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Intraocular Inflammation and Uveitis > Infectious Uveitis > Flashcards

Infectious Uveitis Flashcards

1
Q

stellate KP

A

HSV, VZV, Fuchs

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2
Q

chronic, unilateral anterior uveitis with irregular, slightly dilated pupil +/- iris atrophy

A

HSV and VZV

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3
Q

infectious anterior uveitis with high IOP

A

HSV, VZV, toxoplasmosis (cause trabeculitis)

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4
Q

acute unilateral vision loss. discrete foci of retinal necrosis involving peripheral retina that rapidly spread circumferentially, + vitritis + occlusive retinal arteriolitis +/- optic neuritis, scleritis, eye pain. otherwise healthy patient

A

ARN

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5
Q

progressive patchy outer retinal whitening, without vitritis, iritis, or vasculitis in immunocompromised patient? most common cause?

A

PORN. VZV (patients often w/ HIV)

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6
Q

salt and pepper fundus

A

rubella

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7
Q

headlight in fog fundus appearance (hazy vitritis overtop white retinal lesion)

A

toxoplasmosis

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8
Q

tx of herpetic uveitis

A

systemic antivirals, topical steroids (may need very long taper)

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9
Q

clinical variants of CMV retinitis

A

fulminant (+ hemorrhage and edema), granular (no hemorrhage or edema), frosted-branch (perivasculitis)

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10
Q

most common ocular manifestation of AIDS

A

HIV retinopathy

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11
Q

extraocular manifestations of congenital CMV

A

fever, thombocytopenia, anemia, pneumonitis, hepatosplenomegaly

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12
Q

most common cause of congenital viral infection

A

CMV

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13
Q

most common ocular manifestations of congenital and acquired EBV

A

congenital: cataract has been reported
acquired: self-limiting follicular conjunctivitis is most common

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14
Q

Classic features of congenital rubella syndrome? Most common ocular finding? Most common cause of vision loss? What two findings classically do not occur together?

A
  • cardiac malformations, ocular findings (pigmentary retinopathy, nuclear cataract, glaucoma, microphthalmia, strabismus), and deafness.
  • pigmentary retinopathy is most common but not visually significant, so cataract and microphthalmia are generally the causes of vision loss.
  • classically, cataract and glaucoma do not occur together
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15
Q

presentation of acquired rubella (German measles)? most common ocular findings?

A
  • fever, maculopapular rash that starts on face then spreads to whole body, lymphadenopathy
  • conjunctivitis. less commonly keratitis and retinitis
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16
Q

how to differentiate between chorioretinitis from congenital toxoplasmosis v congenital LCMV (lymphocytic choriomeningitis virus)

A

intracerebral calcifications in LCMV are periventricular while they are diffuse in toxo

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17
Q
  • most common ocular manifestations of acquired measles?
  • other findings?
  • findings in congenital measles?
A
  • keratitis and mild, papillary, nonpurulent conjunctivitis.
  • cataract, pigmentary retinopathy
  • cataract, optic nerve drusen, diffuse pigmentary retinopathy
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18
Q

unvaccinated 5 year old develops vision loss, behavioral changes, and memory impairment: diagnosis and most common ocular finding

A

SSPE (subacute sclerosing panencephalitis), which is a rare, late complication of acquired measles. focal macular retinitis and RPE changes

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19
Q

presentation, ocular findings, and FA in West Nile virus

A
  • febrile illness, myalgias, and in rare cases encephalitis. eye pain and redness, photophobia, blurred vision.
  • multifocal chorioretinitis with +/- anterior and intermediate uveitis. characteristic linear lesions in midperiphery that follow retinal nerves
  • inactive lesions appear targetoid on FA with central hypofluorescence but hyperfluorescence at the border
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20
Q

febrile illness in farmer or slaughterhouse worker + bilateral macular retinitis

A

Rift Valley Fever

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21
Q

Human T-Lymphocytic Virus Type 1 (HTLV-1) ocular finings. what cell does the virus invade? What else does this virus cause?

A
  • unilateral vitritis, retinal vasculitis, and keratitis among others
  • CD4+ T cells, causes adult T cell leukemia/lymphoma
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22
Q

most common mosquito-borne viral disease in? how do patients present?

A

Dengue fever. fever, petechial rash, bleeding problems form thrombocytopenia, headache, myalgia

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23
Q

most common ocular finding in Dengue fever? additional findings?

A
  • petechial subconj heme

- maculopathy with intraretinal hemorrhages and periphlebitis

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24
Q

Indian immigrant presents with fever, arthralgias, anterior uveitis, pigmented KPs, and posterior retinochoroiditis

A

Chikungunya fever

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25
Q

4 diagnostic criteria of POHS

A

punched-out chorioretinal lesions, peripapillary atrophy, CNV, and absence of vitritis

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26
Q

Ohio or Mississippi River Valley

A

POHS

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27
Q

active form of Histoplasma capsulatum

A

yeast (not filament)

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28
Q

% chance of recurrent CNV within 5 years if recurrent histo-spots appear in macula? If no recurrent histo-spots?

A

15%

5%

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29
Q

most common cause of infectious posterior uveitis in adults and kids

A

toxoplasmosis

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30
Q

common modes of transmission for toxoplasmosis

A

ingestion of undercooked meat or contaminated water, contact with cat feces, blood transfusion or organ transplant, transplacental

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31
Q

hydrocephalus, diffuse intracerebral calcifications, and chorioretinitis in newborn

A

congenital toxoplasmosis

32
Q

utility of toxoplasma serology

A

toxo is a clinical diagnosis, but a negative IgG rules it out (sensitive but not specific). IgG positive within 2 weeks of infection, and IgM persists for 1 year.

33
Q

indications for treatment of ocular toxoplasmosis

A
  • immunocompromised, congenital, acquired while pregnant
  • lesion > 1 disc diameter in size
  • perifoveal lesion
  • CME
  • multiple active lesions
  • moderate to severe inflammation
  • persistent active lesion for > 1 month
34
Q

treatment of ocular toxoplasmosis

A
  1. pyrimethamine + sulfadiazine + prednisone (except not in newborns and pregnant) + folic acid +/- clindamycin
  2. bactrim + prednisone
35
Q

classic fundus finding of toxocara

A

peripheral retinal granuloma with a fibrous band extending to the optic nerve

36
Q

risk factors for toxocara transmissoin

A

contact with dog or cat feces, playgrounds and sand boxes

37
Q

treatment of toxocara

A

periocular and/or systemic steroids. no antimicrobials

38
Q

most common ocular tapeworm infection, name of the worm, and method of transmission?

A

cysticercosis, Taenia solium, ingestion of undercooked pork

39
Q

white vitreous or subretinal cyst with a motile body that reacts to light. extraocular findings?

A

cysticercosis. CNS involvement can lead to seizures

40
Q

cause and vector of river blindness

A

Onchocerca volvulus. black fly

41
Q

treatment of river blindness

A

Ivermectin to kill microfilaria, doxycycline to the kill adult worm (by killing the parasitic bacteria Wolbachia which is critical for sexual development of the worm)

42
Q

subcutaneous skin nodules and uveitis in patient from sub-Saharan Africa

A

River Blindness (Onchocerca volvulus)

43
Q

Hutchinson’s triad for congenital syphlis. Most common sign of untreated late congenital syphilis?

A
  • Hutchinson’s teeth, deafness, interstitial keratitis

- nonulcerative stromal interstitial keratitis

44
Q

In what stages of syphilis do the following occur:

  1. uveitis
  2. lymphadenopathy
  3. maculopapular rash including palsm and soles
  4. painless chancre
  5. gummas on skin, choroid, iris
  6. neurosyphilis
A
  1. 2 or 3
  2. 2
  3. 2
  4. 1
  5. 3
  6. 3
45
Q

testing for syphilis? In infant of mother with syphilis? False positives?

A
  • Either RPR or VRDL (nontreponemal tests) and either FTA-ABS or MHA-TP (treponemal tests). Always test for HIV in patients with confirmed syphilis. Always get LP in patients with syphilitic uveitis
  • FTA-ABS IgM in infants, because IgG from infected mother will cross placenta
  • nontreponemal test false positives: SLE, leprosy, other spirochete infections, pregnancy, among others
  • treponemal test false positives: more rare. other spirochete infections, SLE, RA, leprosy, malaria
46
Q

What is an Argyll Robertson pupil?

A

light-near dissociation (constricts on accommodation but not in response to light). very common in tertiary syphilis

47
Q

treatment of syphilitic uveitis? treatment of primary or secondary syphilis?

A
  • treat as if patient has neurosyphilis: IV penicillin G x 10-14 days
  • IM penicillin G x 1
  • don’t forget to treat sexual partner (for prevention), and to alert appropriate health authorities (reportable disease)
48
Q

fever, chills, hypotension, tachycardia within 24 hours of receiving penicillin for syphilis? management?

A

Jarisch-Herxeimer reaction (immune response to large number of recently killed spirochetes). Supportive care, steroids as needed

49
Q

treatment for penicillin allergic patient with neurosyphilis?

A

penicillin desensitization therapy and then IV penicillin x 10-14 days. can try doxy or tetracycline only for penicillin allergic patients who do not have neurosyphilis.

50
Q

Findings of 3 stages of Lyme Disease

A
  1. erythema chronicum migrans (bull’s eye rash), constitutional symptoms, follicular conjunctivitis
  2. disseminated involvement: skin, CNS (meningitis, encephalitis, Bell’s palsy), joints, heart, eyes. arthritis most prominent, especially large joints like knee. uveitis usually in this stage if it occurs
  3. episodic arthritis, chronic neurologic symptoms. keratitis. uveitis less common in this stage
51
Q

diagnosis of Lyme disease?

A

ELISA with confirmatory Western blot. LP to eval for CNS involvement if patient with confirmed Lyme uveitis

52
Q

treatment of Lyme?

A

oral doxy for patients older than 8, amoxicillin for younger kids. IV ceftriaxone for CNS and cardiac involvement. topical steroids and mydriatics for uveitis

53
Q

tropical farmer with abrupt onset of constitutional symptoms +/- more severe signs of sepsis, and with circumcorneal conjunctival hyperemia and uveitis

A

leptospirosis

54
Q

vitreous culture reveals gram-positive, partially acid fast bacteria with branching filaments: diagnosis and treatment

A

Nocardiosis. bactrim

55
Q

fever, night sweats, weight loss, phlyctenulosis, keratitis, mutton fat KP, iris nodules, uvieits

A

TB

56
Q

noninfectious cause of posterior uveitis that TB most closely mimics

A

serpiginous

57
Q

percentage of people worldwide infected with TB?

percentage of affected patients who have symptoms?

A

33%

10%

58
Q

obliterative peripheral periphlebitis in young otherwise healthy males presenting with recurrent retinal and vitreous heme? microbial etiology?

A

Eales disease. Possible association with TB

59
Q

What does a positive PPD or quantiferon test indicate?

Positive PPD cutoffs?

A
  • prior exposure to TB (includes BCG vaccine)
  • 5mm for high risk (HIV, exposed to active TB)
  • 10mm for intermediate risk (healthcare workers, diabetes, renal disease, immigrants from endemic countries, taking IMT)
  • 15mm for low risk
60
Q

8 year old kid with constitutional symptoms and unilateral granulomatous conjunctivitis with regional lymphadenopathy

A

Parinaud oculoglandular syndrome caused by Bartonella henselae (cat scratch disease)

61
Q

unilateral optic nerve swelling, macular star, white retinal lesions, vitritis: diagnosis and treatment

A

neuroretinitis from cat scratch fever (Bartonella henselae). Tx = doxycycline, or azithromycin if under 8 years old.

62
Q

50 year old male with migratory arthritis and chronic diarrhea with bilateral panuveitis and retinal vasculitis: diagnosis, diagnostic test, and treatment.

A

Whipple disease. Duodenal biopsy is confirmatory. bactrim

63
Q

cells infected by HIV

A

CD4+ T cells and macrophages

64
Q

Diagnosis of HIV

A

ELISA w/ confirmatory Western blot

65
Q

CD4 level where symptoms generally start to develop

A
66
Q

Antiretroviral treatment algorithm for HIV

A

2 x NRTI + NNRTI + PI

67
Q

5 classes of HIV-related ocular disease. Most common?

A 
HIV retinopathy (most common)
opportunistic infections
conjunctival SCC
lymphoma of retina or orbit
Kaposi sarcoma of eyelid and conj
68
Q

3 most important HIV-related opportunistic pathogens causing retinitis

A

CMV, VZV, toxoplasma

69
Q

fundus findings of HIV retinopathy

A

cotton wool spots, retinal hemorrhages, and microaneurysms

70
Q

CD4 level below which CMV retinitis manifests

A
71
Q

drug associated with increased risk of immune recovery uveitis (IRU). other related side effect of this drug?

A

cidofovir. also can cause anterior uveitis and hypotony syndrome in absence or IRU

72
Q

HIV patient started on antiretroviral therapy and CD4 increases from 50 to 100. Patient then develops uveitis

A

immune recovery uveitis associated with CMV

73
Q

major complication of CMV retinitis

A

retinal detachment (up to 50%)

74
Q

pale yellow placoid macular lesions in AIDS patient

A

syphilis

75
Q

hemorrhagic conjunctival mass in HIV patient

A

Kaposi sarcoma, HHV8

Intraocular Inflammation and Uveitis (7 decks)

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