Retinopathy Challenge

This content comes from the accuretina-quiz.php found here: /wp-content/themes/accuretina/accuretina-quiz.php

        
        	Step 1 of 18
        	
            
                5%
            
                        
                                    Name*
                            
                            
                                                    
                                                    First
                                                
                            
                            
                                                    
                                                    Last
                                                
                            
                        
Email*
                            
                        

DRS 7-field retinal photography:
I.  Originated from an NIH funded diabetic retinopathy  research group beginning in the 1970’s
II.  Provides for standardized grading scales that are reproduceable across readers
III.  Requires stereo pairs for each field (28 images in a full imaging study)
IV.  Is the reference standard for clinical studies of diabetic retinopathy
			
				
				A. I, II
			
			
				
				B. I, III
			
			
				
				C. I, II, IV
			
			
				
				D. All of the above
			
                    
                    
                          
                    
                
                
                    
                        OD Panorama 
In retinal image set, the ETDRS diabetic retinopathy level is:
			
				
				A. Level 10 Diabetic Retinopathy Absent and no similar or confounding pathology seen.
			
			
				
				B. Level 14 Diabetic Retinopathy Absent, Other Pathology present No microaneurysms are present, but there are very small amounts of lipid deposits, cotton wool spots, or blood vessel abnormalities that can have other causes besides diabetes.
			
			
				
				C. Level 15 Diabetic Retinopathy Absent, Other Pathology present No microaneurysms are present, but there are a few, small retinal hemorrhages that can have other causes besides diabetes.
			
			
				
				D. Level 20 Mild Non-Proliferative Diabetic Retinopathy (NPDR) Only microaneurysms are present.  Microaneurysms are small out-pouchings on the capillary (small blood vessel).
			
                    
                    
                          
                    
                
                
                    
                        GIF of stereo retinal pair
Stereoscopic field images were used for:
I.   Evaluating depth and thickness of retinal artifacts 
II.  Identifying clinically significant macular edema
III. Detecting microaneurysms 
IV. Differentiating between IRMA and neovascularization
			
				
				A. I, II
			
			
				
				B. I, III
			
			
				
				C. I, II, IV
			
			
				
				D. All of the above
			
                    
                    
                          
                    
                
                
                    
                        OD Panorama 
In reviewing this retinal image set, the ETDRS diabetic retinopathy level is:
			
				
				A. Level 20 Mild Non-Proliferative Diabetic Retinopathy (NPDR) Only microaneurysms are present.  Microaneurysms are small out-pouchings on the capillary (small blood vessel) walls that are definitive for diabetic retinopathy (i.e. they are not caused by any other disease or condition).
			
			
				
				B. Level 35 Mild NPDR Microaneurysms are present, along with venous loops, a few small retinal hemorrhages, cotton wool spots and/or the questionable presence of other lesions such as intra-retinal microvascular abnormalities (IRMA) or venous beading.
			
			
				
				C. Level 43 Moderate NPDR Presence of a moderate number of microaneurysms and retinal hemorrhages in several areas of the retina OR definite IRMA in one location.
			
			
				
				D. Level 47 Moderately Severe Increasing number of microaneurysms and retinal hemorrhages is several areas of the retina AND definite IRMA in one location; OR the widespread presence of IRMA or the definite presence of venous beading in only one location.
			
                    
                    
                          
                    
                
                
                    
                        OS 2 L
What clinically significant pathologies are present in this left eye, field 2?
			
				
				A. Hard exudates
			
			
				
				B. Soft exudates
			
			
				
				C. Dot Blot Hem
			
			
				
				D. All of the above
			
                    
                    
                          
                    
                
                
                    
                        OS Panorama 
In reviewing this retinal image set, the ETDRS diabetic retinopathy level is:
			
				
				A. Level 35 Mild NPDR Microaneurysms are present, along with venous loops, a few small retinal hemorrhages, cotton wool spots and/or the questionable presence of other lesions such as intra-retinal microvascular abnormalities (IRMA) or venous beading.
			
			
				
				B. Level 43 Moderate NPDR Presence of a moderate number of microaneurysms and retinal hemorrhages in several areas of the retina OR definite IRMA in one location.
			
			
				
				C. Level 47 Moderately Severe Increasing number of microaneurysms and retinal hemorrhages is several areas of the retina AND definite IRMA in one location; OR the widespread presence of IRMA or the definite presence of venous beading in only one location.
			
			
				
				D. Level 53 Severe NPDR Very large numbers of microaneurysms and retinal hemorrhages in several areas of the retina; moderate levels of IRMA in several locations; or venous beading in more than one location.
			
                    
                    
                          
                    
                
                
                    
                        
What combination of diabetic retinopathy pathology is seen in this right eye field 2 image? 
I)	Hard exudates
II)	Nerve fiber layer infarct (cotton-wool patch)
III)	Dot-blot hemorrhages
IV)	Retinal detachment
V)	Pre-retinal hemorrhage
			
				
				A. I, II, III
			
			
				
				B. I, III, V
			
			
				
				C. II, III, IV
			
			
				
				D. I, II, III, V
			
                    
                    
                          
                    
                
                
                    
                        OS 2 L
Clinically Significant Macular Edema (CSME) is seen when one of the following occurs:
1) Retinal thickening at or within 500 microns or 1/3 disc diameter of center of macula.
2) Hard exudates at or within 500 microns of the center of the macula with adjacent retinal thickening.
3) Retinal thickening GREATER than 1 disc diameter in size which is within 1 disc diameter from the center of the macula. 

This left eye, field 2 is an example of:
			
				
				A. Normal eye
			
			
				
				B. Macular Edema – not clinically significant
			
			
				
				C. Macular Edema- clinically significant
			
                    
                    
                          
                    
                
                
                    
                        OD 5 R
This right eye field 5 image shows fluffy white patches in the retinal periphery.   These artifacts are:
			
				
				A. Accumulations of axoplasmic fluid in the nerve fiber layer
			
			
				
				B. Nerve fiber layer infarctions
			
			
				
				C. Often seen in diabetes patients
			
			
				
				D. B & C
			
			
				
				E. A, B & C
			
                    
                    
                          
                    
                
                
                    
                        OS 1 R
This right eye field one image is an example of:
			
				
				A. Macular edema
			
			
				
				B. Splinter hemorrhage of the disc
			
			
				
				C. Microaneurysms
			
			
				
				D. Vitreous detachment
			
                    
                    
                          
                    
                
                
                    
                        OD 2 R
This right eye field 2 image of a diabetic patient shows:
			
				
				A. Macular edema, clinically significant
			
			
				
				B. Macular edema, not clinically significant
			
			
				
				C. Exudates within 500µm of center macula
			
			
				
				D. A & C
			
                    
                    
                          
                    
                
                
                    
                        OS Panorama 
In reviewing this retinal image set, the ETDRS diabetic retinopathy level is:
			
				
				A. Level 47 Moderately Severe Increasing number of microaneurysms and retinal hemorrhages is several areas of the retina AND definite IRMA in one location; OR the widespread presence of IRMA or the definite presence of venous beading in only one location.
			
			
				
				B. Level 53 Severe NPDR Very large numbers of microaneurysms and retinal hemorrhages in several areas of the retina; moderate levels of IRMA in several locations; or venous beading in more than one location.
			
			
				
				C. Level 61 Mild Proliferative Diabetic Retinopathy (PDR) Presence of any neovascularization (NV) not on the optic disc; or presence of fibrous proliferation without visible NV.
			
			
				
				D. Level 65 Moderate PDR Presence of larger or more numerous areas of NV not on the optic disc; or a small amount of NV on the disc; or the presence of small amounts of pre-retinal or vitreous hemorrhaging without extensive NV away from the optic disc; or any NV on disc.
			
                    
                    
                          
                    
                
                
                    
                        OS 2 L
This left eye, field 2 image presents:
			
				
				A. Retinal vein occlusion resulting from bleeding under the retina
			
			
				
				B. Retinal hemorrhage resulting from bleeding from a retinal arteriole
			
			
				
				C. Hem. central retinal vein occlusion
			
			
				
				D. Vitreous hemorrhage from neovascularization of the disc
			
                    
                    
                          
                    
                
                
                    
                        OS Panorama
In reviewing this retinal image set, the ETDRS diabetic retinopathy level is:
			
				
				A. Level 61 Mild Proliferative Diabetic Retinopathy (PDR) Presence of any neovascularization (NV) not on the optic disc; or presence of fibrous proliferation without visible NV.
			
			
				
				B. Level 65 Moderate PDR Presence of larger or more numerous areas of NV not on the optic disc; or a small amount of NV on the disc; or the presence of small amounts of pre-retinal or vitreous hemorrhaging without extensive NV away from the optic disc; or any NV on disc.
			
			
				
				C. Levels 71, 75 High Risk PDR Large areas of NV with pre-retinal or vitreous hemorrhaging; or NV on the optic disc with pre-retinal or vitreous hemorrhaging; or extensive NV on the optic disc.
			
			
				
				D. Levels 81, 85 Advanced PDR Extensive NV and/or extensive pre-retinal or vitreous hemorrhaging; may include detachment of the macula.
			
                    
                    
                          
                    
                
                
                    
                        OD 2 R
Neovascularization is the formation of new abnormal blood vessels in response to poor perfusion or ischemia.   The image above illustrates these abnormal vessels:
			
				
				A. Along the retinal arcades
			
			
				
				B. Emerging from venous loops
			
			
				
				C. On the optic disk
			
			
				
				D. A & C
			
			
				
				E. All of the above
			
                    
                    
                          
                    
                
                
                    
                        OD 4 R
This right eye field 4 image showing proliferative diabetic retinopathy has anatomical features of:
			
				
				A. Venus tortuosity
			
			
				
				B. Neovascularization
			
			
				
				C. Macular edema
			
			
				
				D. A & B
			
			
				
				E. A & C
			
                    
                    
                          
                    
                
                
                    
                        OS 2 L
This 64-year-old diabetic woman presented for evaluation of blurry vision in her left eye. She has had type 2 diabetes for 30 years and is on oral hypoglycemic therapy with an HbA1c of 8.4. Her last eye exam was three years ago. Findings are most likely due to:
			
				
				A. Rhegmatogenous retinal detachment (hole or tear in the retina)
			
			
				
				B. Tractional retinal detachment (scar tissue growth resulting in retina separation)
			
			
				
				C. Exudative retinal detachment (fluid accumulative separation)
			
			
				
				D. Traumatic retinal detachment (impact)
			
                    
                    
                          
                    
                
                
                    
                        OS Panorama
In reviewing this retinal image set, the ETDRS diabetic retinopathy level is:
			
				
				A. Level 61 Mild Proliferative Diabetic Retinopathy (PDR) Presence of any neovascularization (NV) not on the optic disc; or presence of fibrous proliferation without visible NV.
			
			
				
				B. Level 65 Moderate PDR Presence of larger or more numerous areas of NV not on the optic disc; or a small amount of NV on the disc; or the presence of small amounts of pre-retinal or vitreous hemorrhaging without extensive NV away from the optic disc; or any NV on disc.
			
			
				
				C. Levels 71, 75 High Risk PDR Large areas of NV with pre-retinal or vitreous hemorrhaging; or NV on the optic disc with pre-retinal or vitreous hemorrhaging; or extensive NV on the optic disc.
			
			
				
				D. Levels 81, 85 Advanced PDR Extensive NV and/or extensive pre-retinal or vitreous hemorrhaging; may include detachment of the macula.