Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BCSCSAP Review > Intraocular Inflammation and Uveitis > Flashcards

Intraocular Inflammation and Uveitis Flashcards

1
Q

Test that is indicator of active infection in syphilis

A

serum rapid plasma reagin (RPR)

does not confirm that patient has syphilis

Confirmatory: fluorescent treponemal antibody absorption (FTA-ABS) assay and microhemagglutination assay for T pallidum antibodies (MHA-TP) (treponemal antigent tests that do not correlate with disease activity, may be positive for a lifetime)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What topical corticosteroid medication is most likely to cause a corticosteroid-response elevation in IOP?

A

prednisolone acetate 1%

greatest at reducing intraocular inflammation with greatest effect on IOP

(Fluorometholone is very potent but penetrates poorly into eye)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Equivalent of difluprednate 0.05% to PF1%

A

dosing 4 times daily is equivalent of 8 or more toal drops of PF1% but higher rise in IOP than PF1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

MOA of methotrexate (in reducing inflammation)

A

extracellular release of adenosine

folic acid analogue and inhibitor of dihydrofolate reductase inhibits DNA replication but its anti-inflammatory effects result from extracellular release of adenosine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Tx Lyme dz

A

doxycycline

alt: ceftriaxone, amoxicillin, cefuroxime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

unilateral stellate KP, cataracts, increased risk for glaucoma

A

Fuchs heterochromic uveitis

(AKA: fuchs heterchromic iridocyclitis or Fuchs uveitis syndrome)

other s/s: elevated IOP, diffuse iris atrophy, TID, 5% bilateral, rubella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Another name for chronic anterior uveitis

A

iridocyclitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

2-3% of patients referred to uveitis clinics have this dz

A

Fuchs heterochromic uveitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Signs of Fuchs heterochromic uveitis

A

diffuse iris stromal atrophy with variable pigment epithelial layer atrophy

small, white, stellate KPs scattered diffusely over entire endothelium

cells in AC and anterior vitreous

glaucoma + cataracts (PSC)

RARE/ABSENT: macular edema, synechiae, fundus scars, retinal periphlebitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

chronic indolent intraocular inflammatin s/p cataract, think..

A

propionibacterium acnes

Candida parapsilosis

others implicated: aspergillus flavus, torulopsis candida, paecilomyces lilacinus, verticillum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Uveitis associated CME that fails topical corticosteroids. Next steps?

A

20-40 mg triamcinolone sub-Tenon (superotemporal posterior) q monthly

delivers juxtascleral corticosteroid closest to macula

if still fails…

2-4 mg of intravitreal preservative-free triamcinolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

uveitis tx CI in uveitis a/w MS

A

tumor necrosis factor-alpha inhibitors

etanercept and infliximab - aw exacerbations of CNS demyelination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

% of patients with MS that have uveitis and pars planitis

A

30% uveitis in patients with MS

15% pars planitis in patients with MS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Preferred tx for MS-associated

A

IV and intravitreal corticosteroids

topical cycloplegics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

ocular inflammatory disorder aw activation of mast cells via IgE antibodies

A

vernal conjunctivitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how long does 0.59-mg fluocinolone acetonide implant release therapeutic levels of corticosteroids to the vitreous cavity?

A

30 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Positive RPR, next step?

A

serum FTA-ABS (since RPR may be falsely positive) if positive

Lumbar puncture with

CSF VDRL (diagnostic) and

CSF FTA-ABS

Antibiotic therapy - series of PCN IV or IM dosing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Percentage of blindness in the US attributed to inadequately treated uveitis

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Clinical triad to diagnose ocular histoplasmosis syndrome

A

peripapillary atrophy (pigment changes)

multiple white, atrophic punched-out chorioretinal scars (histo spots)

choroidal neovascular membrane causing maculopathy

NO vitreous cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

If histo spots are seen in the macula, what is % chance of macular CNV developing in 3 years

if no spots are observed

A

25%

2% (no spots)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What would active CNV look like in ocular histoplasmosis syndrome (OHS)

A

yellow-green subretinal membrane typically surrounded by a pigment ring

overlying neurosensory detachment

subretinal hemorrhage

frequently border of histo scar in disc-macula area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Useful clinical feature suggests Vogt-Koyanagi-Harada syndrome?

A

Alopecia

Poliosis

(is the decrease or absence of melanin (or colour) in head hair, eyebrows, eyelashes or any other hairy area)

Vitiligo (loss of pigment in skin)

3 seen in 30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Usefulness (positive predictive value) of ANA screen in uveitis

A

prevelance of lupus is less than 0.47% in patients with uveitis so the PPV of ANA for diagnosis is less than 3%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

weight loss, cough and findings in image. Test for granulomatosis with polyangiitis

A

c-ANCA antibody (anti-proteinase 3 antibody)

most specific

(picture: anterior scleritis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How to differentiate progressive outer retinal necrosis from acute retinal necrosis

A

Host immunosuppression

ARN - intact immune function

PORN - immunocompromised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

HLA Aw33

A

increased RR of ARN in Japanese patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

virus aw conjunctival papillomas

A

human papillomavirus (HPV) 6 and 11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

65 yo M with unilateral vision loss (photophbia, floaters, pain), occlusive retinal arteriolitis, vitritis, multifocal yellow-white peripheral retinitis. Best Tx?

A

systemic ACYCLOVIR (IV 10mg/kg q8 hrs x 10-14 days)

after 24-48 hours antiviral add prednisone 1mg/kg/day then taper

Dx: ARN

Note: presentation above is classic triad seen within 2 weeks for ARN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Feared complication of ARN

A

75% of patients will develop a combined tractional-rhegmatogenous retinal detachment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

immune response to mycobacterial infection

A

conversion of macrophages to giant cells that form caseating granulomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Causative organisms in healthy 40 year old man

A

herpes simplex and varicella-zoster virus

ARN AKA necrotizing herpetic retinitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Diagnosis

A

ARN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Diagnosis

A

ARN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Diagnostic criteria for this disease

A

One or more foci of retinal necrosis with discrete borders, located in the peripheral retina

Rapid progression in absence of antiviral therapy

Circumferential spread

Occlusive vasculopathy, affecting arterioles

Prominent vitritis and/or anterior chamber inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Diagnostic characteristic of this syndrome

A

Usually unilateral

MEWDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Goldmann-Witmer (GW) test needs these 2 tissues

A

Aqueous and serum

GW = (xIgG in aqueous/total IgG in aqueous)/(xIgG in serum/total IgG in serum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

systemic complication of prolonged NSAID use in patient with non-necrotizing anterior scleritis

A

myocardial infarction

others: HTN, stroke (COX-2), GI ulceration, GI bleeding, nephrotoxicity, hepatotoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

most likely cause of uveitis in HIV patient with CD4+ <50/uL who responded to HAART

A

immune recovery uveitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Condition can lead to elevated IOP due to blockage of angle by inflammatory cells and debris

A

TOXOPLASMA retinochoroiditis

others: ARN, CMV, sarcoid, Fuchs heterochromic iridocyclitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Should always be ruled out as common causes of uveitis

A

TB, syphilis, sarcoid (CXR)

41
Q

27 year old bilateral anterior and intermediate uveitis, vitreous cell, KP, vitreous cellular aggregates near vitreous base. Test provides most definitive evidence of this disease?

A

histopathology of conjunctival nodule, lung secimen or other tissue involved demonstrating noncaseating granuloma

Other tests:

spiral CT (higher sensitivity)

CXR (plain PA and lateral)

ACE (least specific, moderate sensitivty)

42
Q

Frequency of ocular invovement in sarcoidosis? MC ocular involvement

A

50%

uveitis

43
Q

Posterior uveitis + marked visual symtoms + minimal findings on clinical exam

A

Acute zonal occult outer retinopathy

(AZOOR)

44
Q

acute loss of one or more zones of outer retinal function (not apparent on exam)

VA 20/40

Photopsia

abnormal ERG

Unilateral

Young myopic women

50% vitritis

A

AZOOR

45
Q

regional immunity

A

many organs and tissue sites possess modifications to the classic immune response

46
Q

Many organs and tissue sits possess modifications to the classic immune response arc (afferent, processing, effector)

A

regional immunity

47
Q

Patients with what ocular inflammatory disorder might benefit from pars plana vitrectomy

A

intermediate uveitis

48
Q

resident macrophage of retina

A

microglial cells

49
Q

Factor AW vision loss in patients with ocular sarcoidosis

A

delay of more than 1 year in presentation to a uveitis specialist

(may need IMT!)

50
Q

MC ocular manifestation a/w inflammatory bowel disease?

A

anterior uveitis

(Scleritis LESS COMMON!)

frequently carry HLA B27

51
Q

26 to 50 cells/hpf

A

Grade 3+

52
Q

Diagnosis.

Active or recurrent?

A

Serpiginous choroiditis

lesions involve the outer retina, RPE, choriocapillaris, and large choroidal vessels.

Patients present with acute geographic or serpentine lesions that are gray or gray–yellow (due to disruption of the RPE or outer retina).

Fundus photo showing recurrence of serpiginous choroiditis near the edge of a scar.

53
Q

Only presenting feature. Diagnosis?

A

Granular pigment changes in the fovea

Multiple Evancescent White Dot Syndrome (MEWDS)

pathognomonic

54
Q

Diagnosis

Expected finding on FA?

A

MEWDS

Fundus photo:

  • subtle numerous white spots at the level of the RPE/deep retina.*
  • There are also blurred disc margins.*
  • There is foveal granularity.*

FA: subtle early and late hyperfluorescence of the white dots in a wreath-like pattern

55
Q

Tx for uveitic CME

A

sub-Tenon triamcinolone

56
Q

autoimmune regulator (AIRE) deficient mice develop spontaneous uveitis

A

auotoreactive T cells escape deletion

57
Q

HLA-A29 with fundus and FA

Diagnosis?

A

Birdshot chorioretinopathy

multiple creamy, subretinal lesions radiating fom ON

FA: CME

58
Q

Diagnosis

A

left posterior pole showing a hazy view and the distribution of deep creamy oval lesions

Birdshot chorioretinopathy

59
Q

27 yo AA M with unilateral photophobia and reduced VA. Grade 3+ vitritis with peripheral retinal whitening. Possible PMHx?

A

Previous viral meningitis

Younger patients with HSV-1 and HSV-2 retinitis have a higher RR of previous viral encephalitis or meningitis

(Image: ARN)

60
Q

MC cause of ARN

A

VZV > HSV1, HSV-2 >>> CMV

61
Q

Histological finding in Vogt-Koyanagi-Harada (VKH) syndrome

A

Dalen-Fuchs nodules

epithelioid hisiocytes and lymphocytes between Bruch membrane and RPE

62
Q

Risk factor for ocular involvment of Candida?

A

Hospitalization

candidemia in 10%-37% of patients

(Note: Immunodeficiency is NOT a risk factor)

63
Q

Risk factors for this disease

A

Candida chorioretinitis or endophthalmitis

Hospitalization with h/o recent GI surgery

bacterial sepsis

systemic abx

indwelling catheter

hyperalimentation

debilitating Dz eg, DM

immunomodulatory therapy

prolonged neutropenia

organ transplantation

NOT Immunodeficiency

64
Q

RF a/w increased risk for corneal transplant rejection

A

stromal vascularization of the recipient cornea

65
Q

Mechanism of type IV hypersensitivity

A

recognition of antigen by memory T cell results in activation and amplification of clones that react to specific antigent in skin

produces clinical signs of inflammation in 24-36 hours

66
Q

Mechanism of low IOP in inflamed eye

A

ciliary body hyposecretion

67
Q

TNF alpha inhibitor used for nonocular inflammation that doesn’t work for uveitis

A

Etanercept

used in JIA and RA

(less effective than inliximab and adalimumab for uveitis)

68
Q

White dot syndrome that lesions on FA are LEAST aparent

A

birdshot uveitis

69
Q

Diagnosis

A

Block early, stain late

APMPPE

Acute posterior multifocal placoid pigment epitheliopathy

70
Q

Early hyperflourescence with late staining lesions

A

Punctate Inner Choroiditis (PIC)

71
Q

FA blockage of choroidal flush in early stage and staining at active edge

A

serpignious choroiditis

72
Q

antibodies to myeloperoxidase

A

MPO-ANCA or p-ANCA

microscopic polyangiitis

73
Q

mature cataract + AC cell + elevated IOP + intact lens capsule

A

Phacolytic gluaucoma

clogging TM by macrophages engoged with lens protein

74
Q

establishes the inner blood-ocular barrier

A

tight junctions between the endothelial cells of the retinal circulation

75
Q

establishes outer blood-ocular barrier

A

tight junctions between cells of RPE

76
Q

23 yo M with recurrent unilateral anterior uveitis, KP, IOP 32 and 1+ cell and flare with mixed white and pigmented clels in AC. Normal fundus exam.

Diagnosis?

A

Herpes simplex virus keratouveitis

stellate KP

77
Q

KP type in sarcoid

A

mutton-fat bilateral

78
Q

Asian + bilateral uveitis + hearing disturbance + poor vision + yellow-white subretinal scars

A

VKH

79
Q

Coincide with ocular disease in VKH

A

auditory problems observed in 75% patients with VKH in prodromal phase

central dysacusia 30% (tinnitus or high frequency early in course improves in 2-3 months)

80
Q

What uveitis therapy has highest risk of causing secondary glaucoma severe enough to require pressure-lowering surgery

A

intravitreal fluocinolone 0.59 mg implant

GL Tx required in 75%

glaucoma surgery in 37%!

81
Q

Group of JRA or JIA patients with greatest likelihood of developing uveitis

A

Positive ANA and Negative RF

82
Q

Group of JRA with lowest likelihood of developing iritis

A

(+) RF positive (-) ANA

Still disease

83
Q

AW glaucomatocyclitis crisis (Posner-Schlossman syndrome)

A

CMV

84
Q

Rhegmatogenous RD in patients with uveitis is characterized by what feature?

A

a relatively HIGH association with PROLIFERATIVE VITREORETINOPATHY

30% have PVR at presentation

85
Q

Incidence of RRD in patients with uveitis

A

3%

Panuveitis and infectious uveitis MC A/w RRD

30% have PVR at presentation

86
Q

Stage of LD-associated intermediate uveitis occur

A

Stage 2, disseminated disease

less common stage 3

87
Q

MC ocular manifestation of early stage 1 LD

A

follicular conjunctivitis

88
Q

Medication used to treat severe uveitis that permanently cross-links DNA and highest rate of secondary malignancy

A

cyclophosphamide

alkylating agent

also hemorrhagic cystitis (hydrate)

89
Q

MC systemic finding AW bechet disease

A

aphthous ulcers

transient hypopyon in 25%

90
Q

Mediator that plays a role in AC-associated immune deviation (ACAID)

A

transforming growth factor beta (TGF-beta)

91
Q

MC infectious cause of unilateral granulomatous conjunctivits with lymphadenopathy

A

Bartonella henselae

Parinaud oculoglandular syndrome or granulomatous conjunctivitis and ipsilateral lymphadenopathy

Note: Adult chalmydial inclusion conjunctivitis is follicular not granulomatous

92
Q

Largest number of cases of SO result from

A

PPV

93
Q

JIA occurs MC oligoarticular-onset, girls with +ANA

tx strategy?

A

early consideration of systemic IMT such as MTX

94
Q

Tx Toxoplasma chorioretinitis

A

pyrimethamine, folinic acid, sulfadiazine

95
Q

Onchocerciasis

A

“African River Blindness”is a filarial infection caused by the nematode Onchocerca volvulus

96
Q

second leading cause of blindness due to infection in the world

A

Onchocerciasis

blindness through corneal sclerosing keratitis, secondary glaucoma, cataracts, chorioretinitis, and optic atrophy.

97
Q

Findings expected

Tx

A

Sclerosing keratitis from onchocerciasis

intraocular microfilariae (in AC)

anterior uveitis

SPK

sclerosing keratitis

scleritis

chorioretinitis

optic neuritis and atrophy

cataract

PAS

glaucoma

Tx: ivermectin, suramin, diethylcarbamazine (DEC)

98
Q

Leading cause of corneal blindness

A

trachoma

BCSCSAP Review (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions