Final Cards Flashcards
(122 cards)
1
Q
Anemia is a decrease of _______ or ________.
A
Decrease in RBC (hematocrit) or hemoglobin content.
2
Q
What are maturation nuclear defects?
A
- B12 including pernicious anemia(?)
- folate
- drug toxicity
- refractive anemia
3
Q
What causes decreased production?
A
Fe deficiency, marrow damage (aplastic anemia and infiltration/fibrosis). Decreased stimulation (renal disease, metabolic, and inflammation).
4
Q
Which anemia is due to deficient heme or globin synthesis?
A
Microcytic anemia; i.e. iron deficiency
5
Q
Which anemia is due to primary bone marrow failure.?
A
normocytic anemia; normal RBC distribution w/ normochromic indices; i.e.: aplastic anemia
6
Q
Which anemia is due to impaired DNA synthesis as occurs w/ B12 or folate deficiency?
A
Macrocytic anemia; i.e.: anemia of chronic disease
7
Q
What is the most common cause of iron deficiency anemia?
A
Most common cause is blood loss.
males: chronic occult bleeding from GI tract
females: menses
8
Q
Which anemia is caused by a B12 deficiency due to autoimmune gastritis?
A
pernicious anemia
9
Q
In pernicious anemia, autoantibodies are directed against intrinsic factor or parietal cells that produce ___________ factor.
A
intrinsic factor
10
Q
name characteristics of pernicious anemia
A
- premature graying of hair
- sensory neuropathy of the lower parts of the legs (stocking and glove neuropathy/paresthesias)
- vibratory and proprioceptive disturbances
- spastic ataxia
11
Q
What gets lost during aplastic anemia that eventually leads to bone marrow hypoplasia?
A
Loss of blood precursors.
12
Q
Which of the following drugs does not cause aplastic anemia?
a. chloramphenicol
b. trimethoprim
c. acetazolamide
d. penicillamine
e. NSAIDS
f. antineoplastic drugs
g. anti-convulsants
h. tamoxifen
i. gold salts
A
Answer: h, tamoxifen does not cause aplastic anemia
chloramphenicol and trimethoprim are antibiotics
13
Q
Which of the follow is not a sign/symptom of anemia?
a. pallor of the skin and mucous membranes
b. cheilosis (scaling and fissures); nail bed, mucous membrane, palm crease
c. koilonchyias (spoon nails)
d. tachycardia
e. high fever
f. tinnitus
A
answer: e
- no high fever is experienced
14
Q
Which ocular sign/symptom of anemia should be the first sign of an associated systemic disease?
a. palpebral conjunctival pillow
b. sub-conj heme
c. retinopathy of anemia
d. roth spots
e. flame-shaped heme
A
Answer: C; retinopathy of anemia is often the first sign of an associated systemic disease. Resolves after a few weeks of treatment of the systemic disease.
15
Q
Which beta-thalassemia is common in US African Americans?
A
Cooley’s anemia.
- complete lack of beta protein
- leads to severe anemia
- requires frequent blood transfusions
16
Q
How are coagulation disorders most commonly acquired?
A
- vitamin K deficiency
- liver disease
17
Q
Which mineral builds up due to frequent transfusions in beta-thalassemia?
A
Iron overload occurs and requires chelation to prevent death from early organ failure.
18
Q
Match the vitamin K factor w/ the thing being made.
Vitamin 2, 7, 9, and 10
substances made: pro-converting, Christmas, prothrombin, Stuart
A
2 = prothrombin
7 = pro-converting
9: Christmas
10: Stuart
19
Q
What factor is missing in hemophilia A? hemophilia B?
A
Hemophilia A: factor 8 absent
Hemophilia B: factor 9 absent
20
Q
Which ocular signs/symptoms are associated w/ coagulation disorders?
A
- lid ecchymosis, sub-conj. heme, CRVO, CRAO, retinal/vitreous/choroidal hemes and detachment; papilledema, CN palsies, pupil anomalies
21
Q
Which conditions are caused by abnormal protein content in the blood?
A
dysproteinemias; usually immunoglobulins that affect fragility and cause purpura.
22
Q
Which dysproteinemia is characterized by excessive production of immunoglobulin or its derivative polypeptide?
A
hyperglobulinemia
23
Q
Which dysproteinemia is characterized by immunoglobulins that precipitate when cooled.
A
Cryoglobinemia
24
Q
What is a rare lympho-proliferative disorder w/ immunoglobulin M production; in > 65 dos?
A
Waldenstrom’s macroglobinemia; have a hyper viscosity of the blood
25
Which corneal finding is present in Waldenstrom's macroglobinemia?
corneal crystals
26
name the disease:
- middle or old age
- cancer of plasma cells that than produce excessive monoclonal immunoglobulins
- osteolytic lesions of the long bones, axial skeleton, skull
multiple myeloma
27
Which condition present w/ conjunctival/cornea crystals?
multiple myeloma
28
Which urinary condition is associated w/ multiple myeloma?
- Bence-Jones proteins (part of light chain of antibodies)
29
In leukemia leukemia the marked leukocytosis is produced by _______ bone marrow.
normal bone marrow
30
Which leukemia typically affects children, but can affect adults?
acte lymphocytic leukemia
31
Which leukemia affects adults?
acute myelocytic leukemia
32
Your patient comes in w/ hemorrhages and Roth spots as well as choroidal infiltration. Your patient most likely has what kind of leukemia?
chronic myeloid leukemia
33
Define prolonged bleeding time w/ normal platelet count.
platelet dysfunction
34
What is an abnormal decrease in platelets (count)?
thrombocytopenia
35
Which ocular sign is a tell-tale in thrombocytopenia?
bleeding/hemorrhage s everywhere; anterior chamber, vitreous, retina
36
What is characterized by increased red cell count, packed cell volume and hemoglobin level?
erythrocytosis
37
What has findings that include increased red cell count, packed cell volume and hemoglobin level (Hb concentration and RBC mass).
polycythemia vera; has many non-specific symptoms, but can diagnose w/ high RBC count of over 6 million/microL.
38
True/False
| Valine is substituted for glutamic acid in Hemoglobin C.
False.
Hemoglobin C = Lysine substituted for glutamic acid
Hemoglobin S = Valine substituted for glutamic acid
39
What is the sickle cell trait?
Hemoglobin A is normal.
40
Recall all sickle cell related conditions in the posterior segment.
- Salmon patch hemorrhages
- black sunburst
- sea fans
- angioid streaks (PEPSI))
41
Should you report tularemia?
Yes, it is a reportable bacterial infection because it can be used as a biological weapon.
42
What is the definitive host for echinococcus?
dogs and wild carnivores; intermediate hosts include pigs, sheep, domestic animals, and rodents. Humans are accidental intermediate hosts.
43
Loa loss likes to go into subcutaneous tissue, in the human eye this would be your ________________.
sub-conjunctival area; nematode
44
Where are schistosomiasis found in the eye?
conj/sclera, retina and choroid, orbit
45
What is the trichinosis triad?
bilateral peri-orbital edema, fever, eosinophilia
46
What is leprosy caused by? and how is it spread?
mycobacterium leprae; droplet infection; affects cooler parts of the body
47
Your patient presents w/ thickened corneal nerves, superficial stromal keratitis, corneal opacities, panes, and exposure keratopathy as well as uveitis. What's your dx?
leprosy
48
In tuberculosis bacilli are engulfed by _______ and spread through the lymphatics and blood do seed distant organs.
macrophages
49
Your patient presents with Hilar adenopathy, infiltrates of the apical posterior segments of the upper lobes, hemoptysis, and night sweats.
Tuberculosis
50
What is a common corneal finding in TB?
interstitial keratitis; very important to know that you can get stromal involvement
51
Where is histoplasmosis associated with?
Ohio and Mississippi river valley
52
What condition does histoplasmosis imitate?
Tuberculosis-like granulomatous infections
53
What is the histoplasmosis quad? (not triad!)
hist-spots, peripapillary atrophy, macular involvement (CNVM formation) and NO VITRITIS (which is really a part of TB)
54
Malaria infects the ________ _______ cells, that then rupture and release __________ causing fever, chills, and rigors.
infects RBCs that rupture and release cytokines
55
What blood conditions have a protective effect against malaria?
hemoglobin S, hemoglobin C and thalassemia
56
Your patient presents to clinic with CWS, macular edema, Retinal hemorrhage and roth spots... what is your Dx?
Malaria; the retinal heme is a prognostic sign for cerebral malaria.
57
What is your Ddx for Roth Spots?
anemia
bacterial endocarditis
leukemia
Malaria
58
Where are oocysts found? What are found in humans?
Oocysts are shed from intestine of cat, birds, and other mammals. Cysts and trophozoites are found in the human.
59
How does toxoplasmosis present in an adult vs a child that is conceived (not aborted, since it's past the 1st trimester)?
Adult: mostly asymptomatic
Child: CEREBRAL CALCIFICATION, seizures, encephalitis, myocarditis, pericarditis
60
Microphthalmia, cataracts (leukocoria), scleritis, and acute uveitis are part of the toxoplasmosis quad, what are some other ocular signs/symptoms?
blurred vision, floaters, pain, glaucoma, photophobia
In the retina, there is choir-retinitis, bilateral macular scars in childhood, SME, RD, vasculitis (vein and artery occlusions), neovascularization, vitritis and vitreous haze.
61
What is the most common form of transfer of toxoplasmosis?
Usually from congenital infection. However, in the US
62
What are headlights in the fog a presentation of?
Toxoplasmosis; old lesion can often be seen next to the new lesion. CNVM may occur as a late sequelae.
63
How does toxoplasmosis present neurally?
Neuro: papillitis, papilledema, nystagmus, neuroretinitis, VF defects, strabismus
64
How does toxoplasmosis present in the urea?
granulomatous iridocyclitis
65
Your patient was dx w/ toxo 8 months ago, what antibodies do you expect to be present?
What test should you use to definitively confirm toxoplasma gondii DNA?
IgM and IgG; PTOX (use CSF or amniotic fluid)
66
You see blood results for a 5 month old child. The mother was dx w/ toxoplasmosis during her pregnancy and you find elevated IgG antibodies in the baby's blood report. Does this child have toxoplasmosis?
NO; IgG is not useful for dx infection in infants
67
What are the different combination of pyrimethamine, sulfadiazine, clindamycin, sulfamethoxazole, and trimethoprim to treat for toxoplasmosis?
pyrimethamine & sulfadiazine (w/ folic acid)
clindamycin & sulfadiazine
trimethoprim & sulfamethoxazole
**you can add on a steroid only if you are using antibiotics.
68
What is the ocular triad for syphilis? And Hutchinson's triad?
uveitis, retinitis, and optic neuritis
Hutchinson's triad: notched incisors/mulberry molars (Hutchinson's teeth), deafness, and congenital interstitial keratitis
69
Your patient presents w/ salt and pepper fundus, what is your dx?
a. histoplasmosis
b. RP
c. syphilis
d. toxoplasmosis
e. retinitis
Answer: c, syphilis
Other ocular signs are cancre of conjunctiva, interstitial keratitis (cornea), and Argyll-Robertson pupil
70
Your patient's lab results report back as (+) RPR and (-) VDRL, what is his condition?
(+) syphilis, but it is not active
71
What medication is most often used? But you should use one drug over the other in order for the medication to reach the eye?
PCN is most often use for primary and secondary syphilis.
Benzathine PCN should not be used for tertiary syphilis, it does not reach high enough concentration in the eye or CNS. Probenecid is sometimes used to raise level of PCN in the eye and brain.
72
Which CN is affected during the second stage (neurologic, cardiac or arthritis signs) of Lyme disease?
CN 6 palsy; AB-ducens; AB-duction
73
Is lyme disease a granulomatous or non-granulomatous condition?
granulomatous disease; w/ granulomatous KP
74
Your patient presents w/ no hx of HTN, conjunctival suffusion, and bilateral periorbital edema. He lives in northern california. There are spots on his arms. What is your Dx?
rocky mountain spotted fever
75
What category are you for CD4 > 500/microL?
Category A
76
Which category is CD4 +200-499/microL?
Category B
77
Which category is CD4 M200?
Category C
78
What is stage 3 HIV?
AIDs
79
Your patient is immunodeficient and has a clear vitreous, but has an outer retinal necrosis leading to full thickness tissue necrosis w/ minimal or no vitritis. What type condition does he have?
Progressive Outer Retinal Necrosis syndrome (PORN)
80
Your patient presents w/ orbital pain and decreased vision, vitritis, and is "typically" healthy. What kind of condition does your patient most likely have?
Acute Retinal Necrosis Syndrome (ARN)
81
Which family is CMV (cytomegalovirus infection), which is a DNA virus, from?
the herpes family
82
Posterior signs of congenital HSV
- posterior lenticular opacification
- microphthalmia
- micro cornea
- iridocyclitis
83
Important signs/symptoms of neonatal HSV.
- periocular skin disease
| - inflammation elsewhere in the body
84
ocular signs/symptoms of primary HSV
- cute follicular conjunctivitis
| - superficial cornea, then affecting eyelid or conjunctiva
85
what is a common association w/ herpes zoster?
HZV is a varicella virus that causes chickenpox.
86
Where does HZV become latent in?
latent in the sensory ganglia and reoccurs as Herpes Zoster (not chickenpox)
87
Does Herpes Zoster cross the midline?
No, it does not cross the midline.
88
What is associated w/ Guillain-Barre Syndrome?
- HZV
- Mumps
- Varicella
These same 3 viruses can cause disci form keratitis
89
What is associated w/ Bell's Palsy?
- HZV
90
What is Hutchinson's Sign?
Present in HZV, it is a lesion on the tip of the nose
91
How many mg do you give of acyclovir / day po for HZV?
800mg
92
H2 blocker and antacid therapy reduces some of the acute skin rash discomfort. What type of condition are you treating?
HZV
93
Common conjunctiva findings in Molluscum Contagiosum
Secondary toxic keratoconjunctivitis w/ follicular conjunctival reaction
94
What is a finding of the auto infection for Molluscum Contagious?
Kissing lesions
95
How are mumps spread?
airborne respiratory droplets
96
What are three CNS conditions that Mumps causes?
- hearing loss
- CN palsy
- Guillain Barre Syndrome
97
What associations in the retina can mumps cause?
AMPPE and choroiditis
98
What has the nickname of "German measles?"
RNA virus in Toga group causes German measles; congenital rubella
99
What bilateral symptoms do you see in patients w/ congenital rubella?
bilateral hearing loss, mental retardation, meningitis
100
What condition is associated w/ dental hypoplasia?
congenital rubella
101
When do you see salt-and-pepper fundus?
- congenital rubella
| - congenital syphilis
102
ocular signs of congenital rubella
- microphthalmia
- glaucoma
- keratoconus
- spherophakia
- angle dysgenesis
- salt-and-pepper fundus
103
Which congenital diseases (name at least 4) cause hearing conditions in addition to the eye.
- congenital CMV
- congenital syphilis
- congenital varicella
- congenital rubella
104
What condition is associated w/ Koplik's spots and maculopapular rash?
Rubeola/ ordinary measles (highly contagious)
105
What is the common name for varicella?
chicken pox
highly contagious childhood disease caused by varicella zoster; latency may occur after primary infection
106
Related to HLA-B27
- chlamydia
107
Where do you see Arlt's line?
Chlamydia trachoma
108
inclusion conjunctivitis
- chlamydia trachoma's serotypes D-K
- unilateral
- marked tarsal follicular response
109
What organism is gonorrhea associated w/?
gram negative
| diplococcus Neisseria gonorrhoeae
110
What is associated w/ HLA B51 and HLA B5?
Behcet's syndrome
111
What has a characteristic Fern leaf pattern (FANG shows diffuse capillary leakage)?
ocular signs and symptoms Behcet's syndrome
112
What is associated w/ candle wax drippings?
sarcoidosis
113
What is the source for cholesterol retinal emboli (Hollenhorst)?
- carotid atheroma
- aortic atheroma
- ulceration
114
What is the source of a Fibrin platelet (Fisher plug)?
- carotid artery atheroma
| - White at bifucation
115
What is the source of calcific retinal emboli?
- cardiac valves
| - aortic wall
116
List systemic manifestations of bacterial endocarditis.
- (vascular) tissue infarction, vasculitis
- (CNS) strokes, brain abscess, meningitis
- (renal) glomerulonephritis
- (mucocutaneous) Osler's nodes, Laneway's lesions, petechial hemorrhages
117
List ocular manifestations of bacterial endocarditis.
- endophthalmitis
- uveitis
- roth spots
118
What are the line of medications to take? (antibiotics for dental procedures for patients w/ endocarditis?)
1. amoxicillin
2. ampicillin (cefazolin or ceftriaxone)
3. cephalexin (clinamycin or clarithromycin)
4. cefazolin or ceftriaxon (clindamycin)
119
What is angina pectoris?
This is a stable angina. If it responds to rest or nitroglycerin and if the patterns of frequency, easy of onset, duration, and response to medication have not changed substantially over 3 months.
There is also variant or prizmetal angina (occurring at rest and is not related to physical exertion).
120
clinical presentations of acute coronary syndromes
- unstable angina (chest pain at rest)
| - Acute MI: Non ST elevation MI or ST Elevation MI
121
define NSTEMI and STEMI
NSTEMI: subendocardial, nontransmural. The ECG shows ST-segment depression and/or T-wave inversion.
STEMI: the ECG shows early ST_segment elevation and later Q waves.
122
clinical presentations of sudden cardiac death
- within 1 hour
- early AM
- caused by severe arrhythmia
- prophylactic ICDs (intracardiac devices) are the optimal first-line therapy for patients
