Diabetic Retinopathy Lesions of NPDR 1 Question: Lesions of NPDR include (check all that apply) FEEDBACK: Reason answer is correct or incorrect. a dot/blot hemorrhage This is a lesion of NPDR b cotton wool spots This is a lesion of NPDR c vitreous hemorrhage This is a lesion of PDR only d hard exudates This is a lesion of NPDR e IRMA This is a lesion of NPDR f macular edema This is a lesion of NPDR g neovascularization This is a lesion of PDR only 2 Question: Hard exudates FEEDBACK: Reason answer is correct or incorrect. a are lipoprotein precipitates of serum that have leaked into the retina Yes, this is what they are b represent infarction of the retina nerve fiber layer No they don’t c come from neovascularization No they don’t d are frequent causes of decreased vision Hard exudates seldom cause vision loss but are a marker of macular edema and leakage 3 Question: Hard exudates (check all that apply) FEEDBACK: Reason answer is correct or incorrect. a are lipoprotein precipitates of serum yes b come from leaky aneurysms yes c come from IRMA IRMA do not leak d are associated with edema yes e predispose to neovascularization No they do not f. can accumulate in circular or linear patterns yes 4 Question: increased retinal blood flow due to hypoxia can be manifested by ( pick all that apply) FEEDBACK: Reason answer is correct or incorrect. a venous beading Yes – this is due to increased flow b IRMA Yes – yes this is due to increased flow c dot hemorrhages No – while dot hemorrhages may be associate with hypoxia, they are not due to increased retinal blood flow these d hard exudates These are due to breakdown of blood retina barrier but no increased flow e cotton wool spots These are occlusions of precapillary srterioles Lesions of PDR
1 Question: The hallmark lesion of proliferative diabetic retinopathy is FEEDBACK: Reason answer is correct or incorrect. a neovascularization of the retina and/or optic disc By definition, this is PDR b macular edema This can be seen in any retinopathy c vitreous hemorrhage This can be seen in PDR but is not specific to PDR d hard exudates This is due to breakdown of blood retina barrier and not proliferation of new vessels e venous beading This is due to increased flow, not prolifweration 2 Question: retinal neovascularization is the result of FEEDBACK: Reason answer is correct or incorrect. a chronic intraretinal hemorrhages no b decreased protein kinase C activity Increased PKC may play a role in neovascularization c capillary endothelial cell dysfunction This results in leakage, not proliferation d upregulation of VEGF yes e nonperfusion of the optic disc Nonperfusion in retina upregulates VEGF, not the disc 3 Question: complications of neovascular proliferation include (pick all that apply) FEEDBACK: Reason answer is correct or incorrect. a macular edema This results from breakdown of blood retina barrier b hard exudates This results from breakdown of blood retina barrier c vitreous hemorrhage This can result from ruptured neovascular tissues in PDR d traction retinal detachment This results from contracture of fibrovascular proliferation in PDR e cotton wool spots This is a result of occlusion of precapillary arterioles f IRMA These are dilated capillaries seen in increased flow situations 4 Question: Neovascularization of the retina or optic disc may be present in asymptomatic eyes. FEEDBACK: Reason answer is correct or incorrect. a True Neovascularization by itself produces no change in vision, but complications of neovascular proliferation do cause vision loss by bleeding in the eye or retinal detachment
seven less than 7.0 2 Question: The ideal systolic blood pressure for someone with retinopathy is FEEDBACK: Reason answer is correct or incorrect. a less than 130 mmHg UKPS study recommendations b less than 130 c 130 or less d 130 mmHg e 130 mmHg or less 3 Question: How often should persons diagnosed with type 1 diabetes have their eyes examined by an ophthalmologist FEEDBACK: Reason answer is correct or incorrect. a every year starting at the time of diagnosis b every year beginning 5 years after the diagnosis of diabetes Standard screening recommendation c every year if their HgbA1C is greater than 7 d Every 6 months 4 Question: How often should persons with type 2 diabetes have their eyes examined by an ophthalmologist FEEDBACK: Reason answer is correct or incorrect. a annually beginning at the time of diagnosis Standard screening recommendation b annually beginning 5 years after the diagnosis of diabetes c only if they have ocular symptoms d every 6 months 5 Question: A woman with type 1 diabetes is trying to become pregnant. She should have her eyes examined for retinopathy (Best answer) FEEDBACK: Reason answer is correct or incorrect. a beginning in the second trimester b prior to conception Standard screening recommendation c only if she has visual symptoms d if her blood sugars are poorly controlled 6 Question: Your patient should be referred to an ophthalmologist if (check all that apply) FEEDBACK: Reason answer is correct or incorrect. a there is sudden loss of vision Best practices/Standard screening recommendation b there is unexplained loss of vision Best practices/Standard screening recommendation c you find hard exudate near the fovea Best practices/Standard screening recommendation d you find NVD or NVE Best practices/Standard screening recommendation e there is pre-retinal or vitreous hemorrhage Best practices/Standard screening
5 Question: A 30 year old female with a 25 year history of type 1 diabetes presents with a sudden onset of floaters in her right eye. The most likely reason for this vision loss is FEEDBACK: Reason answer is correct or incorrect. a macular edema Macular edema causes slowly progressing loss of central visual functions. b traction retinal detachment TRD usually is slowly progressing over weeks or months c vitreous hemorrhage This may occur suddenly without any warning in patients with PDR d hard exudation Hard exudates seldom cause vision loss but are markers of a slowly progressive and persistent leaking of injured blood vessels that also results in edema, which is what causes the vision loss. e retinal neovascularization Retinal neovascularization is asymptomatic until it breaks and bleeds.