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Systemic Disease OD 5 > Final Cards > Flashcards

Final Cards Flashcards

1
Q

Anemia is a decrease of _______ or ________.

A

Decrease in RBC (hematocrit) or hemoglobin content.

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2
Q

What are maturation nuclear defects?

A
  • B12 including pernicious anemia(?)
  • folate
  • drug toxicity
  • refractive anemia
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3
Q

What causes decreased production?

A

Fe deficiency, marrow damage (aplastic anemia and infiltration/fibrosis). Decreased stimulation (renal disease, metabolic, and inflammation).

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4
Q

Which anemia is due to deficient heme or globin synthesis?

A

Microcytic anemia; i.e. iron deficiency

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5
Q

Which anemia is due to primary bone marrow failure.?

A

normocytic anemia; normal RBC distribution w/ normochromic indices; i.e.: aplastic anemia

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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

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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

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8
Q

Which anemia is caused by a B12 deficiency due to autoimmune gastritis?

A

pernicious anemia

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9
Q

In pernicious anemia, autoantibodies are directed against intrinsic factor or parietal cells that produce ___________ factor.

A

intrinsic factor

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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
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11
Q

What gets lost during aplastic anemia that eventually leads to bone marrow hypoplasia?

A

Loss of blood precursors.

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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

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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

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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.

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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
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16
Q

How are coagulation disorders most commonly acquired?

A
  • vitamin K deficiency

- liver disease

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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.

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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

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19
Q

What factor is missing in hemophilia A? hemophilia B?

A

Hemophilia A: factor 8 absent

Hemophilia B: factor 9 absent

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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
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21
Q

Which conditions are caused by abnormal protein content in the blood?

A

dysproteinemias; usually immunoglobulins that affect fragility and cause purpura.

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22
Q

Which dysproteinemia is characterized by excessive production of immunoglobulin or its derivative polypeptide?

A

hyperglobulinemia

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23
Q

Which dysproteinemia is characterized by immunoglobulins that precipitate when cooled.

A

Cryoglobinemia

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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

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25
Q

Which corneal finding is present in Waldenstrom’s macroglobinemia?

A

corneal crystals

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26
Q

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
A

multiple myeloma

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27
Q

Which condition present w/ conjunctival/cornea crystals?

A

multiple myeloma

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28
Q

Which urinary condition is associated w/ multiple myeloma?

A
  • Bence-Jones proteins (part of light chain of antibodies)
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29
Q

In leukemia leukemia the marked leukocytosis is produced by _______ bone marrow.

A

normal bone marrow

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30
Q

Which leukemia typically affects children, but can affect adults?

A

acte lymphocytic leukemia

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31
Q

Which leukemia affects adults?

A

acute myelocytic leukemia

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32
Q

Your patient comes in w/ hemorrhages and Roth spots as well as choroidal infiltration. Your patient most likely has what kind of leukemia?

A

chronic myeloid leukemia

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33
Q

Define prolonged bleeding time w/ normal platelet count.

A

platelet dysfunction

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34
Q

What is an abnormal decrease in platelets (count)?

A

thrombocytopenia

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35
Q

Which ocular sign is a tell-tale in thrombocytopenia?

A

bleeding/hemorrhage s everywhere; anterior chamber, vitreous, retina

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36
Q

What is characterized by increased red cell count, packed cell volume and hemoglobin level?

A

erythrocytosis

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37
Q

What has findings that include increased red cell count, packed cell volume and hemoglobin level (Hb concentration and RBC mass).

A

polycythemia vera; has many non-specific symptoms, but can diagnose w/ high RBC count of over 6 million/microL.

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38
Q

True/False

Valine is substituted for glutamic acid in Hemoglobin C.

A

False.
Hemoglobin C = Lysine substituted for glutamic acid
Hemoglobin S = Valine substituted for glutamic acid

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39
Q

What is the sickle cell trait?

A

Hemoglobin A is normal.

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40
Q

Recall all sickle cell related conditions in the posterior segment.

A
  • Salmon patch hemorrhages
  • black sunburst
  • sea fans
  • angioid streaks (PEPSI))
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41
Q

Should you report tularemia?

A

Yes, it is a reportable bacterial infection because it can be used as a biological weapon.

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42
Q

What is the definitive host for echinococcus?

A

dogs and wild carnivores; intermediate hosts include pigs, sheep, domestic animals, and rodents. Humans are accidental intermediate hosts.

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43
Q

Loa loss likes to go into subcutaneous tissue, in the human eye this would be your ________________.

A

sub-conjunctival area; nematode

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44
Q

Where are schistosomiasis found in the eye?

A

conj/sclera, retina and choroid, orbit

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45
Q

What is the trichinosis triad?

A

bilateral peri-orbital edema, fever, eosinophilia

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46
Q

What is leprosy caused by? and how is it spread?

A

mycobacterium leprae; droplet infection; affects cooler parts of the body

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47
Q

Your patient presents w/ thickened corneal nerves, superficial stromal keratitis, corneal opacities, panes, and exposure keratopathy as well as uveitis. What’s your dx?

A

leprosy

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48
Q

In tuberculosis bacilli are engulfed by _______ and spread through the lymphatics and blood do seed distant organs.

A

macrophages

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49
Q

Your patient presents with Hilar adenopathy, infiltrates of the apical posterior segments of the upper lobes, hemoptysis, and night sweats.

A

Tuberculosis

50
Q

What is a common corneal finding in TB?

A

interstitial keratitis; very important to know that you can get stromal involvement

51
Q

Where is histoplasmosis associated with?

A

Ohio and Mississippi river valley

52
Q

What condition does histoplasmosis imitate?

A

Tuberculosis-like granulomatous infections

53
Q

What is the histoplasmosis quad? (not triad!)

A

hist-spots, peripapillary atrophy, macular involvement (CNVM formation) and NO VITRITIS (which is really a part of TB)

54
Q

Malaria infects the ________ _______ cells, that then rupture and release __________ causing fever, chills, and rigors.

A

infects RBCs that rupture and release cytokines

55
Q

What blood conditions have a protective effect against malaria?

A

hemoglobin S, hemoglobin C and thalassemia

56
Q

Your patient presents to clinic with CWS, macular edema, Retinal hemorrhage and roth spots… what is your Dx?

A

Malaria; the retinal heme is a prognostic sign for cerebral malaria.

57
Q

What is your Ddx for Roth Spots?

A

anemia
bacterial endocarditis
leukemia
Malaria

58
Q

Where are oocysts found? What are found in humans?

A

Oocysts are shed from intestine of cat, birds, and other mammals. Cysts and trophozoites are found in the human.

59
Q

How does toxoplasmosis present in an adult vs a child that is conceived (not aborted, since it’s past the 1st trimester)?

A

Adult: mostly asymptomatic

Child: CEREBRAL CALCIFICATION, seizures, encephalitis, myocarditis, pericarditis

60
Q

Microphthalmia, cataracts (leukocoria), scleritis, and acute uveitis are part of the toxoplasmosis quad, what are some other ocular signs/symptoms?

A

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
Q

What is the most common form of transfer of toxoplasmosis?

A

Usually from congenital infection. However, in the US

62
Q

What are headlights in the fog a presentation of?

A

Toxoplasmosis; old lesion can often be seen next to the new lesion. CNVM may occur as a late sequelae.

63
Q

How does toxoplasmosis present neurally?

A

Neuro: papillitis, papilledema, nystagmus, neuroretinitis, VF defects, strabismus

64
Q

How does toxoplasmosis present in the urea?

A

granulomatous iridocyclitis

65
Q

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?

A

IgM and IgG; PTOX (use CSF or amniotic fluid)

66
Q

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?

A

NO; IgG is not useful for dx infection in infants

67
Q

What are the different combination of pyrimethamine, sulfadiazine, clindamycin, sulfamethoxazole, and trimethoprim to treat for toxoplasmosis?

A

pyrimethamine & sulfadiazine (w/ folic acid)

clindamycin & sulfadiazine

trimethoprim & sulfamethoxazole

**you can add on a steroid only if you are using antibiotics.

68
Q

What is the ocular triad for syphilis? And Hutchinson’s triad?

A

uveitis, retinitis, and optic neuritis

Hutchinson’s triad: notched incisors/mulberry molars (Hutchinson’s teeth), deafness, and congenital interstitial keratitis

69
Q

Your patient presents w/ salt and pepper fundus, what is your dx?

a. histoplasmosis
b. RP
c. syphilis
d. toxoplasmosis
e. retinitis

A

Answer: c, syphilis

Other ocular signs are cancre of conjunctiva, interstitial keratitis (cornea), and Argyll-Robertson pupil

70
Q

Your patient’s lab results report back as (+) RPR and (-) VDRL, what is his condition?

A

(+) syphilis, but it is not active

71
Q

What medication is most often used? But you should use one drug over the other in order for the medication to reach the eye?

A

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
Q

Which CN is affected during the second stage (neurologic, cardiac or arthritis signs) of Lyme disease?

A

CN 6 palsy; AB-ducens; AB-duction

73
Q

Is lyme disease a granulomatous or non-granulomatous condition?

A

granulomatous disease; w/ granulomatous KP

74
Q

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?

A

rocky mountain spotted fever

75
Q

What category are you for CD4 > 500/microL?

A

Category A

76
Q

Which category is CD4 +200-499/microL?

A

Category B

77
Q

Which category is CD4 M200?

A

Category C

78
Q

What is stage 3 HIV?

A

AIDs

79
Q

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?

A

Progressive Outer Retinal Necrosis syndrome (PORN)

80
Q

Your patient presents w/ orbital pain and decreased vision, vitritis, and is “typically” healthy. What kind of condition does your patient most likely have?

A

Acute Retinal Necrosis Syndrome (ARN)

81
Q

Which family is CMV (cytomegalovirus infection), which is a DNA virus, from?

A

the herpes family

82
Q

Posterior signs of congenital HSV

A
  • posterior lenticular opacification
  • microphthalmia
  • micro cornea
  • iridocyclitis
83
Q

Important signs/symptoms of neonatal HSV.

A
  • periocular skin disease

- inflammation elsewhere in the body

84
Q

ocular signs/symptoms of primary HSV

A
  • cute follicular conjunctivitis

- superficial cornea, then affecting eyelid or conjunctiva

85
Q

what is a common association w/ herpes zoster?

A

HZV is a varicella virus that causes chickenpox.

86
Q

Where does HZV become latent in?

A

latent in the sensory ganglia and reoccurs as Herpes Zoster (not chickenpox)

87
Q

Does Herpes Zoster cross the midline?

A

No, it does not cross the midline.

88
Q

What is associated w/ Guillain-Barre Syndrome?

A
  • HZV
  • Mumps
  • Varicella

These same 3 viruses can cause disci form keratitis

89
Q

What is associated w/ Bell’s Palsy?

A
  • HZV
90
Q

What is Hutchinson’s Sign?

A

Present in HZV, it is a lesion on the tip of the nose

91
Q

How many mg do you give of acyclovir / day po for HZV?

A

800mg

92
Q

H2 blocker and antacid therapy reduces some of the acute skin rash discomfort. What type of condition are you treating?

A

HZV

93
Q

Common conjunctiva findings in Molluscum Contagiosum

A

Secondary toxic keratoconjunctivitis w/ follicular conjunctival reaction

94
Q

What is a finding of the auto infection for Molluscum Contagious?

A

Kissing lesions

95
Q

How are mumps spread?

A

airborne respiratory droplets

96
Q

What are three CNS conditions that Mumps causes?

A
  • hearing loss
  • CN palsy
  • Guillain Barre Syndrome
97
Q

What associations in the retina can mumps cause?

A

AMPPE and choroiditis

98
Q

What has the nickname of “German measles?”

A

RNA virus in Toga group causes German measles; congenital rubella

99
Q

What bilateral symptoms do you see in patients w/ congenital rubella?

A

bilateral hearing loss, mental retardation, meningitis

100
Q

What condition is associated w/ dental hypoplasia?

A

congenital rubella

101
Q

When do you see salt-and-pepper fundus?

A
  • congenital rubella

- congenital syphilis

102
Q

ocular signs of congenital rubella

A
  • microphthalmia
  • glaucoma
  • keratoconus
  • spherophakia
  • angle dysgenesis
  • salt-and-pepper fundus
103
Q

Which congenital diseases (name at least 4) cause hearing conditions in addition to the eye.

A
  • congenital CMV
  • congenital syphilis
  • congenital varicella
  • congenital rubella
104
Q

What condition is associated w/ Koplik’s spots and maculopapular rash?

A

Rubeola/ ordinary measles (highly contagious)

105
Q

What is the common name for varicella?

A

chicken pox

highly contagious childhood disease caused by varicella zoster; latency may occur after primary infection

106
Q

Related to HLA-B27

A
  • chlamydia
107
Q

Where do you see Arlt’s line?

A

Chlamydia trachoma

108
Q

inclusion conjunctivitis

A
  • chlamydia trachoma’s serotypes D-K
  • unilateral
  • marked tarsal follicular response
109
Q

What organism is gonorrhea associated w/?

A

gram negative

diplococcus Neisseria gonorrhoeae

110
Q

What is associated w/ HLA B51 and HLA B5?

A

Behcet’s syndrome

111
Q

What has a characteristic Fern leaf pattern (FANG shows diffuse capillary leakage)?

A

ocular signs and symptoms Behcet’s syndrome

112
Q

What is associated w/ candle wax drippings?

A

sarcoidosis

113
Q

What is the source for cholesterol retinal emboli (Hollenhorst)?

A
  • carotid atheroma
  • aortic atheroma
  • ulceration
114
Q

What is the source of a Fibrin platelet (Fisher plug)?

A
  • carotid artery atheroma

- White at bifucation

115
Q

What is the source of calcific retinal emboli?

A
  • cardiac valves

- aortic wall

116
Q

List systemic manifestations of bacterial endocarditis.

A
  • (vascular) tissue infarction, vasculitis
  • (CNS) strokes, brain abscess, meningitis
  • (renal) glomerulonephritis
  • (mucocutaneous) Osler’s nodes, Laneway’s lesions, petechial hemorrhages
117
Q

List ocular manifestations of bacterial endocarditis.

A
  • endophthalmitis
  • uveitis
  • roth spots
118
Q

What are the line of medications to take? (antibiotics for dental procedures for patients w/ endocarditis?)

A
  1. amoxicillin
  2. ampicillin (cefazolin or ceftriaxone)
  3. cephalexin (clinamycin or clarithromycin)
  4. cefazolin or ceftriaxon (clindamycin)
119
Q

What is angina pectoris?

A

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
Q

clinical presentations of acute coronary syndromes

A
  • unstable angina (chest pain at rest)

- Acute MI: Non ST elevation MI or ST Elevation MI

121
Q

define NSTEMI and STEMI

A

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
Q

clinical presentations of sudden cardiac death

A
  • within 1 hour
  • early AM
  • caused by severe arrhythmia
  • prophylactic ICDs (intracardiac devices) are the optimal first-line therapy for patients

Systemic Disease OD 5 (1 decks)

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