Test Your Diabetic Retinopathy Knowledge! Trivia Quiz
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- 1.
What form of diabetic retinopathy is more prevalent in patiets who have ahd diabetes longer and who are on insulin? This form of diabetes requires treatment.
- A.
Proliferative
- B.
Non-proliferative
Correct Answer
A. ProliferativeExplanation
Proliferative diabetic retinopathy is more prevalent in patients who have had diabetes for a longer duration and who are on insulin. This form of diabetic retinopathy is characterized by the growth of abnormal blood vessels in the retina, which can lead to vision loss if left untreated. Treatment is necessary to prevent further complications and manage the condition effectively.Rate this question:
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- 2.
Select the following risk factors for retinopathy.
- A.
Nephropathy
- B.
Glaucoma
- C.
Moderate carotid artery stenosis
- D.
Pregnancy
- E.
Hypertension
Correct Answer(s)
A. NepHropathy
D. Pregnancy
E. HypertensionExplanation
Retinopathy is a condition that affects the blood vessels in the retina, leading to vision problems or even blindness. Nephropathy, pregnancy, and hypertension are all risk factors for retinopathy. Nephropathy refers to kidney damage, which can cause changes in blood vessels throughout the body, including the retina. Pregnancy can also lead to changes in blood vessels, increasing the risk of retinopathy. Hypertension, or high blood pressure, can damage blood vessels and increase the risk of retinopathy as well. Therefore, these three factors are associated with an increased risk of developing retinopathy.Rate this question:
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- 3.
What is the number one risk factor for the development of diabetic retinopathy?
- A.
HgA1C
- B.
Duration
- C.
Ethnicity
- D.
Co-morbidity with Glaucoma
Correct Answer
B. DurationExplanation
The number one risk factor for the development of diabetic retinopathy is duration. This means that the longer a person has diabetes, the higher their risk of developing this eye condition. Diabetic retinopathy is a complication of diabetes that affects the blood vessels in the retina, leading to vision problems and potentially even blindness. The longer a person has diabetes, the more likely they are to experience damage to their blood vessels, increasing their risk of developing diabetic retinopathy.Rate this question:
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- 4.
Select the false statement
- A.
Diabetics are prone to cranial nerve palsies therefore EOMs are a useful test
- B.
IOPs help rule out POAG and neovascular glaucoma
- C.
Pan retinal photocoagulation is usually used to treat the midperiphery, this treatment is required before CSME can be treated on a diabetic
- D.
Additional treatments for Diabetic retinopathy include using a focal and grid laser as well as a vitrectomy and ILM strip
Correct Answer
C. Pan retinal pHotocoagulation is usually used to treat the midperipHery, this treatment is required before CSME can be treated on a diabeticExplanation
Need to treat CSME first!!!Rate this question:
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- 5.
What are the two events that cause diabetic retinopathy to occur?
- A.
Hyperperfusion and edema
- B.
Neovascularization and pericyte degeneration
- C.
Hypoxia and edema
- D.
Vasodilation and basement membrane thickening
- E.
Breakdown of the blood retina barrier
Correct Answer
C. Hypoxia and edemaExplanation
Diabetic retinopathy is a condition that occurs due to damage to the blood vessels in the retina caused by diabetes. Hypoxia, which refers to a lack of oxygen supply to the tissues, is a major factor in the development of diabetic retinopathy. When the blood vessels in the retina are damaged, it can lead to inadequate oxygen supply to the retinal tissues, resulting in hypoxia. Edema, which is the accumulation of fluid in the tissues, is another event that occurs in diabetic retinopathy. The damaged blood vessels can leak fluid into the surrounding tissues, causing edema. Therefore, the combination of hypoxia and edema plays a significant role in the development of diabetic retinopathy.Rate this question:
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- 6.
You are examining a patient and you find they have proliferative diabetic retinopathy (PDR) in their OD eye and nothing in their OS eye. What should you do next?
- A.
Refer the patient to their PCP for better control of their diabetes as indicated by the PDR in their OD eye
- B.
Refer to their PCP for a possible carotid artery stenosis on their OS side.
- C.
Refer the patient to an OMD for PRP or laser Tx on their OD eye
- D.
Tell the patient their OS eye is doing well but their OD eyes is showing signs of their diabetes indicating they need better blood sugar control
Correct Answer
B. Refer to their PCP for a possible carotid artery stenosis on their OS side.Explanation
Diabetic ret should typically be bilateral. If you see one eye that has nothing and the other eye has moderate you know there is probably some type of carotid occlusion on the side without diabetic ret.Rate this question:
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- 7.
During your exam on a 50 yo caucasian M with a 20 year Hx of diabetes you find that he has macular edema and neovascularization. What order do you treat him in?
- A.
Neovascularization then macular edema
- B.
Macular edema then Neovascularization
- C.
They both require PRP for treatment so they can be treated at the same time
- D.
You can treat the neovascularization after the macular edema has resolved on it's own
Correct Answer
B. Macular edema then NeovascularizationExplanation
ALWAYS tx the macular edema BEFORE the neo. o If a pt has CSME and they have neo, the doctor is always going to do focal laser first to tx the macular edema and then do PRP. The reason is when they do PRP you may be pushing more fluid into the macula. So you want to take care of the edema at the macula first. Vitrectomy can also be done for neo. The reason why is the vitreous plays a big role in angiogenesis and neoformation. By doing a vitrectomy the chances of having neo go down. Focal/grid, vitrectomy, ILM strip can all be done for macular edema. PRP, vitrectomy, ILM strip can be done for neo.Rate this question:
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- 8.
Focal/grid, vitrectomy, ILM strip can all be done for macular edema. PRP, vitrectomy, ILM strip can be done for neo.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
The statement is true because the procedures mentioned (focal/grid, vitrectomy, ILM strip) can indeed be done for macular edema. Additionally, the procedures mentioned (PRP, vitrectomy, ILM strip) can also be done for neo (neovascularization). Therefore, both statements are accurate and the answer is true.Rate this question:
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- 9.
Select the false statement
- A.
If the pt has a really dense cataract, PRP is always done before the cataract surgery because cataract surgery creates a lot of inflammation.
- B.
• PRP it shouldn’t be done anywhere in the vicinity of 2dd of the macula. • It also shouldn’t be 500microns from the nasal aspect of the nerve head.
- C.
Hemes will hyperfluress on a FA because they will block the fluorescein.
- D.
Typically a surgeon wont do a lot of PRP on one visit. They will break it up to 2-3 sessions of PRP within a few weeks to avoid ciliochoroidal effusion.
Correct Answer
C. Hemes will hyperfluress on a FA because they will block the fluorescein.Explanation
Ciliochoroidal effusion - All of that laser creates edema in between the choroid and the sclera. That is very bad. That creates choroidal detachment, angle-closure and a shallow AC. FA on a pt with MA they are going to light up like a Christmas tree -> later stages of the FA you will see hyperfluorescence because it keeps leaking a little bit. Hemes will hypofluorous on a FA because they will block the fluorescein. Blood will hypofluorous and ME will hyperfluress.Rate this question:
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- 10.
Select the false statement
- A.
Flame hemes are located in the RNFL, dot blot hemes are located in the inner nuclear/outer plexiform layer.
- B.
Intra-retinal microvascular abnormalities will often leak on an FA. It will also grow towards the vitreous and goes across both arteries and veins.
- C.
Cotton Wool Spots an appear similar to RNFL myelination the can be differentiated from one another by proximity to optic nerve, the presence of striations and whether or not it is long standing
- D.
In order to diagnose severe nonproliferative diabetic retinopathy you need to have 4 quadrants of severe hemorrhaging, 2 quadrants of venous beading and 1 large area of IRMA. You typicall need to see 2 or more of these to be considered severe
- E.
Venous beading is the highest predictor that a patient is going to convert to proliferative diabetic ret.
Correct Answer
B. Intra-retinal microvascular abnormalities will often leak on an FA. It will also grow towards the vitreous and goes across both arteries and veins.Explanation
The false statement is "Intra-retinal microvascular abnormalities will often leak on an FA. It will also grow towards the vitreous and goes across both arteries and veins." This statement is incorrect because intra-retinal microvascular abnormalities do not typically leak on a fluorescein angiography (FA) and they do not grow towards the vitreous. They are localized within the retina and can be seen crossing arteries and veins.Rate this question:
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- 11.
Optociliary shunt vessels
- A.
Joins obstructed veins to non-obstructed veins and obstructed arteries to non-obstructed arteries.
- B.
Connect the central retinal vein to the choroidal veins. It occurs when retinal venous circulation is compromised
- C.
Often lead in outer plexiform and inner nuclear layers
- D.
Are composed of lipids and originate in the outer plexiform layer
Correct Answer
B. Connect the central retinal vein to the choroidal veins. It occurs when retinal venous circulation is compromisedExplanation
Optociliary shunt vessels are formed when there is a compromise in the retinal venous circulation. These vessels connect the central retinal vein to the choroidal veins. They do not join obstructed veins to non-obstructed veins or obstructed arteries to non-obstructed arteries. Optociliary shunt vessels are often seen in the outer plexiform and inner nuclear layers and are composed of lipids.Rate this question:
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- 12.
Which of the following is not a criteria for CSME
- A.
Retinal thickening greater than 1DD within 1DD of the macula.
- B.
Exudates at or within 500 microns of the macula
- C.
Retinal thickening at or within 500microns of the macula.
- D.
Exudates at or within 500 microns of the macula with associated retinal thickening.
Correct Answer
B. Exudates at or within 500 microns of the maculaExplanation
Exudates by themselves may not mean there’s active leaking there. It could just mean that they may have had edema at some point, but now there resolved and there’s just edema. Having exudates there alone by themselves doesn’t necessarily mean they have edema there.Rate this question:
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- 13.
Which of the following is a classic sign for CSME?
- A.
Circinate ring
- B.
Decreased VAs and papilledema
- C.
Focal or diffuse edema without exudates
- D.
Macular edema with a tractional component
Correct Answer
A. Circinate ringExplanation
They can definitely have CSME even if they have 20/20. It may be mild, but they can still have CSME. If you think that you see CSME and they see 20/20, they may still have CSME. Again the goal of the treatment isn’t to improve vision but to save vision. If the patient has 20/20 vision that’s great, so you want to preserve that 20/20 vision.Rate this question:
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- 14.
Both PRP and focal and grid lasers try to accomplish the same thing when being used to treat diabetic retinopathy. They are both killing the retina in order to decrease the oxygen demand.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Focal and grid laser -you’re essentially trying to seal off the leakingRate this question:
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- 15.
What is the first line treatment for neovascularization?
- A.
Focal laser
- B.
PRP
- C.
Grid laser
- D.
Kenalog injection
Correct Answer
B. PRPExplanation
The first line of treatment for neo is PRP. The first line for macular edema is focal or grid laser. Kenalog injection/steroids done if the focal injection is not effective or if there’s way too much edema.Rate this question:
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- 16.
Select the false statement regarding FA
- A.
If you have dot blot hemes you’re gonna get a HYPOfluorescence. It’s going to be dark, and block the fluorescein
- B.
Leakage such as edema or neovascularization will cause HYPERfluorescence at the beginning of the FA, and as time goes on, 5 minutes, 10 minutes, that amount of leaking is going to grow in size and intensity because it keeps leaking.
- C.
Cotton wool spots you’re going to have HYPOfluorescence because they’re areas of non-perfusion
- D.
Microaneurysms will have Hypofluorescence
Correct Answer
D. Microaneurysms will have HypofluorescenceExplanation
Microaneurysms you’ll have HYPERfluorescence. It’s going to be lighted. There may be some adjacent HYPERfluorescence or leaking.Rate this question:
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- 17.
Select the false statement
- A.
Fibrovascular proliferation can cause a tractional RD. It can do other things like distort the retina and optic nerve by dragging it. It can also create vitreal hemorrhages becauseit is tugging on a vessel or neo. It can also create a macular hole.
- B.
Pre-retinal heme or a intra-vitreal heme indicates that you have proliferative DR, even if you can’t see neo.
- C.
There are 3 main types of hemorrhages. There is (1) Intra-retinal (dot or blot heme) (2) Pre-retinal (between retina and posterior hyaloid face of vitreous) (3) Intra-vitreal hemorrhage (inside the vitreous).
- D.
Unlike CSME, Diabetic Papillopathy can not happen at any stage of diabetic retinopathy. It typically occurs at high risk severe diabetic retinopathy.
- E.
NVI originates when the retina becomes so ischemic, the angiogenic factors have no way to be transported, so they move towards the front of the eye. The angiogenic factors will go into the vitreous and into the AC and will bathe the aqueous and iris
Correct Answer
D. Unlike CSME, Diabetic Papillopathy can not happen at any stage of diabetic retinopathy. It typically occurs at high risk severe diabetic retinopathy.Explanation
Diabetic Papillopathy • Unilateral mild ONH edema and is usually unilateral. • Any stage, just like CSME. So you get the signs of disc edema including prominent surface vessels, fine hemorrhages on the disc, cotton wool spots around the disc, indistinct boarders.Rate this question:
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- 18.
Roth spots
- A.
Are due to a complication with vitrectomy
- B.
If seen in diabetics, it represents more of acute change. It’s typically not something you see in pts that have good control or just constantly elevated sugar.
- C.
Are typically seen in people with a history of Hep C
- D.
Is common in sickle cell retinopathy
Correct Answer
B. If seen in diabetics, it represents more of acute change. It’s typically not something you see in pts that have good control or just constantly elevated sugar.Explanation
4. Sickle Cell Retinopathy a. Sea-fan neo** – classic sign of Sickle cell b. Black sunbursts – RPE proliferation from deep penetrating hemes c. Salmon patches – fresh blood (intra-retinal) d. Angiod Streaks – Breaks in Bruch’s Membrane (can lead to growth of choroidal vessels into the retinal) e. Hemosiderin patches - patches of extra iron Complications with vitrectomy • Endophthalmitis (infection of posterior chamber). • Cataract, RD from the surgery itself • If they touch the endothelium of the cornea or if there is too much heat during the surgery, it could cause decompensation of the endothelium which can lead to edema. • F/U in 1 day, 1 week, 1 month, 3 months. You are dilating them every time just to make sure things are going ok.Rate this question:
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- 19.
Which of the following signs are found in hypertensive retinopathy?
- A.
More cotton wool spots than hemes
- B.
Blood and thunder
- C.
Vessel changes such as attenuation
- D.
Macular star
- E.
Vessel sheathing
Correct Answer(s)
A. More cotton wool spots than hemes
C. Vessel changes such as attenuation
D. Macular starExplanation
Vessel sheathing - white patch near vessels - associated more with antiphospholipid syndromeRate this question:
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- 20.
Your patient is a 23 yoM with a history of recent trauma . On BIO evaluation you see CWS and Hemes, the majority of which are located near the ONH. Which of the following conditions is the highest on your diferential diagnosis?
- A.
Sickle cell retinopathy
- B.
Interferon Retinopathy
- C.
Ocular Ischemic syndrome
- D.
Eale's Disease
- E.
Antiphospholipid syndrome
- F.
Purtscher's Retinopathy
Correct Answer
F. Purtscher's RetinopathyExplanation
Purtscher's retinopathy is the highest on the differential diagnosis because it is characterized by cotton wool spots (CWS) and hemes, which are seen in the patient's BIO evaluation. Additionally, the majority of these findings are located near the optic nerve head (ONH), which is consistent with Purtscher's retinopathy. Sickle cell retinopathy, interferon retinopathy, ocular ischemic syndrome, Eale's disease, and antiphospholipid syndrome may also present with similar findings, but the location of the CWS and hemes near the ONH suggests Purtscher's retinopathy as the most likely diagnosis.Rate this question:
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- 21.
Selec the statements that apply to fibrovascular proliferation
- A.
May cause a tractional RD
- B.
It is caused by neo growing into the vitreous and actually hemorrhaging into the vitreous
- C.
May distort the retina and ON by dragging it
- D.
It can create a macular hole
- E.
Is the result after PDR is treated and the neo goes away and then you see them in a year and see dot hemes but no neo
Correct Answer(s)
A. May cause a tractional RD
C. May distort the retina and ON by dragging it
D. It can create a macular holeExplanation
Option 2 : that's what causes vitreal hemorrhages
Option 5: Involutional Proliferative Diabetic Retinopathy.Rate this question:
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Mar 20, 2023Quiz Edited by
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Aug 27, 2012Quiz Created by
Mchllmijares
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