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Picture quiz.

The following FREE Visual Recognition Test (VRT) should be completed online by clicking on the VRT button at www.otcet.co.uk. Respondents should use the 12 images/photos to answer the 12 associated Multiple Choice Questions (MCQ). Please note that there is only one correct answer for each MCQ. Successful completion of the VRT will result in two CET points.

Surgical Treatment of Posterior Eye-related Conditions Course Code: C-10533

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1. This patient has been previously diagnosed with proliferative diabetic retinopathy. Which of the following statements is FALSE relating to the treatment of his condition?

a. Argon or frequency doubled YAG lasers con be used to achieve retinal photocoagulation

b. The aim of the treatment is to prevent haemorrhaging of retinal vessels, neovascularisation and macula involvement

c. Complications of photocoagulation include substantial loss of vision, although the visual held itself is unaffected

d. Vitrectomy may also be combined with this procedure to relieve any fraction, which threatens the macula, and to remove blood from any previous vitreous haemorrhage

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2. Which of the following cells are known to be the primary origin of posterior capsular opacification after cataract removal with phacoemulsification?

a. 'A-type' lens epithelial cells, which remain in the capsular bag and form a single cell layer around the capsulorrhexis

b. 'E-type' germinal lens epithelial cells, which remain in the capsular bag and proliferate, then migrate from the equatorial region

c. 'C' type' cells from the ciliary body which proliferate and migrate towards the rim of the posterior capsule

d. Superior capsulorrhexis cells which proliferate into a cellular multilayer over the surface of the intraocular lens

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3. What is the cause of the extruding tissue visible under the sclera of this 72-year-old female patient?

a. It is a dislocated scleral buckle, which was previously implanted to treat a rheqmatogenous retinal detachment

b. It is pressure from the wire extension of a dislocated intraocular lens

c. It is a drainage tube to relieve intraocular pressure in glaucoma after surgical complications led to pigment dispersion syndrome

d. It is the entry point of retinal transplantation in treatment of retinitis pigmentosa

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4. Which of the following procedures has NOT previously been included in the treatment of retinal vein occlusions?

a. Sheathotomy: removal of retinal vessel sheaths to improve venule blend flow commonly combined with vitrectomy

b. Photocoagulation: grid pattern of ablation with a blue-green argon laser in the territory of the vein occlusion to reduce potential for perfused macular oedema

c. Aspirin and hyperbaric oxygen

d. Anterior chamber paracentesis: Up to 0.4ml of aqueous humor is removed with a hypodermic needle to lower intraocular pressure

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5. Which of the following procedures is LEAST likely to cause scleral thinning or perforation, and a need for patch reinforcement--as shown in this image?

a. Pterygium excision

b. Scleral buckle for retinal detachment repair

c. Iridotomy

d. Trabeculectomy

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6. Which surgical procedure is likely to have been performed in this 67-year-old male, who reports a significant increase in myopia after treatment of a retinal detachment?.

a. Pneumatic retinopexy

b. Pare plana vitrectomy

c. None

d. Scleral buckling

7. Which of the following surgical procedures is the most likely cause of the condition displayed in this image?

a. Paresis of the medial rectus

b. Pneumatic retinopexy

c. Cataract extraction and posterior intraocular lens implantation in sulcus

d. Trabeculectomy

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8. This patient was treated for proliferative vitreoretinopathy due to retinal breaks. After surgery, the patient was required to maintain a tilted head-posture for one week. What is the name and main objective of the treatment?

a. Air bubble injection: Dislodges the pigment dispersed throughout the vitreous. Settling occurs and visual acuity returns to normal after three months

b. Expanding gas bubble injection: C3F3 gas injection seals the retinal breaks via surface tension and allows drainage of subretinal fluid

c. Oil injection: Post vitrectomy, the vitreous is replaced with silicone oil, which increases the intraocular pressure and retinal-membrane traction

d. Cryotherapy: This technique is applied to the area of retinal break to increase the potential success of subsequent treatments or to create chorioretinal adhesion

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9. Which of the following is MOST likely to occur after one week post-operatively, following phacoemulsification and intraocular lens implantation?

a. Endophthalmitis: anaerobic gram-positive bacteria causing low-grade intra ocular inflammation and a white plaque on the posterior capsule

b. Phacoantigenic glaucoma: a reaction that may occur after rapture of the lens capsule. Tolerance to protein is lost and granulomatous inflammation ensues

c. Intraocular pressure elevation: after surgery the pressure can rise over time to over 30mmHg. This increase may last for over one week in 1% of patients

d. Uveitis: transient anterior chamber flare and brief inflammatory response

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10. Which of the following options has NOT been described in the literature for use in the treatment of geographic macular atrophy?

a. No treatment

b. Trabecular filtration

c. Vitrectomy and removal of any choroidal neovascular membrane

d. Macular translocation

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11. This patient attended eye-casualty complaining of halos and a red, sore left eye. After therapeutic management, which of the following surgical procedures would MOST likely be performed to treat his condition?

a. Anterior chamber paracentesis: performed after one week

b. Iridectomy: performed immediately on arrival

c. Iridotomy: performed 24-48 hours after IOP is controlled

d. Laser peripheral iridoplasty: performed one week after IOP is controlled

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12. This dense, opaque, epiretinal membrane (ERM) in a 25-year-old patient adheres strongly to the underlying retina. Which of the following best describes the standard surgical treatment for this condition?

a. After vitrectomy, a bent vitreoretinal blade is used to pick an edge of the ERM, which is removed with forceps. An absence of retinal breaks is confirmed

b. Three pars plana incisions are made and a blunt-tipped pick or bent needle is used to slice into the thickest pert of the ERM, which is removed in pieces

c. After vitrectomy, indocyanine green is used to identify and remove the internal limiting membrane (ILM), which then allows the ERM to be removed in one piece.

d. Three pod pars plana incisions are made and the vitreous is detached from around the optic nerve head by aspiration. Ultrasound is used to break up and remove the ERM pieces, and the retina is checked for any breaks

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Dr Rachael Peterson and Brian Tompkins

With thanks to OPTOS for generously supplying the images for this article. www.optos.com, Tel: 0808 100 4546
COPYRIGHT 2009 Ten Alps Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2009 Gale, Cengage Learning. All rights reserved.

Article Details
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Author:Peterson, Rachael; Tompkins, Brian
Publication:Optometry Today
Geographic Code:4EUUK
Date:Jan 16, 2009
Words:1083
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