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Ocular Disease > Anterior Uveitis - part 2 > Flashcards

Anterior Uveitis - part 2 Flashcards

1
Q

when is uveitis considered “chronic”?

A

when it relapses less than 3 months after discontinuing treatment

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2
Q

which chronic diseases cause non-granulomatous uveitis?

A

JRA, herpes family and Fuch’s heterochromic iridocyclitis

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3
Q

which chronic diseases cause granulomatous uveitis?

A

TB, Sarcoidosis, syphilis, cat scratch fever, and fungal infections

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4
Q

what is Ankylosing Spondylitis?

A

a chronic proliferative inflammation in joint capsules and intervertebral ligaments (arthritic syndrome)

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5
Q

what is the hallmark sign of ankylosing spondylitis?

A

calcification of sacroiliac joint (hips) - causes limited motion in lumbar spine

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6
Q

what gender is most commonly affected by ankylosing spondylitis?

A

males are affected 4x more than females

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7
Q

which HLA typing is present in ankylosing spondylitis?

A

HLA-B27 (80% of patients are positive)

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8
Q

what type of uveitis occurs with ankylosing spondylitis?

A

unilateral and 50% occurs after 15 years of having the disease

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9
Q

how is ankylosing spondylitis treated?

A

steroids and non-steroidals = Indomethacin and Sulindac

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10
Q

what causes Behcet’s syndrome?

A

viral etiology with many immunological features

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11
Q

which HLA typing is associated with Behcet’s?

A

HLA-B5 about 70% of the time

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12
Q

what is the typical demographic for Behcet’s?

A

young adults, asian races, women 2x more than men

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13
Q

what are the 3 main areas affected by Behcet’s?

A

mouth, genitals, skin (oral open sores)

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14
Q

what is the treatment for Behcet’s?

A

steroids and antimetabolites (Chlorambucil)

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15
Q

what are 2 causes for reactive arthritis (Reiter’s syndrome)?

A

post-venereal exposure (chlamydia) and post-dysentery (shigella)

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16
Q

what is the clinical triad for reactive arthritis?

A

“can’t see, can’t pee, can’t climb a tree”

conjunctivitis/anterior uveitis, urethritis, and arthritis (usually mono-articulate)

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17
Q

what happens in the primary state of syphilis?

A

isolated chancre about 21 days after infection

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18
Q

what happens in the secondary state of syphilis?

A

plantar/palmar rash

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19
Q

what happens in the tertiary state of syphilis?

A

cardiac and neurologic effects, Gumma, 3-5 years after infection

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20
Q

what type of organism cases syphilis?

A

Treponema pallidium - spirochete

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21
Q

what do you test for inactive syphilis conditions?

A

FTA-ABS

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22
Q

what do you test for active syphilis conditions?

A

FTA-ABS and VDRL

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23
Q

what are 4 ocular findings associated with syphilis?

A

granulomatous uveitis (anterior, posterior, pan), interstitial keratitis, argyll-robertson pupil, chorio-retinitis (salt/pepper fundus)

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24
Q

what is argyll-robertson pupil?

A

both pupils are constricted and irregular, near light dissociated and dilate poorly in dark/respond poorly to dilating agenss

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25
what are 4 other conditions besides syphilis that have argyll-robertson pupils?
diabetes, chronic alcoholism, MS, and sarcoidosis
26
what is the Hutchinson's triad seen in congenital syphilis?
eyes/ears/teeth = interstitial keratitis, notched incisor teeth and deafness (+ flattened nasal bridge)
27
what is the treatment for syphilis?
penicillin, oral and topical steroids for keratitis
28
what are some diagnostic tests for Crohn's disease and ulcerative colitis?
barium enema, sigmoidoscopy and intestinal biopsy
29
what are 2 diseases of the GI tract that may cause uveitis?
crohn's disease and ulcerative colitis
30
what are the 2 most common demographics for juvenile rheumatoid arthritis?
children and female (4x more)
31
what are the signs/symptoms for JRA?
swollen, stiff, warm, tender joints with limited range of motion
32
which lab tests are run for JRA?
no specific ones - the non-specific ones are: rheumatoid factor (RF), ANA, and HLA typing
33
what is the treatment for JRA?
NSAIDs for arthritis
34
what is included in the still's triad seen in JRA?
iridocyclytis, band keratopathy, and uveitis cataract
35
what is psoriaritic arthritis?
starts with red scaly patches on skin, nails affected then arthritis follows, affects few joints on fingers/toes and uveitis
36
what are 3 ocular findings in juvenile xanthogranuloma (JXG)?
anterior uveitis, epibulbar mass and spontaneous hyphema
37
what triad is seen in systemic lupus erythematosus (SLE)?
joint pain, fever, rash (malar on cheeks) and discoid rash
38
name the diagnostic tests for sarcoid (4)
lymph node/tissue biopsy, Kveim test (spleen biopsy intradermal injection), Hilar adenopathy in chest x-ray and blood work
39
what are the most common demographics for sarcoidosis?
young/black females in southeastern US and Sweden
40
what is the treatment for sarcoidosis?
NSAIDs, steroids, and anti-malarials
41
what is the etiology of tuberculosis?
mycobacterium tuberculosis
42
what are the diagnostic tests for TB?
chest x-ray, PPD and tissue biopsy
43
what are 2 ocular findings associated with TB?
phlyctenular conjunctivitis and anterior uveitis
44
what is the treatment for TB?
systemic isoniazid, ethambutol, rifampin and streptomycin
45
what organism causes lyme disease?
Borrelia burgdorferi - tick bite (bulls eye rash)
46
what is the treatment for lyme disease?
Doxycycline
47
what are 3 causes of uveitis associated with Herpes?
viral load in aqueous, autoimmune component, and anterior chamber reaction
48
what are 4 ocular presentations that occur in herpes simplex?
conjunctivitis, corneal epithelial disease, neurotrophic ulcer, uveitis and retinitis
49
what is the treatment for herpes simplex uveitis?
0.25% scopolamine TID, oral acyclovir 400mg 5x a day, topical 1% trifluridine 9x per day, systemic steroid 40-60mg QD, and 400gm Acyclovir BID (prophylaxis)
50
what is Hutchinson's sign and what condition is it present in?
Herpes zoster = lesion seen on the nose predicts that you will have ocular involvement (whole nerve is affected)
51
which CN is herpes zoster located?
first division of CN 5 - unilateral and doesn't usually involve lower lid
52
what is the treatment for herpes zoster uveitis?
0.25% scopolamine TID, topical steroid 1% prednisolone acetate QID, acyclovir 800mg 5x per day and aqueous suppressants if needed
53
how is the treatment for herpes zoster different than herpes simplex?
the dose of antiviral - acyclovir is doubled in zoster (800mg vs. 400mg) and in zoster you use a topical steroid
54
who typically gets herpes zoster?
older patients or immune compromised younger patients (HIV, malnutrition, certain medications and bone marrow tumors/lymphoma)
55
who typically gets herpes simplex?
younger patients
56
what was the conclusion from of the HEDS1 study?
there is no benefit to oral acyclovir if the patient is already on topical acyclovir and topical steroids
57
what was the conclusion of the HEDS2 study?
lower recurrence of HSV when patient is on long term oral acyclovir (400mg BID x 1 year)
58
what causes varicella zoster virus?
chicken pox
59
when would a patient have stromal keratitis with uveitis after chicken pox?
4-6 weeks following chicken pox
60
what is the treatment for varicella zoster virus?
topical steroid 1% prednisolone acetate QID, 0.25% scopolamine BID and erythromycin ointment to lesions
61
what is the cause of vogt-harada-koyanagi syndrome (VKH)?
autoimmune disease with inflammation of melanocytes
62
what is the typical demographic for VKH?
darker pigmented people = asian, native american, japansese and 20-50 year olds
63
what are the findings for VKH?
peri-limbal vitiligo, alopecia, poliosis, VA loss, hearing loss/tinnitus and neurologic signs (seizures, paralysis)
64
why is there VA loss in VKH?
it attacks retinal melanocytes = bilateral VA l
65
who typically gets uveitis from rubella?
always congenital
66
which organism is responsible for leprosy (hanson's disease)?
mycobacteria
67
what are the 3 signs of leprosy?
skin sores, chronic uveitis and low grade hypopion
68
what are some masqueraders of uveitis?
retinoblastoma, leukemia, FB, retinal detachment, RP, lymphoma and MS
69
when is lab testing mandatory for uveitis?
it it is recurrent, bilateral or granulomatous
70
what do elevated hemoglobin levels indicate?
associated with lung disease = TB, sarcoid, smokers, high altitudes, leukemia
71
why would you test the mean platelet volume in a CBC?
looking for inflammatory bowel diseases
72
what do high levels of neutrophils indicate?
bacterial infection or arthritis
73
what do elevated levels of lymphocytes indicate?
viral infection or active allergies
74
what do elevated levels of monocytes indicate?
systemic infection
75
what do elevated levels of eosinophils indicate?
allergic reactions, parasitic and collagen vascular disease
76
what do low numbers of basophils indicate?
low numbers + uveitis = leukemia
77
what are 3 lab tests for venereal diseases?
VDRL, FTA-ABS and RPR
78
what can you determine using a VDRL blood test?
if there is an active venereal infection - titer falls as disease gets better
79
what does a positive FTA-ABS indicate?
there was a history of a venereal infection = positive for life
80
which 4 conditions may give false positive with VDRL and RPR?
HIV, lyme, malaria and lupus
81
what is the angiotensin-converting enzyme (ACE) test for?
highly sensitive and specific for sarcoid
82
what may give you a false negative with ACE?
chronic oral steroids, diabetes, TB, hyperthyroidism, leprosy and ACE inhibitors
83
what are 4 conditions that use ANA testing?
JRA, RA, lupus, and chronic infections (syphilis, sjogren's, sarcoid)
84
what does ANA screen for?
antibodies
85
if you have less than 500 cells/mm^3 of T-lymphocytes (CD4) - what does that indicate?
immune suppression
86
if you have less than 500 CD4 cells/cubic mm what are you at risk for?
TB and lymphoma
87
if your CD4 count is less than 200 cells/cubic mm what are you at risk for?
toxoplasmosis
88
if your CD4 count is less than 100 cells/cubic mm what are you at risk for?
CMV retinitis, herpes zoster retinitis, and cryptococcal choroiditis
89
what is the erythrocyte sedimentation rate (ESR) test?
specific test for inflammation - non-specific for diseases (proteins stick to RBCs)
90
which conditions have elevated ESR?
systemic lupus, polymyalgia rheumatica and giant cell arteritis
91
what are the norms of ESR for men and women?
men = age/2 women = age + 10/2
92
what is c-reactive protein a marker for?
inflammation - more direct than ESR - indicates plasma protein elevated
93
what does the rheumatoid factor (RF) test for?
detects auto-antibodies that bind to IgG
94
which other tests do you combine with RF?
ANA, ESR and C-protein
95
what are 2 lab tests for herpes simplex?
GIEMSA stain and ELISA titer (but a positive titer is non-specific)
96
why would you prescribe topical cycloplegic and mydriatic agents for uveitis?
to reduce pain, prevent synechiae and stabilize blood aqueous barrier to prevent more protein leakage or flare
97
which cycloplegic do you use only in office to open pupil and prevent synechiae?
0.25% scopolamine BID
98
what type/dose of cycloplegic do you prescribe to the patient to take home?
5% homatropine QID
99
why is 1% atropine a bad option for patients to use?
immobilizes pupil for too long at a time and may encourage synechiae to form
100
what is the steroid you give to patients?
1% Pred Forte q3-4 hours (need brand name - no substitutions)
101
what anti-inflammatory is prescribed to patients?
oral ibuprofen 1600-2400 mg/day for adults
102
why do you avoid prostaglandins and pilocarpine in uveitis?
they will create more inflammation and want to keep pupil dilated not constricted
103
when should the patient return to clinic for uveitis follow-up?
24 hours after initial exam - should stabilize with medications 48-72 hours
104
what do you do it the condition is stabilized at the 24 hour appointment?
use steroid for 1 week then rapidly taper the steroid for 1 week
105
what do you do if synechaie form?
1gt 10% phenylephrine q15 min in office, YAG laster may also work
106
Which condition would have an x-ray like this one?
Tuberculosis
107
what condition has mouth sores like this picture?
Reactive arthritis (Reiter's syndrome)
108
what is this condition?
Behcet's
109
which condition would have a chest x-ray like this one?
sarcoidosis

Ocular Disease (10 decks)

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