 Yeah, I think we should get started. All right guys, so this review will have some pictures that I'll like you to basically diagnose and tell me what it is. Morning Rachel. You know, I really thought about how to present a review material as high yield as I can for you guys this morning. You know, I know an hour of your time is very, very precious. So I went over all my kind of old old cap notes and kind of really the high yield material, all the questions. So yeah, I'll ask you questions of kind of what the high yield material is kind of to focus you on. Okay, kind of what you need to know, but it'll be kind of random, all right? Okay, so first question, just keep track. So group one, what's the diagnosis? Some of the pictures are not the best, but that's not an excuse. Okay, all right, what is it? Nope, what's? Nope, so this is a PVD, okay? Not very good. That's a weissering that you're seeing right there, floating around, okay? That's okay, that's okay. Just to give you guys a sense of some of the pictures not good, this is one of the worst ones, so it's okay. So okay, so no points for that. So let's talk about kind of a PVD, okay? How it happens, PVD. So when there's a partial PVD, so there's liquefaction and then there's a cineresis of the vitreous. Fluid can get underneath the macula, okay? The periphobia, and that's a partial detachment. What's the area around anatomically, what's the area around the vitreous adhesion to the optic nerve, what is it called? Area of martigiani, okay? No points there again, okay? And then you have the vitreous connected anteriorly. Where is it connected to? What is it called? To the lens capsule, what is it called? Ligament of weird, or something, we something, okay? No points again. And then what's the space between anterior vitreous and the lens capsule, burger space, okay? These are, you know, you'll see these all in the OCAPs. These are like the minute questions that the OCAPs ask. And these are the questions I'll be asking you today, like the weird associations that they love. So once the PVD or the vitreous detaches from area of martigiani, then that's complete PVD, and that's what you see kind of the y-string, okay? PVD, and I'm not gonna belabor the clinical findings of PVD and the differential diagnosis, but some of the high yield topics are earlier onset, is in myopia, diabetes, trauma, uveitis, and cataract surgery, okay? And then the clinical points, that's usually not tested, but clinically you should know that, okay? All right, this group, what is this? Great, coital rupture, okay? So for those of you not sure where the coital rupture is, is that crescent right there around the optic nerve for trauma that's usually where it's located, constructed to the optic nerve, okay? Things that you need to know, anteriorly they're parallel to the auricirata, okay? And then the complication for coital ruptures are coital neobascularization that can happen, okay? What is this? This group, okay? Is this one, I think that's my answer would be, for this one this is commotion, okay? Question for commotion is where's the damage? What's the mechanism? Photosubter, so outer retinal, okay? So that's the OCAP question for commotion is that it's in the outer retina, okay? Very good. Next one, this group, what did you say? Tersens, okay, that's one. It's not tersens. Perture, okay, very good. So some of the things that you need to know about OCAPs for perture syndrome, so what's the mechanism for pertures? Least of cytokines and crush injury. Yeah, compliment, that's the buzz word for perture's compliment. So what are the things that can cause pertures? Pancatitis is the big thing that they always kind of ask questions, but trauma to long bones, fat embolism, amniotic embolism, those are the ones that we cause for pertures, okay? So lots of cotton wool spots, those whiteing that you can see some pre-retinal hemorrhage, okay? Fat or amniotic fluid embolization, crush injury to the chest, long bone fractures and pancreatitis, this is the case scenario that you'll be given, okay? This one, this one's a little bit hard, but let's say this is kind of a baby, this group. Perfect, non-accidental trauma, okay? So you have those blood with a white center. This doesn't typically come out of OCAPS and AT, so. Okay, this one, this one has history of trauma. What is this group? All you guys are looking at, for those of you that just came in right now. So I went through all my notes last night and kind of looked at kind of the high yield questions that I've seen over the years for OCAPS. And just going through it. Okay, what is this? History of trauma, okay? Let's say a gunshot wound. Like a scleral rupture. So this is called sclopateria, okay? So the typical board's question is sclopateria. What's the mechanism of sclopateria? Shock waves, okay? So it's not direct impact. It's kind of the shock waves from something, okay? So that's sclopateria. High velocity, it's not really contusion, but it's shock waves, okay? Very good. This one, what is this? Perfect, that's what it is, intracular foreign body. You try to rule out a globe. And we've all, I have some questions here that I thought. So sometimes when intracular foreign bodies are inside the eye, sometimes it's never detected, right? And there's chronic findings. If it's iron, you can have heterochromia, cataracts, optic atrophy, if it's copper, chalcosis. One of the, so one of the questions for OCAPs is, where is copper located in the eye? And what does it look like? Copper. Where is it? Yeah, yeah, what's a typical, like, where is copper? Desimace. Desimace, okay? So that's a typical question in OCAPs. Copper is in a decimace. And then iron, remember there's heterochromia, okay? The initial findings are, you know, sometimes ERGs. That's another typical question for ERGs. For iron, ERGs are normal. And then you get, I think, lowering of B waves, okay? So iron, copper, copper, what's the finding for copper? And cataracts, what is it called? Yeah, perfect, good, yeah, so those are the questions. All right, what is this? Perfect retinal detachment. What are the predisposing things for retinal detachment or what are the lesions not predisposing to retinal detachment? Okay, hi, Mayopia, who? Lattice is predisposing to retinal detachment. What else predisposes to retinal detachment? Sure, I'm thinking of anatomic things inside the eye that you would see that we say, you know, this is how your risk. How about vitro retinal tuft? Is that predisposing to RD or not? Yes, good. How about like enclosed aura base, meridional folds? Yes, very good. How about cobblestone degeneration? No, perfect. How about reticular degeneration? Perforal cystoid degeneration? No, okay, so those do come out, okay? Anything else about retinal detachments? Retinal detachments versus retinoschesis, do you get an absolute scatoma or a relative scatoma in retinal detachment? Relative scatoma, okay. So I think about it in retinoschesis, the layers are split, okay, and you don't have a connection between kind of the retina and that's why they have an absolute scatoma. In retinal detachments, does lasers burn it or is there a whitening when you laser it versus retinoschesis? Yes, for retinoschesis, correct. There's a whitening when you add retinoschesis, okay. Very good, retinal detachment. We've all known kind of the three different parts, retomatogenous, exudative, and tractional, okay. Not gonna go through that. And they typically don't ask about kind of surgical approaches for retinal detachments. Okay, speaking of which, what is this? Schesis. Schesis, okay. Where is the schesis? Outer plexiform, so is this degenerative retinoschesis or juvenile retinoschesis? Degenerative, okay, because it's in the kind of the outer nuclear layer. Where is a juvenile retinoschesis split? Okay, yeah, I just think about it like RNFL for some reason. So retinoschesis and their fibro layer for the juvenile retinoschesis, very good. And it's usually located in for temporarily. Let me just think. Oh, for retinal, going back to retinal detachments, the other question is where breaks can usually happen for trauma when you get a trauma and you get a break? Where do you usually see it? Infer temporal is number one. Super nasal is the other one, okay? So I've always kind of remember, it's not the best kind of remembrance, but so once you have trauma, the globe expands equatorially and it's just kind of a little bit not equator, but infer temporal, I don't know if that makes sense. Probably not. All right, retinoschesis split occurs between the inner nuclear and outer plexiform layer, okay? So that's important. And oh, the other thing that comes out for OCAPS is its association with hyperopia, okay? So that's the important one. Like these small things really does matter. So I remember because a retinal detachment it's associated with myopia and retinoschesis it's associated with hyperopia and it's always confusing with these associations of hyperopia and myopia. So just remember hyperopia and retinoschesis, okay? All right, next thing is another high yield one. Which group is next, okay? That group, if I would describe this, I mean the buzzwords are kind of retinal folds or spoke like things in the macula, okay? This group. Come on guys, spoke like. Yeah, this is juvenile retinoschesis, okay? This is another high yield one, okay? Juvenile retinoschesis, and let's see. This is one of the differential diagnosis for vitreous hemorrhage in a kid, okay? Juvenile retinoschesis. What are the other differential diagnosis for vitreous hemorrhage in a kid? What do you think about? Trauma. Trauma, good. Sure. The classic ones. ROP. Not really. What do you guys think about for vitreous hemorrhage for a kid? Trauma. RV is one. Juvenile xanthogranuloma is another one. Intermediate uveitis is another one, okay? So those are the things that should be popping up in your head. How about this is another one? Juvenile retinoschesis, okay? Very good, very good. All right, what is this? Who is next? That's Lattice, okay, very good Lattice. So for Lattice, when you see Lattice, even kind of clinically, you have these like the RPE hyperpigmented and you have a trophic vessels to white when crossing it. That's characteristic of Lattice's generation, okay? So Lattice, you guys talked about it already. This is a risk for retinal detachment, but the risk is low. That's why we don't prophylactically laser these, okay? Very good. Good. All right, this one. Cole, you said it? Very good, CRA. So cherry red spots, other cherry red spots are Tay-Sachs, Neiman, Pig, commotion can look like this, okay? Typically, you have acyclineal retinal artery. That's why you get the macula sparing. Speaking of, let's talk about the anatomy first, okay? Some high yield things. What's the, how big is the macula dimensions? 5.5 millimeters, okay? So 5.5 is the whole macula. So how about the fovea? Less than that, right? 1.5 millimeter. So the fovea is the same as the optic nerve, basically area. So optic nerve is about 1.5. So fovea is 1.5. How about the para fovea? 0.5 outside of the 1.5, okay? It's a ring of kind of a 0.5 millimeter in that kind of radius. And then outside of that, the periphovia. Yeah, periphovia, then periphovia. Yeah, around one, yeah, good. I think it's two, actually, okay? So, so, it doesn't equal 5.5. That's what I remember when you, when you, so, so, but that, but you know, but those dimensions are, or sometimes you get asked those and kind of where that is. And then the foveola is kind of 0.35, okay? And was there a question? Okay, so C-R-A-O, a lot of things to think about with, you know, for O-CAPs, they don't actually ask a lot of the C-R-A-Os, B-R-A-Os, B-R-B-Os, you know? This is one of the most common things we see in clinic, but they don't ask a lot of that. They, you know, if it's a kid, you think about metabolic storage diseases. As I've said, Tay-Sach, Sniemenpik, Sandhoff, and Hurlers. Let's see, very good. Yeah, the cellular retinal arteries, sometimes they ask about that. Okay, this one, what is this? What's next? This could be a lot of things, right? So, but what is this? Well, salvo retinopathy, yeah, this is a classic one. So, you know, for those of you who haven't seen this, this is kind of just a hyaloid, kind of circling, and then you have it. So it's a pre-retinal hemorrhage trapped by hyaloid. So history of sneezing, coughing, and you know, lifting heavy stuff. Very good. Good, nothing else gets asked about that. This one, what is this? Not very good. Anybody? Yeah, great, yeah. So this is a B-R-A-O, okay? B-R-A-O, very similar to C-R-A-O in terms of how they ask, you know, how they would ask questions for basically a stroke workup. Just remember, emboli from carotids, hard valves, it could be calcium or arteriosclerosis, okay? Very good. And this one, blood and thunder, C-R-V-O, very good. Very good, C-R-V-O. You know, just clinically, you know, the non-eschemic forms versus the ischemic forms. So you can find that through FA. That doesn't get asked anymore as well, okay? But if there's a neovascularization, you do PRP. Very good. This one, B-R-V-O, good. Blood and thunder, kind of, sectorally. Very similar, okay, very good. Very good. Oh, one of the questions that get asked for B-R-V-O is kind of what quadrants the most common, you know? So it's super temporally, okay? A lot of things to remember right now. Okay, what is this? So cotton wool spots, not much hemorrhage. What do you think about? HIV's a good differential, for sure. This is hypertensive retinopathy, okay? So when you see more cotton wool spots than blood, think about hypertensive retinopathy. So just check for blood pressure. You can have copper or silver wiring. Good. Macular star, let's talk about macular star. Why is it a macular scar when there's exudation? Why is it that pattern? Where's the swelling? What part of the retina? Henlease rate layer, okay? And that's why it's kind of a, in a petaloid configuration. Other things that you can see in pictures are, I don't have pictures for this, sometimes in hypertensive retinopathy, are l-schnick spots or secret streaks. So sometimes they'll show you kind of a peripheral picture with these kind of dots. And, you know, that could be hypertensive. And then you'll just check for blood pressure. What is this? Perfect, okay, perfect, perfect. So nonproliferative diabetic retinopathy, a lot to know about here clinically. So the most important things to talk about here are, they have it here, is a kind of definition of a severe nonproliferative diabetic retinopathy. And that's the 4-2-1 rule. Four quadrants of dog blood hemorrhages or two quadrants of a venous beating or one quadrants of Irma. That's the definition for a severe nonproliferative diabetic retinopathy. Very good. Sometimes they ask questions about the trials, about, you know, insulin levels for type one or type two diabetics. So intensive control decreases the risk for even the prop and organ damage as well. Okay, what is this? Okay, so this is NVD from Diabetes. Would you do PRP on this person? Would you do PRP on this person? Yes, why? Because what? Partly, because I think, you know, the disc diameter of the new vascular may be about one half disc diameter. Okay, so if it's greater than that, you can, you know, that's the definition of high-risk PDR is important to know. If it's, you know, any NVD with vitrious hemorrhage, you do PRP. If it's a small NVD, you don't necessarily need to do PRP. If it's, you know, about half disc diameter. So even without vitrious hemorrhage, you can do PRP. NVE with vitrious hemorrhage, you do PRP as well. So those are the three definitions of high-risk PDR. There's also another set of definitions of PRP having, you know, three over the four. Do you guys remember all that? Okay, perfect. Very good. And then that's just what I said. New vascularation is greater than one third you do PRP, okay? If it's less than that, it has to have vitrious hemorrhage, okay? What is this? What is it? It's macular. Yeah, with macular. So this is a clinically significant macular edema. These definitions, you don't get, you know, fortunately I haven't seen a question like this in OCAPS or in the boards anymore asking for definitions of CSME. This is the old definition of when to do focal or grid laser, okay? But, you know, in here you can see that, well, it's hard to see, but this is, there's thickening of the retina within 500 microns of the fovea, okay? With associated exudation and that's the definition of clinically significant macular edema. So this person, back in the days, definitely would require to do focal. Nowadays, if we see DME, we would probably treat with anti-vegF, okay? So, but the definition of clinically significant macular edema are those three, okay? And just think about it as, you know, it focuses on thickening and not exudation. Thickening within 500 micrometers, 500 microns of the fovea. Retinal exudates within 500 microns of the fovea associated with adjacent thickening. And then retinal thickening, more than one disk area in size within what's the diameter of the center of the fovea. So if they have that, then they would qualify for focal laser, okay? All right, now it gets more fun. What is this? Sickle cell. So what do you see up there? Salmon patches. What is it? Salmon patch. Yes, salmon patch. Why do you get a salmon patch? What's the mechanism? What is it? For pro-fral vascular obliteration. So this is a kind of, we think that the sickle, there's sickling and then there's arterial occlusion and that's why you get salmon patch that gets asked as well. It's not new vascularization. That's kind of what they trick you on. And then below here, what do you see in FAA, buzzword C-fan. What's the other thing that can cause C-fan or the part of the differential that they like to trick you as well? No, not coats. Coats that's mostly telangiectasis, okay? That's the buzzword. Eels could be, but there's one that, you know, they're thinking sarcoid. Okay, sarcoid can cause like a C-fan in vascularization. So they'll show you kind of weird stuff. You see C-fan, it's not really sickle cell. Other things about sickle that's kind of tested. So, you know, so SS, you know, is the one that gets more systemic manifestations, but who actually gets more eye problems? Or Estal, okay, SC more than Estal, that's the other thing. Avoid carbonic and hydrogen inhibitors, especially for the ones with high FEMA. You guys know that. Other things, you see these, I've seen pictures of these as well, shown like kind of the, what is it called? Oh yeah, the sunburst spots, okay? Kind of that black thing. That's also highly testable and for OCAPs. Very good, good, good. All right, this one, what is this? Whose group is it? Okay. RAM, perfect, okay. So, those of you not sure where the RAM is, it's in this area right here, somewhere here, usually it's kind of in a vessel, you see kind of hemorrhage around it. You don't really sometimes see the aneurysm and then they'll show you some exudates. For RAM, they like to test this because it can have hemorrhages. It's one of the things that can cause hemorrhages in all layers of the retina, pre-retinal, intra-retinal, sub-retinal, et cetera, okay. And then what is it associated? What do you need to check on a patient if you see somebody like this? Hypertension, okay, so that's the answer. Hypertension, very good. And this one, this one's not easy. Anybody? History. Of radiation? Yeah. This is radiation retinopathy, okay? So, radiation retinopathy, so brachytherapy, et cetera. We just have a lot of pictures to go, right? Let's just go forward. So, you know, radiation retinopathy can mimic a lot of different things. You treat it just like a diabetic retinopathy, basically. Okay. Doses, never asked the question, I've never seen a question asking kind of a, you know, how much radiation it causes before your information, 30, 35, grace. But actually, when you start getting to 50 grace, okay, that's when, you know, 50% of the patients get radiation retinopathy. Okay, so that's really the threshold that I think about. Let's think, there was one more thing about, it's not really six months in one year, that's what I was thinking. It's more like a little bit longer than that, about 18 months before it presents. This one, so the other eye is normal, the other eye is not. Oh, excuse me. Very good, yeah. Usually mid-purple hemorrhages. You've seen a lot of this, hopefully, in call by now. O-I-A, O-I-S. So, carotid evaluation, five-year mortality is 40 to 50%, so pretty high. This one, he gets, you know, the next couple of sites are a bit difficult. Looks like it could be, like, hypertensive retinopathy. Yeah, it could be, right, yeah. So, this is leukemic retinopathy, okay? Leukemic retinopathy. What they test in leukemic retinopathy is somebody with kind of decreased vision, you see this and you have an APD, what do you need to do? Well, they have an APD. Well, like, for a leukemia. You get imaging, you know, and then what do you do with that? They need, like, yeah, emergent radiation. That's the answer. Yeah, that's usually, that's the answer. You get a CBC and if there's anything, you give two, radiation. All right, this one? Perfect, yeah, R-O-P. And what stage is this? Yeah, three. Yeah, I think it's a different patient, but so, you know, I ask a lot about R-O-P questions, you know, it's important to know the stages of R-O-P stage one, you have the line stage two, it's kind of a little bit more volume of the ridge. Stage three has a vascular proliferation to the vitreous. Stage four has a peripheral retinal detachment. Stage five is a total retinal detachment. You know, there's four A and four B. They don't ask about threshold disease, you know, you should know that, you know, things always change every year, but I've never seen any questions of when to treat just because it's always, I think it's always just kind of a moving target, you know, it's hard to test. But the things I do see is, you know, when to screen for R-O-P. So the gestation, what, how many weeks? Less than 30, yeah, sometimes it put 32, but it's less than 30, and then in terms of weight, less than 1500, and then, or, or if they have, if they've been in the ICU, if they've been septic, kind of just been sick, you know, maybe a little bit earlier. So those are the questions for R-O-P. We don't typically do cryo, typically just laser right now, and anti, you know, possible anti-vegetary, if it's really posterior, that's what you need to know for R-O-P. There's a lot in the BCSC about kind of the follow-up plan two weeks, one week. I've never seen any questions of that over the several years. This one, this one looks like RAM as well, right? So, but anything else that causes a lot of exudation? Coats, perfect, coats. All right, coats disease. So coats disease is one of the telangitages. So think about that for telangitage. Mac-Tel is kind of another telangitatic disease. This is the male unilateral disease. There's no genetic mutation for coats, so this is spontaneous. Another testable thing is the bimodal age distribution. So, you know, this is the disease that has two age distribution. I've seen that in questions. And I think that's it, you know, can cause a lot of a kind of a serious detachment. Okay, this one. This one, they love to test. What is this? Rachel's team. So there's stuff temporal to the fovea. What is it? Group two, Mac-Tel, perfect. So this is Mac-Tel, okay? It can still be called juxtaphoial telangitasia. And the BCSC, you know, even this year, they still kind of group it into three. Type one, type two, type three. Type two is Mac-Tel, you know, bird scenes research. But usually when you see, if you look at a fovea and you just see pigment changes, temporal to the fovea, okay? And nothing else around it, then it's a Mac-Tel. Other things that, you know, they ask for Mac-Tel is, you know, there's temporal leakage. There's like these atrophic looking cysts, temporal to the fovea. Anti-vegif does not respond very well to these patients. Those are the questions that get asked. Okay. Oh, and it's association with diabetes. So it's associated with diabetes. I think that still gets asked. Okay, this one, what is this? CSER, okay. So this is the classic smoke stack pattern of leakage, which doesn't really show very often. The other one is the expansile dots. Associations with stress, steroid use, type A personality, are, you know, sometimes anti-psychotic medications is another one that is associated with. And you just observe this, okay? They may ask questions about kind of treatment and the treatment is PDT, okay? Or laser. Okay, what is this? Optic pit, okay. Optic pit. What associations do you think about for optic pit? Rental detachment, so fluid can get in the optic pit and can detach the macula. So that's the important thing for optic pit. What else? Can't think of anything else. Oh, bear knows, we have another one, but yeah, papillorino syndrome, okay? That's sometimes they get asked as well with a PAX2 mutation. That's another thing for optic pit. Okay, this one, it's a good one. Okay, myelinated retinal fiber layer. What are the associations of myelinated retinal fiber? Hyperopia, myopia? Myopia, what else? I think about amblyopia as well. Okay, that's the other thing that they like to ask is amblyopia. Usually unilateral, usually is not visually significant, but again, you would see that in amblyopia. Very good. Okay, so myelination anterior to the lamina crevosa. Okay, this one, what is this? Yep, drusen, so this is macular degeneration. Okay, good, good. You know, for macular degeneration, they like to ask kind of the associations, what are the risk factors for, so smoking, hyper tetra family history, how about male or female? Female, okay, good. Trying to think, oh, the arids vitamins, that's kind of another high yield topic of what they ask, so just knowing it's vitamin C, vitamin E, luteins, e-sandine and zinc are in the arids two formulation. They don't ask about, you know, the arids one had beta carotene increases lung cancer, that's why we don't use it anymore. They don't ask about the old laser questions anymore for macular degeneration, mostly the anti-veg F now. And then the CNV, the three different types of CNV, classic or type one, type two and type three, okay. So, good. This one is a bit hard, but what is this? Toxo or OHS? Yeah, this is my optic degeneration, okay. So, that's why I said it's hard, I gave it to you guys. But yeah, that's what I thought actually when I first saw it, is probably kind of Toxo. You see peripapillary atrophy, you see kind of a thinned retina overall, so high myopia. So, I looked back in the BCSC and the definition of pathologic myopia is greater than minus six diopters or greater than 26.5 millimeters of axial length. That's, I think, typically lower than what I think most people kind of think about pathologic myopia. Since we're talking about optics, okay. Just throwing a couple of optics questions as well. So, you know, one thing that they ask is, you know, what kind of lens do you use to do like PRP? So, high plus lens or minus lens or like a high plus plane of concave or minus, yeah, okay. Very good. So, that's the question they ask, it's a plus lens. So, how do I remember it? You have a 90 diopter lens, right? It's plus 90, okay. It's inverted, okay. And when you go to do a PRP, it's also inverted. So, I think about a high plus lens. Okay, you get a wider view of things. Okay. It makes the figure, right? It's magnified as well. Since you asked that, how magnified is the main star wide field? Yeah, two. How about, no, not the wide field, but the PRP is two. How about the main star wide field? It's 1.5, but it's not tested in the O-caps. But it's a plus lens, okay. So, this is important because when do you do a minus lens? When do you need a... Like focal, right? You need a direct, highly magnified view. We don't do that as much anymore, even in residency, okay. But that's how I think about it. You use a 90 diopter, it's a high plus lens. You use that for PRP as well, okay. So, that's kind of an optics thing. Good. All right, this one. Good, what's your mnemonic? Good, what are they? Paget disease of what? The bone, sometimes they put breast, okay. So, Paget disease of the bone, okay. What else? Taylor Statenose, what else? Good, what else? Very good, what else? There's one in that mnemonic that gets tested as well. Beta thalassemia, okay. That's not in the mnemonic, so, but that gets tested as well. So, adjoined streaks. These are breaks in wear, brooks, okay. Very good, brooks. And you worry about crudal neurovascularization. Very good, good guys. One thing for pseudo-exanthoma elasticum, you know, that sometimes the case gets presented with a GI bleed, okay. So, think about a pseudo-exanthoma when a GI bleed. You have definitely seen that a lot. The other thing for like GI stuff that you think about is Von Hippolendau. Okay, when I think about that. Okay, that's it. Very good. Keep going. What is this? Macular hole, very good. And that white thing is all ERM, okay. So, macular hole. So, the stages of macular hole are important. You don't do surgery for stage one because they do a spontaneous resolution. Stage two is already a full thickness hole. So, through the RPE basically, but it's still small. Stage three is a little bit bigger. And stage four has, you know, larger already. Okay, this one. One guys, we still have a lot to go. ERM, very good. ERM, they don't ask a lot of questions for this, for ERM. But clinically, when it becomes 24 years or so, metamorphopsia that you can consider surgery. Okay, this one. What is this? Okay, or just a choroidal detachment. Okay, choroidal detachment. So, you can see kind of a, you know, it looks like the retinas detached, but it just looks like, you know, it doesn't have those corrugations. It looks thicker, you know, so that's kind of a choroid detachment. And ultrasound, you can see it as well. There's kind of a space. So, choroids detached. So, cord detachment, you know, the important point to think about is treatment. So, you kind of do a cycloplegic for choroidal detachment, okay. The other thing is choroidal detachment. If it's a choroidal effusion versus a super choroidal hemorrhage, what's the IOP, which is which, very high. Okay, so it's painful, it's high. And a choroidal effusion is gonna be low, okay. But the treatment is cycloplegics. When they become kissing, then you do surgery. But if not, then you just kind of watch it. You can, you know, you can drain as well if it's the really large. Good, I guess it's written there already. Yeah, many of these are important clinically, but, you know, for the old caps, it doesn't get asked. That's why I just skip over. Okay, what is this? Yeah, vitreous hemorrhage, very good. So, this is, you know, for vitreous hemorrhage we've talked about this for kids already. Very good, this one. RP, very good. What are the differential diagnosis for RP? The ones that they can trick, what do you think about right away when you have? Sure, coderod. What? You can, yeah, that's very good. Ducent for unilateral RP, you think about that. Syphilis is another mimicar. Azor is another mimicar, okay. These are the ones that get asked, you know, kind of trick you in the old caps of what it is. But RP, and which one is RP is the worst? X-linked, autosomal recessive, autosomal dominant. X-linked is the worst, okay. And then autosomal recessive is also bad. Autosomal dominant is the, you know, kind of easier. Oh, so associations for RP is very important, okay. So what are the associations, clinical findings in RP? Some of it listed here already. PSC. PSC, very good, that's one. What else? CME, very good. Optic disc, what? Druzen, very good, yeah, that's great. You do see that with optic disc, good. What else? That's for Usher syndrome, okay. You can have that for Usher syndrome. Anything else? Vitrucell, okay, so you can get mistaken for UVitis. So vitrucell. There's one obscure other association for RP. Vasoproliferative tumors, okay, is associated with RP. That gets tested as well, okay. You know, besides the waxy powder disc, attenuated vessels, okay. But vasoproliferative tumor, optic disc, Druzen, very good, those are the ones. Vasoproliferative tumor, yeah. When I think about vasoproliferative tumor, okay, I think about RP, I also think about R-O-P, R-O-P. Is there another association with it? Good. We don't do vitamin A palmitate, okay, and that will never get asked. High yield topics as well are the syndromic forms of RP, okay, the hearing loss Brad already talked about for Usher disease, I'm just thinking, what else? Kernsayer syndrome kind of has a salt and pepper retinopathy, heart block is what you think about for Kernsayer syndrome and CPEO, those are the things that get tested. I haven't seen A beta lipoprotein of being tested, but basically it's a fat, you know, you can't digest fat soluble. So this is, it looks very, very similar to vitamin A deficiency, okay. Other associations of RP is the one with a polydactyly. What do you guys think about that? Gets tested as well. Bardae beetle, very good. So Bardae beetle, they'll have a syndromic surgery. You have polydactyly, they get hypogonadism as well, intellectual disability. Okay, what is this? Croid oremia, this is, I think in every OCAPS, I always see a picture of a Croid oremia, okay. So just remember this. So Croid oremia, what's the genetic transmission? Excellent, good. So mostly males, okay. Croid oremia, what's the mutation? C.H.M., or what is it other called? What is it? Or, that's true. There's always one that they like to put. It's like geranol, geranol, something, something, so, but you remember the geranol, geranol esterase, it's a rabescopory, so they love putting that in, okay, for a Croid oremia, C.H.M. mutation. They put a chromosome in there, I can't remember what chromosome C.H.M. is. X. Oh yeah, it's X again, that's right, okay, nevermind. This is another one that they love to put, okay. So you see this a lot as well. And I gave this, what? Adgyrate atrophy, so gyrate atrophy. Very confusing, right? So, you know, ordnithine levels are elevated. And, oh, and then the treatment, the treatment. B6, and retric arginine, so very, very confusing, okay. I have a way to remember this, I forgot already, autosomal recessive, okay. Gyrate atrophy, okay. And it's ordnithine aminotransferase, okay. So that's the defect. This one, bullseye mycolopathy, this is combedestrophy, okay, combedestrophy. What are the mutations for, it's really annoying, but sometimes you just need to know a couple of the mutations, because the more that you know, what are the mutations for high, you know, that, it's never the answer, but you always see it in the answer choices. For con, goosey 2D, or like the goosey genes, okay. Goosey, yeah, yeah, goosey 2D, okay, for con dystrophy. Okay, this one, I know there's a lot of like, really my new points that I've seen a lot, so. So this is, what is this, come on guys. Irvine gets. No. Yeah. No, so pisiform flex, stargards, right, stargards. So is it leaking or staining? That's why it's stargards and not, or you know, not like CME, okay. Okay, what's the mutation? ABCA4, okay. What's the other mutations? Excuse me? PRPH2, very good. And ELOVL4, okay, PRPH2. Okay, what else do you think about PRPH2? These are tested. See these, PRPH2. Nope, pattern dystrophy, which is a bigger term and it's really adult viteleiform macular dystrophy. Okay, PRPH2, okay. Stargards and C's. So an FA, dark coroid, that's the buzzword for FA. This is autosomal dominant, okay. Don't worry about this, it's not tested anymore. Very good. Okay, this one? Best disease, what's the mutation? Best of it. Or VMD1, yes. So that's, you never see best one in the test, unfortunately, VMD1. So, and you know, what's abnormal in the test or what do you take it? EOG, and what's the ardent ratio? Less than what is abnormal? 1.6, okay. 1.6 is abnormal, okay, for the ardent ratio, okay. And this is autosomal dominant, okay. All right, very good. This one, I know, very good. Thanks for remembering that, yeah. I put this in. I said it was. This is tested as well. I'll be punctatus, okay. So, flavium aculatus is an old term for stargarts. We know it's stargarts anymore. So if you forget that term, that's probably kosher. So, this is a fundus albipunctatus, okay. What's the mutation? You see that? Yeah, awesome, RDH5, or, what is it called? I know there's a lot, right? I actually forgot, so there's another, there's a name for RDH5. Good, very good guys. Is it ready? So, this is one of the congenital night blindness that has an abnormal fundus, okay. That's what you need to know about this. CSMB, so it's non-progressive. This one, this one I haven't seen this, you know, this is highly testable, but I haven't actually seen this on the test. Oh, shame. Huh? Oguchi disease, very good. So, which one is dark adapted and which one's light and has light? That one's light. That one's dark, okay. So, when you dark adapt these patients, their fundus becomes normal. What do you point to that? To the left, left and right. All right, I'm sorry, right. This one is dark adapted, okay. So, when you look at a patient, they have kind of a darker-ish picture and when you dark adapt it for like several hours, like 10 hours or something, they become normal. So, that's Oguchi disease that's, and I've seen this, you know, term like even in the test, the mitzvul nakamura, something phenomenon, okay. You know, sometimes they'll put those things to trick you. So, Oguchi disease. Very good. This one, very good. So, this is albinism, okay. Albinism, a lot of things that they like to test on albinism. So, foveal hypoplasia is one. You see foveal hypoplasia, that's albinism. The tyrosinase positive, tyrosinase negative, that's kind of the older term for it. And it's really the oculocutaneous versus oculo, just the ocular forms of albinism. But the biggest thing for albinism is you need to think about Chediak-Higashi syndrome and Hermansky pudlock. So, Chediak-Higashi has neutropenia. They get a lot of infections and Hermansky pudlock. The peas, you know, platelets are problematic, Puerto Ricans and the other peas. Okay, I'm not gonna go over this. Autosomal, yeah, platelets, bleeding. Both of them bleed, but the other one gets neutropenic, so. Okay, what is this? This is hard. So, these are the kind of the differential diagnosis for pigmentary retinopathies. This is phenothiazine toxicity, okay. What are the phenothiazines? Chloropromazine and? Thyroidazine, okay, the old anti-psychotic medications. Let's see if they get bipolarous. And this one, bullseye maculopathy. These are medication toxicities. What is it? Plaquino, or chloroquine, okay. Chloroquine or hydroxychloroquine. I don't, you know, they never look at the numbers. I've never seen a question of, you know, how much, but that's highly testable. Okay, this one. This is hard. This is a differential diagnosis for crystalline retinopathy. So, what are the crystalline retinopathies? Tamoxifen, talc, biedi, so this is biedi, okay. What else? Catazantine, right, like in sunblocks or tanning agents. Methoxyfluorine, the old kind of medication. So, crystalline, you know, you can have crystals for Mac-Tel. You know, that's another thing. Cystinosis is another one. So, for crystalline retinopathy, okay, good. Bernstein has never seen this as well, so. This one. End of a dot. Let's, eight o'clock. I think we should stop. What is that? Solar retinopathy, okay. Let me just see if there's any good ones. Oh, I was gonna go over this one. So, what is this? Hemangioblastoma from von Hippolandau Disease, chromosome three, right? You get a lot of cysts in the GI, pancreas, kidneys, epididymis. Hemangioblastomas in the brain. I can go over maybe this one. This one. Port Weinstein, Sturge Weber syndrome. The important thing is glaucoma. When it's below 10, it's, you know, angle dysgenesis. This is the mechanism for glaucoma. After 10 years old, the one older, it's Episcleros fetus pressure. That's one that gets tested. Remember, when there's double use, they are spontaneous, okay? So, the wilds, this one. Good, racemos angiomatosis. Racemos something angiomatosis. There's no cap, intervening capillaries. It doesn't leak this one. Good, retinal astrocytoma from tuberous sclerosis. The genes are TSC1, TSC2, chromosome nine, and chromosome 16. Subongal, you know, the subongal adjuv fibromas. Calcification through CT. And then you get proidol hemangioma. So, this one is important, just proidol hemangioma. So, just remember, you have it with ultrasound. So, this is high reflectivity, okay? So, kind of close in here. The high reflectivity, you think about proidol hemangioma. Lower is melanoma, okay? Low to mid is melanoma. That's the biggest thing. Terpy, this one. Melanocytoma, proidol melanoma. These are METs, neural retinitis. Oh, for neural retinitis. What are the, you know, there's two bugs, right? Bacillostoma, something, and acilostoma. Those get tested. I think that's it, okay? I'll talk about the retinol necrosis in FAA next week. What do you guys want to review for FAA next week? For, I just want to have it more high yield. I'll think of something. Okay, thanks guys.