Download Eye-Q Answer Key 2013--Dr. Michael S. Jacobson 18th Annual

Eye-Q Answer Key 2013--Dr. Michael S. Jacobson
18th Annual Georgia Retina Pearls--Maggiano’s
April18, 2013 and April 23, 2013
Bob had lived a long life, which was drawing to its end. As his family surrounded him on his
deathbed, he mumbled he wanted to see his eye doctor.
“Eye doctor?" they asked. "Why in the world do you want to see your eye doctor?"
"Just get him for me.“ I do not have long.
So they go get Dr. Smith, who, on seeing Bob about to depart this life, asked, “Bob, it pains me
to see you like this. What can I possibly do for you?"
Bob opened his eyes slightly and said, "Doc, before I go, there's one thing I have to know. Which
one was clearer – 1 or 2?"
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Question 1
1. Georgia Retina has the best looking doctors in the country.
2. Georgia Retina has 10 doctors in 8 offices
3. Georgia Retina has been in practice for almost 20 yrs and was founded with co-management at its core.
4. Georgia Retina has been a leader in clinical trials to assure your patients gain access to the latest
breakthroughs
Select the most correct answer
A. all are correct
B. 2,3 & 4 are correct
C. none are correct
D. 1 is correct
Answer 1
1. Georgia Retina has the best looking doctors in the country.
2. Georgia Retina has 10 doctors in 8 offices but will soon be opening a new office in the Covington/ Conyers
area.
3. Georgia Retina has been in practice for almost 20 yrs and was founded with co-management at its core.
4. Georgia Retina has been a leader in clinical trials to assure your patients gain access to the latest
breakthroughs
A. all are correct
B. 2,3 & 4 are correct
This response depends on your ability to discern good looks, coolness and the quality of your vision
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Question 2– who are these guys?
Question 2– who are these guys?
Answer 2– These are our new retinal docs starting this summer?
Dr. Krishna Mukkamala
College and Medical School at VCU/MCV (biomed engineering)
Residency at New York Eye & Ear
Prestigious VR fellowship with Dr Stanley Chang at Columbia U in NYC
Prolific author: 1 chapter, 4 pending articles, 9 publications and 12 posters
Married to Shivani who is a doctor also, they have an 18mo daughter
His interests are hiking , biking and travelling
Answer 2– These are our new retinal docs starting this summer?
Dr. Hyung Cho
Went to Dartmouth College (same as Dr Jacobson) and was in his same fraternity
Medical School and residency at Albert Einstein (NYC)
Prestigious VR fellowship with Dr Jay Duker at Tufts (same as Dr Rivellese)
Prolific author: 4 chapters, 6 abstracts, 12 publications and many posters
Single
Fluent in Korean & some German
Accomplished break dance
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Question 3
55 yo white woman in with a history of breast cancer and who smokes 1PPD and has had no prior eye exams
presents with a “ocular irritation” and her eye doctor finds her to have this 2DD pigmented lesion. She should be
told that….
Answers 3
A. this is a melanocytoma
B. this is most likely a choroidal nevus.
C. this is most likely a choroidal metastasis.
D. this is most likely a choroidal melanoma
Choose the correct answer:
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Question 4
A 65 yo white woman in good health develops blurred vision (20/60) and distortion which progresses. She is
found to have vitreomacular adhesion and advised that:
Answers 4
A. this will likely resolve spontaneously
B. this will not benefit from a gas bubble
C. this will convert to a macular hole soon if surgery is not done right away
D. this may benefit from a Jetrea injection
Pick the most correct answer.
Answers
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Question 5
 65 yo white woman c/o “floaters” and is found to have a vitreous hemorrhage OS. The referring doctor
thinks there is a superior retinal tear since there is visible elevated tissue but it is obscured by the bleeding.
The FA shows the following hyperfluorescent findings in one quadrant but everywhere else is normal. You tell
her that:
Answers 5
1. laser will make it worse
2. this is most likely adult Coats’ disease
3. this is likely proliferative diabetic retinopathy
4. there is a chance that this may have arisen from an old BRVO
A. 2 & 4 are correct
B. 1 is correct
C. 1 & 3 are correct
D. 2,3 & 4 are correct
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Question 6
 A 75 yo attorney recovered from a macula-off retinal detachment and developed this problem
 OS: 20/200
Answers 6
1. Surgery is worthwhile even under these circumstances
2. MP surgery can now be done often without stitches, with mild sedation, and might only take 15 minutes.
3. He has a 90% chance of gaining VA and/or lessening distortion with surgery.
4. This may be a manifestation of early PVR.
Choose the best answer
A. All are correct
B. None are correct
C. 1 and 3 are correct
D. 2 and 4 are correct
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Question 7 -- 2 part
A 83 yo Vietnamese man- c/o “decreased VA” and is found to have the following OCT findings and VA of 20/200 and
the doctor wants the best care for his patient so he sends the patient to…..
Answers 7A
all are correct, just make sure you refer the pt to a retinal specialist there
A. Georgia Retina
B. Omni Eye Associates
C. Woolfson Eye Institute
D. Emory Eye Clinic
E. Retinal surgeon of your choice
Choose the best answer.
Answers 7 B
This patient has:
1. Wet macular degeneration
2. A good chance with vitrectomy surgery
3. Will benefit from anti-VEGF treatments
4. Macular pucker with sub retinal fibrosis
A. 2 & 4 are correct
B. None are correct
C. 1 & 3 are correct
D. All are correct
Choose the best answer.
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Question 8
How well do you know eyes??
Question/ Answers 8-- How well do you know eyes??
Names the people by their eyes, each correct answer is worth 20% of a correct answer
Jolie, Beyonce,Dicaprio, Mona Lisa, Will Smith
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Question 9
 A 82 yo woman c/o “ gradually worsening vision” She is found to have macular issues and VA of 20/40 OD
and 20/60 OS. Her FA shows well-defined window defects . She needs to know that:
Answer 9-- pick the correct answer
A. This is wet ARMD
B. Her VA will worsen relatively and surprisingly quickly over the next few years
C. There are no clinical trial to address her problem
D. No vitamin supplements have scientifically been proven to slow down this condition
E. She needs an emergent retinal consult
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Question 10
 A 55 yo woman (-10 myope) is referred to our office to assess the unusual appearance of her OS. Her POH is
extensive. She has had bilateral glaucoma since her childhood. She had unsuccessful retinal surgery elsewhere
and then due to uncontrolled pain in that eye, she elected enucleation. Her VA in her OD is 20/30,
 Her OD appears the way it does because of:
Answer 10
A. Macular pucker
B. Progressive degenerative myopia
C. Retinopathy of prematurity
D. Advanced glaucoma
E. Proliferative Sickle Cell Retinopathy
 Choose the best answer
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Question 11
 Best disease-which typically presents with an egg yolk lesion that eventually becomes scrambled and is:
Answers 11 ( Choose the best answer)
A. Inherited in a recessive fashion
B. Inherited in a dominant fashion
C. likely to advance to CF vision
D. likely to have an normal EOG
E. Does not involve the VMD2 gene
Question/ answers 12
>60% of Retinal vein occlusion (RVO) patients are likely to get a good response from:_ avastin, lucentis, ozurdex,
steroid, kenalog, anti vegf injectionsName an injectable agent
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Question 13 -- find the emergency D central artery oclusion
Question 14 -- find the emergency D branch artery occlusion
Question 15-- find the emergency C small Retinal detachment with the macula on
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Question 16/ 17
You should know the doctor to whom you refer, you agree? The more you know about them, the more comfortable
you will be to send your patient. So to make sure that you are familiar, let’s see what you know already!
Question/ answers 16-- test to see if you were listening earlier
This new doctor went to the same college as Dr Jacobson and did the same fellowship as Dr Rivellese. He has a 7 th
degree black belt in Tae-Kwon Do and had performed regularly as a break dancer in a modern dance troupe.
He is Doctor_____CHO____________
(Fill-in the blank)
Question/ answers 17
This new doctor studied biomedical engineering at VCU. He is married and his wife is a doctor and they have a
young daughter. He enjoys hiking , biking and travelling. He is not a 7 th degree black belt, so he will not hurt you if
you do not refer patients.
He is Doctor_______Mukkamala_____________
(Fill-in the blank)
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Question 18
28 yo slightly overweight black woman (160#) in excellent health complains of “inferior field defect OD and flashes”
and the referring doctor was concerned about a hidden RD so he requested an emergent referral. See the fundus
photos. The patient denied any neurologic symptoms.
OU: 20/20
Likely possibilities include:
Answers 18
1. Optic neuritis
2. A brain tumor
3. Pseudo tumor cebrebri
4. Pseudopapilledema
5. Hydrocephalus
A. 1 is correct
B. 2, 3, 4, & 5 are correct
C. None are correct
D. All are correct
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Question 19 Tobacco Dust
You should always look for tobacco dust in a patient with a PVD or photopsias, because the presence suggests that
the pt is likely:
1. To have a hidden RT or RD even if I can not see it
2. Has loose RPE cells in the anterior vitreous
3. exhibiting Shafer’s sign
4. Should see a retinal specialists in a few weeks
Answers 19--Tobacco Dust
A.
1 , 2 & 3 are correct
B. None are correct
C. All are correct
D. Only 1 is correct
E. 1 & 4 are correct
1. To have a hidden RT or RD even if I can not see it
2. Has loose RPE cells in the anterior vitreous
3. exhibiting Schaffer’s sign
4. Should see a retinal specialists in a few weeks
Question 20– “ocular history”
How are you on your ocular history??
Question 20-- “eye for an eye”
“Eye for eye, tooth for tooth, hand for hand, foot for foot”
What part of the bible first mentions this famous quotation of reciprocal justice? Of course this was never intended
to be literal as in Hammurabi’s time, but rather point to the equality that must occur in judicial decisions.
A. Exodus 21:24
B. Genesis
C. Numbers
D. Proverbs
E. Matthew
Pick the correct answer
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Question/ answers 21
Fluorescein angiography..
A. Involves an iodine based dye
B. Only 1: 1000 pts will have a serious reaction to the dye
C. Dye usually reaches the back of the eye at 20-25 seconds
D. Allows us to diagnose Best disease or RP
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Question/ answers 22
This cell layer (see arrows) is the:
Choose the correct answer
A. Ganglion cell layer
B. RPE layer
C. Inner nuclear layer
D. Outer nuclear layer
E. Middle nuclear layer
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Question/ answers 23
The incidence of RD following cataract surgery is:
1. 2-3% after normal surgery
2. Twice as high in high myopes
3. 10% of pts with vitreous loss
4. YAG laser does not effect the incidence
A. 1 & 3 is correct
B. 2 & 4 is correct
C. None are correct
D. All are correct
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Question/ answers 24
Neovascularization of the iris (NVI):
A. Occurs in most PDR patient
B. Occurs in 40% of CRVO pt within the first 3 months of onset. ( 90 day glaucoma)
C. When present , usually means no more PRP is needed
D. Occurs in 15% of CRAO pts
E. Can still be seen well after dilation
Choose the correct answer
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Question/ answers 25
PVD incidence:
Choose the correct answer
A. Does not occur sooner as a consequence of axial length or age
B. 60% of pts by age 5o have developed one even if they are asymptomatic
C. >60% of pts over age 70 have developed one
D. Retinal specialists can almost always detect one if present
Question/ answers 26 T/F
Treatment of wet ARMD: (each answer worth one quarter)
a) May require injections every 4-5 wks for the rest of one’s life (True /False)
b) In responders, VA may improve 90% of the time (True /False)
c) Will no longer include PDT or thermal laser (True /False)
d) May change to Macugen from LUC or AVA if pt has a stroke (CVA) or CVA history (True /False)
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Good job again!
Hope you found it challenging
Congratulations to all our participants
Did you know that Georgia Retina..
 Has cared for 1 out of 50 people in North Georgia
 Has received referrals from more than 200 OD’s
 Accept all insurance plans
 Over the past 5 yrs has provided more charity care than almost any other eye practice in the state
 Wants to be your only choice for retinal care
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For the less engaged patient, when all else fails, use the E chart, I mean the bone chart in this case