)

 

Aut dominant conditions present after puberty

Term

Neurofibromatosis type 1: 

 

Classic triad of signs 

Definition

1. cafe au lait spots 

 

2. neurofibromas (tumors at nerve cells) 

 

3. Lisch nodules on iris 

Term
Neurofibromatosis is common to form at these 3 locations:
Definition

optic nerve 

 

eye lid 

 

auditory nerve

 

(I think thats what this means? written in the side margin of my kmk book on page 384....) 

Term

Marfan's Syndrome: 

 

Ocular SE 

 

Cardiovascular SE

Definition

This CT disorder results in lens subluxation and retinal detachments 

 

Cardiovasc: aortic aneurysms (aneurysms in general) , floppy mitral valves 

Term
This autosomal dominant disorder is characterized by spastic uncontolled movements and dementia with 30-50 YO clinical onset, and only 15-20 year survival rate after that :(
Definition

Huntington's Chorea 

 

Spastic movements...think spastic muscles everywhere (including EOMS) for delayed pursuits/saccades/refixations 

Term
This autosomal recessive condition results in crescent shaped RBCs that cause blocking in arteriole vessels and can lead to organ failure
Definition
Sickle Cell Anemia
Term
The most common form of sickle cell is by a single base pair mutation where ___ is substituted for ___ in the beta globin gene
Definition
Valine is exchanged for Glutamic Acid
Term
Sea fan retinopathy is a result of ….
Definition
sickle cells occluding retinal arterioles that lead to ischemia and thus, neovascularization grows in this "sea fan" shape
Term
Caused by mutations in phenylalanine hydroxyls (converts phenylalanine to tyrosine) & can lead to mental retardation if not treated
Definition
PKU (Phenylketonuria)
Term
PKU Treatment
Definition
Diet low in phenylalanine is initiated (milk, aspartame, meat, chicken)
Term
Tay Sachs is progressive destruction of the nervous system that leads to ocular signs of :
Definition
Cherry red spot (retina- CRAO), atrophy of optic nerve

(these pts pass away early in life)
Term
Only systemic diasease that causes whorl keratopathy
Definition
Fabry's Disease
Term
Lipid deposits in BV walls throughout body allow lipids to build up to harmful levels in eyes, kidneys, autonomic NS, and cardiovascular system
Definition
Fabry's Disease
Term
Osteogenesis Imperfecta ocular SE
Definition
Blue sclera, keratoconus, megalocornea
Term
Systemic conditions that cause blue sclera

One medication that causes blue sclera
Definition
Ehler Danlos, PXE

Minocycline (tx for acne vulgaris)
Term
Condition transmitted only through mothers
Definition
Leber's Hereditary Optic Neuropathy
(progressive loss of central vision in men in 20s-30s)

My Mother Leber Lost My Eyes
Term
more than 50% anemias are in this category
Definition
iron deficiency anemia
Term
Different causes of iron deficiency anemia
Definition
1. GI blood loss from PUD, colon cancer, etc
2. malabsorption or decreased intake of iron (increased need with pregnancy or in childhood)

**Treat with oral iron supplements**
Term
Aplastic anemia is caused by which meds? What are other causes?
Definition
OCT (Oral CAIs, Chloremphenicol, Trimethoprim) ..& chemo drugs

Also caused by infection, radiation
Term
Explain how kidney disease can lead to anemia
Definition
Damaged kidneys synthesize inadequate amounts of erythropoeitin (which stimulates RBC production in bone marrow)
Low RBC production = low RBCs !
Term
What is pernicious anemia?
Definition
Abs against parietal cells in stomach = decreased intrinsic factor (needed for VitB12 absorption)

Leads to VitB12 deficiency
Term
This drug is used to treat rheumatoid arthritis and may also cause folic acid deficiency
Definition
Methotrexate
Term
Folic acid deficiency during pregnancy increases risk for this
Definition
Spina Bifida (neural tube defects in general)
Term
Leading cause of folic acid deficiency is ___ , especially in this group of people
Definition
Dietary! Especially for alcoholics
Term
Proliferation of malignant clone of plasma cells in bone marrow.

Leads to bone destruction, hypercalcemia, renal failure
Definition
Multiple Myeloma

(multiples of a malignant bone killer)
Term
Hodgkins Lymphoma is NOT associated with
a) age groups 15-30 and over 50
b) 50% associated VZV (Varicella Zoster)
c) Bad prognosis, with 15-20 year survival rate following dx
d) Enlarged lymph nodes
Definition
B & C
- 50% associated with Epstein Barr Virus (EBV)
- good prognosis if caught early
Term
60% of lymphomas are Hodkins or Non-Hodgkins?
Definition
Non-Hodgkins Lymphoma

(big lymph nodes & GI tumors found by determining T or B cells through bone marrow biopsy)
Term
Predominate cell type in acute leukemia
Definition
Blast cells aka immature cells
(>30% of marrow cells are blast cells)
Term
Auer rods are found in the blood with this condition
Definition
Acute Myeloblastic Leukemia

(normal WBC with excess myeloblasts)
Term
peak age of this condition is 2-10 yrs. WBC is normal but lymphoblasts are excess!
Definition
Acute Lymphoblastic Leukemia

(75% kids are disease free >5 yrs with tx)
Term
Roth spots are indicative of which conditions
Definition
Leukemia and endocarditis
Term
Chronic Myelocytic Leukemia has ___ year survival rate

Chronic Lymphocytic Leukemia has __ year survival rate
Definition
3 years, (25-60 YO)

5-10 years, (in older than 50 YO)
Term
Swelling of the legs with subcutaneous edema and possibly shortness of breath can be due to
Definition
pulmonary edema

(tx with diuretics and compression stockings)
Term
These cells surround retinal blood vessels and damage to these can allow leakage and cause edema
Definition
Pericytes
Term
diabetic macular edema is caused by ...
Definition
microaneurysms or capillary wall dilation
Term
most common place for thrombosis
Definition
deep venous system in the legs
(low pressure area, pulling blood increases risk for thrombosis)
Term
Virchow's Triad
Definition
Theory delineating cause of venous thromboembolism

VTE results from altered blood flow (stasis), vascular endothelial injury, alterations in constituents of blood through inherited/acquired hyper coagulable state
Term
Acquired causes of hypercoagulation
Definition
birth control
smoking
vasculitis (temporal arteritis)
stasis (immobilization or pregnancy)
Term
inherited hypercoagulation
Definition
Factor V Leiden
prothrombin gene mutation
protein C & S deficiency
Term
A thrombosis in deep leg veins are likely to embolize in what part of the body?
Definition
heart or lungs
(can be immediately fatal)
Term
arterial thrombosis commonly form from what conditions?
Definition
atherosclerosis or MI

These embolize to brain, kidneys, spleen
Term
What is more common: venous or arterial thrombosis?
Definition
Venous

higher pressure in arteries means thrombus here is less likely (blood flow will cause it to move, aka it's an embolus)
Term
ocular conditions that most commonly result from thrombus formation
Definition
CRVO and BRVO
Term
What are the 6 types of emboli
Definition
1. fat (long bone fractures, liposuction)
2. air (chest wall injury_
3. thrombus (#1 cause of emboli)
4/5. bacterial/tumor (tissue destruction, muscle pain)
6. amniotic fluid (lead to clotting)
Term
What's an aneurysm?
Definition
abnormal dilation of a vessel, enclosed by complete arterial wall components
Term
The most common aneurysms occur where?
Definition
abdominal aorta
iliac
other larger arteries
Term
pupil involving CN 3 palsies are likely a result of..
Definition
aneurysms
pupil-sparing fibers are located on outside of CN 3, located close to surrounding arteries (posterior communicating artery)
Term
Aneurysms are basically stretching of vessel walls to cause bulging. You should associate this with which systemic condition?
Definition
Marfan's Syndrome
Term
What are two main symptoms experienced by a patient with atherosclerosis? Are these experienced early or later in the disease?
Definition
SOB and chest pain
patients can be asymptomatic for decades before experiencing this
Term
Biggest risk factor of atherosclerosis
Definition
age (especially greater than 50)
Term
Lab results for atherosclerosis
Definition
increased total cholesterol
decreased HDL
increased LDL
increased CRP
Term
first line therapy for atherosclerosis
Definition
statin medications

(followed by diet and exercise, then artery stents for those showing CAD symptoms)
Term
Most commonly encountered peripheral corneal opacity
Definition
Arcus Senilus

(sign of present or past high cholesterol that DOES NOT affect vision)
** refer if seen in pt under 40 YO
Term
Normal Cholesterol Values
Total:
LDL:
HDL:
TG
Definition
Total: below 200
LDL: under 100
HDL: over 40
Triglycerides: under 150
Term
Characterized by atherosclerosis within the coronary arteries supplying blood to the heart. Patients may have chest pain and dyspnea.
Definition
Coronary Artery Disease
(can lead to an MI)
Term
If a pt experiences an MI, this treatment should be given immediately
Definition
325 mg aspirin
Term
Critical performance standards for CPR:
maintain rate of at least ___ compressions/min. Compress the chest at least ___ with each down stroke (complete recoil in between). The compression- ventilation ratio should be ___ until an advanced airway is put in place. Deliver ___ ventilations per minute.
Definition
Maintain rate of 100 compressions/min
Compress 5 cm (2 inches)
Compression-ventilation ratio of 30 comp: 2 ventilations
Deliver 8 ventilations per minute
Term
25% strokes are due to what?
Definition
Build up of plaque causing stenosis of carotid arteries (CAD)
Term
Visual/Neuro symptoms of CAD
Definition
sensory loss, dizziness, amaurosis fugax, LV in ipsilateral eye

(motor symptoms are contralateral, visual symptoms are ipsilateral)
Term
You are listening for a bruit over the carotid artery but you hear nothing. This can indicate what?
Definition
1. There is no occlusion
2. The artery is 90% occluded (too much blockage for blood flow to actually MAKE a sound)
Term
The most common primary diagnosis in America
Definition
HTN
Term
Percentage of 60-69 YO and percentage of those over 70 YO affected by HTN
Definition
50% of 60-69 YO
75% over 70 YO
Term
T or F
The rise in diastolic BP continues through life, but systolic pressure will level off by age 50.
Definition
False
Systolic continues to rise
Diastolic is stable by 50 YO
Term
Goal of HTN for a patient with DM or renal diseases
Definition
< 130/ 80 mmHg
Term
Pre-HTN range
Definition
120-139 systolic / 80-89 diastolic
Term
Biggest risk of HTN
Definition
age!!
(other risks are family hx, obesity, DM, smoking, excess sodium intake. African Americans have highest risk!!)
Term
At what stage of hypertensive retinopathy is optic disc edema found?
Definition
Stage 4
(not often seen)
Term
Hypertensive retinopathy is manifested by what?
Definition
narrowing of retinal arterioles

Injury to vasculature can cause occlusion or leakage which is seen as NFL infarcts, edema, intraretinal hemorrhages, macroaneursyms.
Term
Findings of hypertensive choroidopathy
Definition
Elschnig spots, Siegreist streaks
Term
Hypertensive retinopathy is directly linked to what factor?
Definition
Management of HTN
Term
most common cause of left sided heart failure
Definition
ischemic cardiomyopathy (from CAD)
Term
most common cause of right sided heart failure
Definition
left-sided CHF
(other causes: pulmonary HTN, COPD, right side MI)
Term
What is rheumatic fever? Who does it typically affect?
Definition
An infection of strep pyogenes that alters shape of heart valves (75-80% cases attack the mitral valve) and valve replacement often needed.

Often in pts age 5-15 YO
Term
Common signs and symptoms of rheumatic fever
Definition
Elevated ESR, red-hot joints, endocarditis
Term
Condition where bacteria infects inner lining of heart and an echocardiogram shows "vegetations" which are mix of bacteria and thrombus
Definition
Bacterial endocarditis
Term
Premature Ventricular Contractions
Definition
The most common heart palpitation
Term
TIAs typically last how long?
Definition
less than 24 hours, often less than 15 minutes
Term
TIAs are often due to...
Definition
inadequate perfusion, often caused an embolism
Term
Types of TIAs
Definition
1. Carotid Artery (contralateral hand/arm weakness and ipsilateral VL)

2. Vertebrobasilar: diplopia, ataxia, vertigo, dysarthria, unilateral or bilateral VL
Term
Which of the following about Hollenhorst plaques is true?
a) found at bifurcations of vasculature
b) larger in size than the actual vessel
c) transient & not always found at the same spot
d) if found, refer ASAP due to probability of TIAs
Definition
These are all true!
Term
Main risk factor for stroke
Definition
HTN

(auscultate subclavian and carotid arteries for bruit as clue to early diagnosis for stroke)
Term
Test used to determine size and location of stroke
Definition
CT scan
Term
This Vf defect is due to stroke at occipital lobe affecting EITHER the middle cerebral or posterior cerebral artery (not both)
Definition
Macular sparing homonymous hemianopsia

(dual blood supply to macula)
Term
VF defect when tumor has compressed both blood supplies to macular cortex
Definition
macula only homonymous hemianopsia
(A stroke would NEVER hit both of these arteries at once!)
Term
Accounts for 80% of all strokes, rusting from occlusion of an artery leading to the brain.
Definition
Ischemic strokes

(embolism of atherosclerotic plaque is most common cause)
Term
The most common type of hemorrhagic stroke
Definition
Subarachnoid hemorrhage
Term
Explain how a subarachnoid hemorrhage leads to a pupil-involving CN 3 palsy
Definition
As blood increases in the subarachnoid space, pressure increases as well (think more fluid contributing to volume of CSF in this space) so as pressure increases, CN 3 is compressed. Pupil fibers located outside CN 3 are quick to be affected by any compression
Term
CN 3 palsies from subarachnoid hemorrhages are usually from insult at what area of the brain?
Definition
Circle of Willis
(the meeting loop for basilar, internal carotids, anterior and posterior communicating arteries)
Term
The anterior cerebral artery is located where and supplies what?
Definition
Location: extension that goes up and forward from the internal carotid

Supplies frontal lobe (logical thought, personality, voluntary movement)
Term
Last and largest branch of the internal carotid is ___
It supplies ____
Definition
Middle cerebral artery (Think MEGA for large)

Supplies frontal lobe, lateral surfaces of temp/parietal lobe (control primary motor and sensory of face, throat, hand, arm, areas for speech)
Term
This artery stems from the basilar artery.

It supplies temporal & occipital loves
Definition
posterior cerebral artery
Term
strokes involving this vessel cause contralateral hemiplegia, color blindness, verbal dyslexia, and VF defects
Definition
posterior communicating artery

(feeds into occipital lobe)
Term
Difference between seizures and epilepsy?
Definition
Seizures are a single event

Epilepsy is recurrent seizures. Status Epilepticus is a prolonged seizure (more than 5 minutes)
Term
4 treatment drugs for epilepsy

1 drug for absence seizures
Definition
Pheytoin, Phenobarbital, Carbamazepine, Valproic Acid

Klonopin (aka Clonazepam)
Term
What the hell is an absence seizure?
Definition
aka petit mal seizures

a brief lapse of consciousness that quickly returns without lethargy following afterwards
Term
Your 40 YO male patient presents for a CVE with red eyes and a stuffy nose. Upon examination you find a grade 1 ptosis OD, mitotic pupil OD (more prominent in your dark exam room).
Your patient reports he's been tired lately from lack of sleep due to extreme headaches during the night that he believes may be due to the fact that he recently quit smoking and drinking, habits he's been dealing with for the past 15 years.
Possible diagnosis?
Definition
Cluster headaches
Look for 30-50 YO smoker/alcoholic males

headaches are often orbital/temporal (unilateral) and wake pts at night. Expect 1-2 attacks/day with each lasting ~1 hour.

Can present with red eyes, stuffy nose, transient or permanent ipsilateral Horner's Syndrome.

(Side note: this HA is known to begin more posterior and travel forward via the track of the trigeminal nerve)
Term
Describe the typical patient experiencing tension headaches
Definition
Females (of all ages) that may be stressed & tense (think tense neck muscles).

HAs are in band-like distribution (hat band)
Term
Migraine headaches are…
1. more common in men or women?
2. present with or without what symptoms?
3. typically last how long?
Definition
1. women (typically start at 20-30 YO)
2. aura, nausea, photosensitivity
3. 4- 72 hours
Term
Big presenting signs that should make you think of brain tumors as possible diagnosis?
Definition
1. Interruption of sleep
2. increasing severity over time (tumor HA typically worse in morning)
3. in kids- 1 or more physical/ neuro deficit in addition to the headaches
Term
Your 75 YO female patient complains about jaw claudication, transient VL, scalp tenderness, and recent neck pain.

What's your plan of action?
Definition
Order and ESR and CRP immediately!
Start patient of prednisone treatment!

The gold std for GCA is a temporal artery biopsy, but it can be performed following the above. The first two are more important so we can confirm diagnosis and initiate treatment ASAP
Term
Inflammation of the meninges is often preceded by what?
Definition
upper respiratory infection

(other causes include virus, TB, fungi, chemical agents
Term
T or F

Viral meningitis is a fairly rare disease with various treatment options available
Definition
False
This form is both common AND very hard to treat
Term
Classic triad of meningitis
Definition
fever, headache, neck stiffness

(look for papilledema)
Term
The most common primary malignant brain tumor typically found in the cerebral hemispheres that can cross the corpus callosum
Definition
Glioblastoma Multiforme

prognosis is less than 1 year life expectancy
Term
The most common brain cancer in adults is due to metastasis that begins in which primary tumor sites?
Definition
Lung and breast
Term
This is often localized to CN 8 and causes gradual onset of painless, progressive proptosis
Definition
Schwannomas

Referred to as acoustic schwannoma if CN 8 localized
Term
The most common functional pituitary adenoma is ___ and causes what kind of VF defect?
Definition
Prolactin-secreting tumor

Causes a bi-temporal hemianopsia as it sits directly below the optic chiasm
Term
Hormones secreted by Posterior Pituitary Gland:

Hormones secreted by Anterior Pituitary Gland:
Definition
Posterior: AHD, Oxytosin

Anterior: everything else
(LH, TSH, Prolactin, GF, ACTH)
Term
Diagnosis of MS requires what?
Definition
TWO separate CNS lesions on TWO or more occasions (two separate scans). lesions MUST involve white matter (periventricular)
Term
The most common presenting symptom of MS
Definition
optic neuritis!!

found in 25% of cases
Term
Ocular findings of MS
Definition
Optic Neuritis, pain on EOM movements, APD, INO, diplopia
Term
This patient presents to you with a CC of sudden non-progressive loss of vision OS that began yesterday. She also noticed blurry vision after taking a hot shower this morning.

Refer for further testing to rule out what?
Definition
MS!!
Uhtoff's Phenomenon: decreased VA after increase in body temp
Term
This condition is characterized by inflammation and demyelination of peripheral nerves and ventral root motor fibers.
Think symmetric ascending muscle weakness that starts in distal lower extremities
Definition
Guillain-Barre Syndrome
Term
Ocular findings of Guillian Barre Syndrome
Definition
Adies tonic pupil, diplopia, papilledema ( due to elevated CSF protein)
Term
This disease may be called "Hugh Heifner disease" because it affects younger women and older men ;)
Definition
Myasthenia Gravis
Term
Myasthenia Gravis systemic symptoms
Definition
Respiratory weakness, jaw muscle weakness
Term
Pathologic process of myasthenia gravis
Definition
Neuromuscular signals are blocked by Abs at the Ach receptors.
Term
Diseases that MG is associated with
Definition
thymomas, rheumatoid arthritis, SLE
Term
Ocular symptoms of MG
Definition
Ptosis and diplopia

(symptoms typically worse at end of the day)
Term
This common form of dementia is characterized by beta amyloid plaques and disorganized protein fibers (neurofibrillary tangles) in brain cells.
Definition
Alzheimer's Disease
Term
Aricept, a medication that inhibits AchE, is used to treat what?
Definition
Alzheimer's Disease

(There is no CURE but this med can help slow progression)
Term
Patients with vascular dementia have damaged brain tissue secondary to...
Definition
reduced cerebral flood flow from blood clots or fatty deposits (cerebral micro infarcts)
Term
Parkinson's is a deficiency of ___ in the striatum due to degenerated neurons in the ___
Definition
Dopamine

Substantia nigra
Term
What is TRAP
Definition
Tremor
Rigidity
Akinesia
Postural Reflexes

(symptoms of Parkinsons)
Term
Typical first sign of Parkinson's
Definition
slowness of movement
(along with cogwheel rigidity, pill-rolling tremor)
Term
This artery is often responsible for epidural hematomas
Definition
middle meningeal artery
Term
Symptoms to look for with head trauma
Definition
pupillary size changes (blown pupil signals impending uncial herniation)

nausea, vomiting

loss of consciousness
Term
Horner's Syndrome can be associated with these systemic diseases
Definition
cluster headaches

Pancoast tumor (at lung apex)
Term
Which fibers are affected in Pancoast Tumor
Definition
sympathetic pre-ganglionic fibers
Term
Sympathetic fibers like to MOOCH! What places do these fibers mooch off of?
Definition
Internal carotid artery
CN 3 to Muller's
CN 5 to Dilator
Term
Bell's Palsy is characterized by a deficit at what location?
Definition
lower motor neurons in CN VII
Term
Biggest ocular concern with a Bell's Palsy patient
Definition
Exposure keratitis

Consider patching eye that can't completely close to prevent corneal dryness . Also consider ointment Rx and ATs
Term
Complete lack of insulin from beta cell production can lead to this condition in (typically) younger people
Definition
DM Type 1
Term
Treatment for DM type 1
Definition
Insulin injections, along with careful glucose and diet monitoring
Term
What is diabetic ketoacidosis and which type is it more associated with?
Definition
Glucose that is not utilized is stored by fat and muscles for energy as ketone bodies (cause fruity breath)

More common in Type 1
Term
Insulin resistance or abnormal beta cell secretion of insulin is commonly associated with which type of diabetes?
Definition
Type 2
Term
Obestiy is associated with what % of DM 2 patients?
Definition
80%
Term
Appropriate lab tests for diabetics
Definition
Fasting glucose level
Hemoglobin A1C
Term
What is A1C and what is a normal level?
Definition
State of glycemia over last 90-120 days

Should be less than 7%
Term
Abnormal fasting glucose level
Definition
126 mg/dL
Term
What type of DM is more associated with a genetic predisposition?
Definition
Type 2
Term
When should diabetic pts come in for a DFE?
Definition
DM 1 within 5 years

DM 2 upon diagnosis
Term
extreme thirst and polyuria resulting from lack of ADH
Definition
Diabetes Insipidus

(remember, without ADH we constantly lose water)
Term
Lab values typical of hypothyroidism
Definition
Low T3, T4

High TSH

(structural or functional abnormality hinders thyroid production)
Term
Most common cause of hypothyroidism in iodine-sufficient areas of the world
Definition
Hashimotos Thyroiditis

This autoimmune-mediated condition affects females much more than men.
Term
How many hyperthyroid cases are caused by Grave's ?
Definition
85%

(aka a lot)
Term
Pathologic process of Grave's
Definition
TSH Auto-Abs (TSH pretenders) that constantly stimulate the thyroid to excessively produce T3 and T4
Term
Hyperthyroidism mostly affects what people?
Definition
middle aged females (8:1)
Term
In what order are EOMs affected in Thyroid Eye Disease?
Definition
IM SLO
(inferior rectus commonly affected first)
Term
Most common ocular signs of Grave's
Definition
proptosis
upper lid retraction
(also look for SLK)
Term
An eye affected by TED will commonly develop what kind of tropia?
Definition
Hypotropia

(IR fibrosis makes the IR like a tight rope, pulling eye in the downward position. **Can result in falsely measured high IOP measurements**)
Term
Hyperparathyroidism is marked by ...
Definition
hypercalcemia
Term
Adrenocortical deficiency that results from autoimmune atrophy of the adrenals
Definition
Addison's Disease
(gotta add more!)
Term
Symptoms of Addison's Disease
Definition
weakness, fatigue, anorexia, weight loss, nausea/vomiting, diarrhea, muscle & joint pain, amenhorrhea

(treat with replacement corticoids)
Term
Majority of Cushing's syndrome cases result from what?
Definition
chronic, prescribed corticosteroid meds

(living on a cushion of steroids)
Term
Typical Cushing's Syndrome patient looks like what?
Definition
Central obesity, moon face, buffalo hump
Term
Condition caused by tumors secreting excess NE and epinephrine. These tumors commonly located on one or both adrenal glands
Definition
Pheochromocytoma
Term
Symptoms of pheochromocytoma
Definition
HTN, papilledema, severe HA, perspiration, palpitations, and anxiety with impending doom
(the 4 P's: pain, palpitations, pallor, perspiration)
Term
Lab test results common in renal failure
Definition
GFR is decreased (glomerular filtration rate)
Creatinine is increased
BUN is increased
Term
Main causes of chronic renal failure
Definition
Diabetes (most common) and HTN
Term
When more than 3.5g of protein found in the urine, this indicates what condition?
Definition
Nephrotic Syndrome
(type of inflammation of the kidney glomerulus)
Term
Post strep glomerulonephritis commonly affects 5-15 YO at what point of infection?
Definition
Occurs 7-21 days after a respiratory or skin infection
Term
Renal cell carcinomas are typically asymptomatic. But if they do have symptoms, what is the classic triad?
Definition
flank pain, hematuria, abdominal renal mass

(1st diagnostic test is abdominal ultrasound)
Term
most common bacterial sexually transmitted disease in the US
Definition
chlamydia
Term
Chlamydia commonly causes inclusion conjunctivitis which presents in what way?
Definition
It's a chronic infection with large inferior palpebral conjunctival follicles
Term
Drugs that treat chlamydia
Definition
Azithromycin

Doxycycline
Term
Treatment for Gonorrhea
Definition
single dose of Ceftriaxone 125 mg IM
AND Doxycycline 100mg p.o. BID x 7 days (this covers for possible chlamydia)
Term
How are the two types of HSV diagnosed?
Definition
multinucleate giant cells on a Wright-Gram stain
Term
Common treatment for HSV
Definition
Acyclovir or Famciclovir

(no cure but tx is prophylactic for breakouts)
Term
An STD caused by the spirochete Treponema pallidum
Definition
Syphilis
Term
Clinical findings of syphilis in each phase
Definition
Primary: chancre (painless genital ulcer)
Secondary: eye, kidney, mucous membranes, skin, CNS, liver
Tertiary: nervous system & ophthalmic lesions (Argyll Robertson)
Term
Salt and pepper fundus is seen in which systemic conditions?
Definition
congenital syphilis

congenital rubella
Term
Interstitial keratitis =
Definition
Syphilis
Term
Screening tests for syphilis
Definition
RPR (rapid plasma reagin)
VDRL (venereal disease research lab)
EIA (enzyme immune assay)
Term
Diagnostic tests for syphilis
Definition
FTA-ABS , TPPA , MHA- TP, dark field microscopy
Term
Which test can determine a currently active case of syphilis and which can determine a latent case?
Definition
RPR for active (+ 4-6 weeks after infection)

FTA-ABS for latent (+ for life)
Term
An elderly male with complaints of increased urinary frequency, urgency, nocturne, a weak stream, dribbling, probably has what?
Definition
Benign Prostatic Hypertrophy
Term
2nd most common cause of cancer death in males
Definition
Prostate cancer

(elevated PSA test indicates prostate cancer)
Term
The most common causes of cancer death in women (in order)
Definition
lung, breast, colon
Term
The most severe neural tube defect that is 100% fatal
Definition
Anencephaly: absence of normal bone & cranial bone tissue
Term
the number one cause of congenital malformation?
Definition
fetal alcohol syndrome
Term
This condition is transferred from mother to fetus and its ocular effects often include microphthalmia and glaucoma. It is screened for early in pregnancy
Definition
Rubella
Term
Name these common GI conditions:

a) gastroesophageal junction incompetence allows gastric juice into the esophagus for heartburn.

b) H. Pylori leads to ulcers (duodenal and gastric) that can lead to extreme pain after eating, the middle of the night when acid secretion is greatest.

c) esophagus lining is replaced by metaplastic columnar cells, can lead to esophageal adenocarcinoma
Definition
a) GERD
b) PUD
c) Barrett's Esophagus
Term
Two main inflammatory bowel diseases
Definition
Crohn's and Ulcerative Colitis
Term
Affected location in Crohn's Disease
Definition
any portion of GI tract.

Usually at terminal ileum, small intestine, colon.
(SKIP lesions)
Term
An autoimmune disease affecting the colon, along with rectal involvement and a 5-10% chance of nongranulomatous uveitis
Definition
Ulcerative Colitis
Term
contributing factors to colon cancer
Definition
low fiber, high fat diets, exposure to toxins

Primarily screened for with colonoscopy
Term
copper accumulation in the liver, brain, and cornea with sunflower cataracts. Can also cause liver cirrhosis, basal ganglia degeneration, dementia
Definition
Wilson's Disease
Term
What is Penicillamine?
Definition
chelating agent used in Wilson's because it binds copper. Many patients stop taking because of SE (Ocular MG, ocular pemphigoid, optic neuritis)
Term
Types of Hepatitis: vaccine available? route spread?
Definition
A- yes, focal oral route
B- yes, blood, IV, sex
C- no, blood, IV, sex (chronic)
D- no, carried with Hep B as superinfection
E- no, fecal oral route
Term
Blood through liver is hindered due to fibrosis, leading to enlargement and formation of firm nodules, then liver shrinkage.

Leads to portal HTN, GI hemorrhaging, liver failure (and death).
Definition
Cirrhosis
Term
How does jaundice occur and what obvious signs are seen?
Definition
The conversion of bilirubin or heme to urobilinogen is disrupted in liver or bilirubin can't be excreted
(either way- bilirubin builds up in bloodstream)

Skin and conjunctiva turn yellow
Term
Cholecystitis, caused by inflamed gall bladder lining, is most common in what group?
Definition
overweight females of childbearing age
Term
Acute pancreatitis is often secondary to what?
Definition
alcohol abuse or gallstones in 70-80% cases.
Term
most common form of hearing loss
Definition
loss of conduction, usually a result of cerumen impaction or trauma
Term
Sensory hearing loss is due to ___

Neural hear loss is due to ___
Definition
Sensory: damage to cochlea

Neural: damage to CN VIII

(differentiate the two with Weber and Rinne tests)
Term
Otitis media is very common in infants and children and is due to what infectious agents?
Definition
Step Pneumoniae and H. Influenza
Term
Vertigo is often caused by what disease?
Definition
Meniere's Disease, a disease associated with episodic and severe vertigo, hearing loss, tinnitus
Term
Acute bacterial sialadenitis is often located where?
Definition
the parotid or submandibular gland

(remember CN VII goes through the parotid gland)
Term
80% of salivary gland tumors involve what gland?
Definition
the parotid gland
(only 50-60% are benign)
Term
leading cause of COPD
Definition
smoking
Term
Describe the signs of both types of COPD
Definition
Emphysema: pink puffers with SOB, decreased breathing sounds, tachycardia
(decreased recoiling means a total exhalation would cause alveolar walls to collapse. So pink puffers only partially exhale)

Chronic bronchitis: blue bloaters with productive cough for 3 consecutive months in 2 or more years with cyanosis of fingers/toes and wheezing/crackling lung sounds.
Term
The pathophysiology of asthma
Definition
Acute reversible bronchoconstriction (triggered and causes coughing, wheezing, dyspnea, tachycardia)

Chronic inflammation of airways
Term
Which of the following can be considered as a form of pneumoconiosis?
a) asbestosis
b) silicosis
c) berylliosis
Definition
All of them!
This disease is secondary to occupational inhalation of dust or other particles inhaled. They cause SOB, decreased lung volume/compliance. Order a chest x-ray to show a ground glass appearance from diffuse infiltrates.
Term
Systemic symptoms of TB? Which is the most common?
Definition
Fever, cough, night sweats

Night sweats are most common
Term
All patients thought to have TB need to have what test done?
Definition
a chest x-ray
Term
Ocular findings of TB
Definition
bilateral anterior granulomatous uveitis

CME

Less common: keratitis, phlyctenules, conjunctival granulomas, scleritis
Term
Two of the most common etiologies of chronic, bilateral anterior granulomatous uveitis
Definition
TB and Sarcoidosis
Term
A positive PPD test for TB is indicated by what amount of induration?
Definition
At least 15 mm of induration in healthy/normal immune system patients

10mm for a health-care worker or someone in contact with active TB patients

5mm for immunocompromised pts (HIV, bone marrow suppression)
Term
The most common cause of bacterial pneumonia
Definition
Streptococcus pneumoniae
Term
the MAIN cause of death from cancer in both men and women
Definition
lung cancer
(adenocarcinoma is the most common lung cancer)
Term
the 4 classifications of neoplasms
Definition
1. behavior
2. degree of differentiation
3. embyologic origin
4. gross appearance
Term
Carcinomas arise from what kind of cells?
Definition
Epithelial
Term
Sarcomas arise from what type of tissue?
Definition
Mesenchymal (connective)
Term
connective tissue cancer that causes bone destruction and is the most common primary orbital malignancy
Definition
Rhabdomyosarcoma
Term
The second most common form of skin cancer
Definition
Squamous cell carcinoma

(Basal cell carcinoma is #1, by a long shot)
Term
To be diagnosed with Bulimia Nervosa, a patient must suffer from how many episodes of binge eating over what period of time?
Definition
2 times per week for at least 3 months
Term
A patient with this condition may appear malnourished with a very swollen belly due to protein malnutrition.
Definition
Kwashiorkor
Term
% of patients that suffer from major depression?
Definition
30%
Term
This condition is due to increased dopamine keels in the mesolimbic region causing a massive disruption of behavior, mood, and thinking for at least 6 months
Definition
Schizophrenia
Term
Signs of endopthalmitis
Definition
hypopyon, vitritis, chemosis, lid edema, reduced red reflex
Term
This presents within a week to a month post-op. Vision loss is insidious, with pain present that worsens.
Definition
Delayed endophthalmitis
Term
lens subluxation is caused by what conditions
Definition
MEWTH

Marfan's, Ehlers Danlos, Weill-Marchesani, trauma, Homocysturinuria,
Term
Ehlers Danlos and Osteogenesis imperfecta cause similar ocular SE like ...
Definition
KC, blue sclera, megalocornea

Difference between the two?

Ehlers Danlos causes lens subluxation…
Term
Most common and most serious SE of Marfan's
Definition
retinal detachments
Term
This is the most common post-op complication following cataract surgery!
Definition
Posterior capsular opacification
(treat with a yag laser)
Term
Elschnig pearls are a type of what?
Definition
posterior capsular opacification

epithelial cell proliferation resulting in clouding of posterior capsule (often 2-6 months after surgery)
Term
This happens in OPL and is most commonly why decreased acuity occurs after cataract surgery
Definition
CME (Irvine-Gass)

often 6-10 weeks after surgery but will likely evolve in 6 months
Term
What conditions cause CME ?
Definition
surgery, diabetic retinopathy, vein occlusions, uveitis, RP, ARMD, retinal vasculitis, Coats Disease

(think anything caused by inflammation?)
Term
Choroidal nevi will (disappear or still be visible) with a red-free filter?
Definition
These will disappear. Remember that retina is soaking up all this green light, so everything below is going to disappear (aka choroid)
Term
Risk factors for PVD
Definition
age (approximates prevalence), myopia, DM, surgeries, inflammation, trauma
Term
Describe the pathophysiology of a PVD
Definition
As hyaluronic acid and collagen complex in vitreous breaks down, collagen clumps up. These clumps can contract and cause the posterior hyaloid to detach from retina.
Term
__ % of patients with an acute symptomatic PVD will have a retinal break
Definition
10-15%
(look for Shafer's sign to aid diagnosis)
Term
Difference between a pre retinal and a vitreal hemorrhage?
Definition
pre-retinal: between retina and an intact vitreous face

vitreal: anterior to posterior vitreous face (inside vitreous)
Term
Diabetic retinopathy is the most common cause of spontaneous vitreal hemorrhages. Tell the story (as Jordan would say) of how this happens
Definition
NV is pre retinal and these new vessels lack endothelial tight junctions, making them super leaky. This creates a situation where vitreal triton can cause sheering of the vessel = hemorrhage
Term
CRVOs result from a compressed artery on a vein that leads to turbulent blood flow, venous vessel wall damage and thrombus formation. Where to thrombi usually form?
Definition
at or near lamina cribs

This leads to ischemia and release of VEGF
Term
Symptoms of a CRVO
Definition
sudden unilateral painless vision loss in elderly patients (most are over 50 YO)
Term
This is the most commonly associated ocular condition with CRVOs
Definition
glaucoma

the optic nerve supports the CRV and CRA so in glaucoma, as nerve fibers are being lost, the vasculature can begin to kink and blood flow order can decrease and turbulence increases
Term
CRVO signs
Definition
hemorrhaging in all 4 quadrants (blood and thunder)
vision is threatened because of macular disease (ischemia and edema) and NV complications

If a young pt presents with this, ask about oral contraceptives!
Term
What are collateral veins?
Definition
They often form over weeks to months after a CRVO at the disc to permit flow between retina and choroid circulations to accelerate draining excess fluid (retinal edema) into choroid circulation after CRVO
Term
Definition of ischemic CRVO
Definition
10 disc diameters or more of non perfusion on FA , likely with 20/200 VA's and a poor prognosis
(Luckily most cases are non-ischemic..67% to be exact)
Term
90-day glaucoma often happens with what condition
Definition
CRVO
60% of ischemic CRVOs develop iris NV while 30% develop glaucoma
Term
by far the most common retinal vascular occlusive disease
Definition
BRVOs
(present with sudden, painless VF loss, blurred vision or no symptoms…if macula is spared)
BRVO is blood in ONE quadrant!
Term
Presenting signs of BRVO
Definition
hemorrhaging in 1 quadrant from obstruction of one branch of CRV, typically at AV crossings. the superior temporal quadrant is most likely location
Term
What is it about AV crossings that leads to veinous occlusions ?
Definition
retinal arteries and veins share a common adventitia at the crossings so a thickened artery can compress a vein
Term
Whats more common: CRAO or BRAO?
Definition
CRAO; if in young then ask about IV drugs or birth control
Term
With suspected CRAO, ask about the following:
Definition
visual blackouts and/or blur (amaurosis fugax)
Term
This often presents with an APD, cherry red spot, superficial whitening of inner retinal layers (returns to normal color later), narrow arterial vasculature, Hollenhorst plaques
Definition
Central Retinal Artery occlusion
Term
Emboli that leads to CRAOs are commonly from where?
Definition
Carotid artery (cholesterol) or the heart (calcified)
Term
Describe the signs of a BRAO
Definition
Edema and white infarction that distributes in the area of the affected BV (mostly temporal). The edema disappears within weeks and a permanent VF defect will present.
Term
Leading cause of new cases of blindness in the US for ages 20-74
Definition
diabetic retinopathy
(DURATION is the biggest risk factor)
Term
The most important signs of diabetic retinopathy because they are threats to vision include:
Definition
macular disease (edema is the most common DR-related cause of blindness) , NV
Term
CSME can happen at any stage of retinopathy. It's based on what criteria?
Definition
1. retinal thickening within 500 micrometers (1/3 DD) of fovea center
2. Hard exudate in 500 micrometers of foveal center with adjacent thickening
3. retinal thickening that is 1 DD in size within 1 DD of fovea center.
Term
Describe each stage of NPDR:
Mild:
Moderate:
Severe:
Very Severe
Definition
Mild: MAs only, 5% risk to progress to PDR
Mod: 15% risk to PDR, anything that is in between…
Severe: 52% risk; follow the 4-2-1 rule
Very Severe: 75% risk, pt meets two or more criteria of 4-2-1
Term
The 4-2-1 rule
Definition
4 quadrants with severe retinal hemorrhages
2 quadrants with venous beading
1 quadrant with IRMA
Term
5% of DR patients progress to proliferative, which can lead to devastating visual outcomes. These patents are at most risk for High Risk Characteristics which are…..
Definition
NV of the disc (greater than 1/4 DD)

Any NVD or NVE with a vitreous or pre retinal hemorrhage
Term
With hypertensive retinopathy, vision is typically unaffected unless vascular changes cause the following...
Definition
macular edema, serous retinal detachments, VEIN OCCLUSIONs
Term
Stages of hypertensive retinopathy
Definition
1- arterial narrowing
2- …and AV nicking
3- ..AND hemorrhages, CWS, HE, edema
4- …and papilledema (hospitalize ASAP)
Term
Venous stasis retinopathy is the precursor to what ocular condition? It often results from blockage at which artery, secondary to which systemic condition?
Definition
This is the precursor to ocular ischemic syndrome (which is posterior/anterior findings AND symptoms) which often occurs at the carotid artery (or ophthalmic…less common) and is secondary to atherosclerosis.

Look for dot/blots at mid-peripheral retina, dilated veins, and NVD.
Term
Venous Stasis Retinopathy is the precursor to OIS, which is often a result of which 3 systemic conditions?
Definition
HTN, DM, cardiac disease

(latter of which is most common cause of 5 year mortality in 40% of these patients). Refer for Carotid Doppler and RTC 3 months to monitor for 90-Day NV
Term
most common cause of amaurosis fugax
Definition
carotid artery embolus
Term
This idiopathic retinal disease often presents in males (many under the age of 10) and progresses rapidly if found in boys under age 4. What the the main symptoms associated with this disease?
Definition
Coat's Disease

Strab & Leukocoria (unilateral in most cases…may simulate a retinoblastoma). Progresses with hard exudates and a total exudative RD if left untreated
Term
Factors that contribute to development of ROP
Definition
birth less than 36 weeks
birth weight less than 2,000 g
had received oxygen therapy
Term
Signs of ROP
Definition
Leukocoria and strab
Since anterior temporal section of retina is last to develop, look for tractional RDs in this region caused by damaged vasculature and NV
Term
T or F
95% of retinoblastoma cases are diagnosed within the first 2 years of life
Definition
Fales:
by age 5
Look for leukocoria and strab (may have decreased vision depending on size and location of tumor)

If bilateral, then DEFINITELY heritable. Which means there's a 50% chance that this kid will pass it on to HIS kid!
Term
Non-heritable retinoblastomas make up how many unilateral cases?
Definition
85%
This will not get passed on to affected patient's kids
Term
Leukocoria differentials
Definition
Coat's Disease
Retinoblastoma
ROP
Toxocariosis
Term
A choroidal nevus isn't a huge deal to us, except if it grows to this size and is located where?
Definition
4DD in size and in close proximity to the optic nerve
Term
Symptoms and signs of Dry AMD
Definition
Most dry AMD cases will not have vision loss though a few can report gradual loss, metamorphosis, blurry vision. Look for drusen and RPE mottling.

Only 12% have severe VL (more than 6 lines loss) and it's likely due to geographic atrophy
Term
Macular Photocoagulation Study Group established 4 main risks that increase progression from dry to wet AMD. These are:
Definition
soft drusen (confluent)
focal hyperpigmentation
HTN
smoking
Term
Characteristic findings of wet AMD (which accounts for 88% legal blindness AMD cases)
Definition
Drusen associated with sub-retinal fluid due to a choroidal neovascular membrane (CNVM)
Term
CNVM's can lead blood or plasma into these two potential places
Definition
sub-RPE
sub retinal space
Term
earliest symptoms of histoplasmosis
Definition
metamorphopsia
(often asymptomatic unless it causes maculopathy)
Term
Clinical triad of histoplasmosis
Definition
peripapillary atrophy of the optic nerve
multifocal lesions in the periphery
maculopathy (including choroid NV…which is a late manifestation)
**remember vitreous is ALWAYS clear with histo**
Term
pathological myopia is axial lengthening greater than 26mm. lengthening in the anterior - posterior direction often leads to scleral thinning and choroid atrophy
Definition
Term
Hallmark of pathological myopia
Definition
posterior staphyloma; bulging of weakened scleral posteriorly.

Also look for oblique optic disc insertion, Fuch's spots, CNVM, lacquer cracks (breaks in Bruch's), macular holes, PSC, PVD, lattice/snail track/ paving stone.
Term
Describe each stage of macular holes
Definition
1: impending hole, low foveal depression with a yellow spot

2: round, small full thickness with pseudo-operculum

3: full thickness & large with operculum, + Watzke Allen (complete break in the middle of a thin light projected within the macular area)

4: Stage 3 AND a PVD
Term
T or F:
Risk of developing a macular hole in the fellow eye is fairly high
Definition
False:

It's less than 1% and there's virtually no risk if a PVD
Supporting users have an ad free experience!