High Yield Knowledge for the Ophthalmology Trainee
This looks like a combined BRVO/ BRAO
Thanks for the comment, gtrichonas. Do you remember which one you were referring to? Unfortunately, we can’t reference the question without the question ID (located at the bottom of every post)
maybe Ehlers Danlos shouldn’t be part of PEPSI any more? https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2717493
Thanks for pointing out that article, pcommiskey! We brought this point up with our retina expert and this is what he said: “Although Ehlers-Danlos doesn’t always have angioid streaks, it is common enough in clinical practice that it is worth considering in your differential. The PEPSI mnemonic is really just a good starting point if you are in clinic and would like to begin a workup for a patient (or if you are being quizzed by a senior/attending). In reality, there is a huge long list of other possible associations of angioid streaks, and people have wondered whether those are true associations or just something that the patient happen to have while having some other rare condition.”
Question ID: 522 “intraretinal hemorrhage” is keyed as the correct answer and “retinal hemorrhage” is keyed as incorrect. The answer text and image both point to “retinal hemorrhage” as the correct answer.
Thanks for the correction, Masumi. This question has been fixed.
Regarding Question ID: 528: what about RNFL changes that accompany the engorged vein? How do you explain them?
Hi Barbara, we actually don’t have a great explanation for those particular changes. It could possibly be RNFL changes in the setting of some associated macular edema. We’ll ask around to some other retina specialists to see if we can get you a better answer!
Question ID: 517
What’s going on with the disc here? To me – it looks abnormal / margins aren’t distinct
Hi Zack, this is a disc with peripapillary atrophy. This could be mistaken for papilledema or optic nerve head drusen, especially since the color of this PPA makes it blend in with the disc itself. Papilledema causing disc margin irregularities to this degree would also lead to more pronounced blurring of the margins and likely would also show some obscuration of the major blood vessels. B-scan and SD-OCT can be used to evaluate suspected optic nerve head drusen to help differentiate it from papilledema.
Very good program
Thank you, glad it’s helpful!
Good images for practice though some of the images have artifacts which could be mistaken for cotton wool spots.
Agreed – there are definitely a few images with annoying artifacts that can easily be mistaken for pathology. We intentionally left these in because artifacts frequently show up in real life too. We think it’s good practice to learn how to differentiate them.
Great images, quizzes and explanations! Just wondering about question ID 534. Is there a flame haemorrhage at 11 o’clock at the disc?
Hi Catriona, it’s hard to tell from this photo. It may be an early flame hemorrhage, or it may be just a small DBH that looks like a flame because there’s a faint blood vessel running adjacent to it which creates an illusion of the blood tracking along the RNFL.
Loved this quizz
These photos with description are awesome! I’d love to see more of them…
I’ve just started trying these practice modules and they’re great! Thanks so much.
Regarding Question ID: 550 In the explanation it says “ see OCT below” but there’s no OCT included.
First off, I love this! It’s a fun resource!
But one quick comment on Question ID: 540. In the explanation for ch nevus growth to melanoma, the acronym TFSOM-UHHD is used. Consider updating it to the newer criteria also published by Shields et al. TFSOM-Dim: To Find Small Ocular Melanomas Doing IMaging. It does incorporate basal diameter of the tumor as a risk factor and specifies symptoms as symptomatic vision loss. https://pubmed.ncbi.nlm.nih.gov/30608349/
very useful education.Thank you very much
I hope to learn about retinal finding in the diagnosis
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