Brainscape's Knowledge GenomeTM

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


See full index

Uveitis > Keys > Flashcards

Keys Flashcards

1
Q

What syndromes are associated with Sarcoidosis?

A

(1) Löfgren’s Syndrome - Acute presentation – arthritis; erythema nodosum; bilateral hilar LN
(2) Mikulicz’s Syndrome - bilat lacrimal & salivary gland swelling 2o lymphoid neoplasia / sarcoidosis etc.
(3) Heerfordt’s Syndrome - uveo-parotid fever – chronic fever; parotid swelling; LMN VII; anterior uveitis

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

What are the ocular manifestations of Sarcoidosis?

A

SYSTEMIC: 90% manifest with bilateral hilar lymphadenopathy
OCULAR: 25-80% get ocular signs
(1) AAU – bilat, mutton fat KPs, Ant/Post Synaechia; nodules (not Berlin)
(2) Posterior Uveitis – vitritis, chorioretinitis, sarcoid spots, CNVM, h’ge
(3) Granuloma – conj, eyelid, orbit, ON, lacrimal drainage system
(4) Vascular – peripheral retinal periphlebitis, exudates (candle wax drippings)
(5) ON – swelling, granuloma, atrophy CNVM

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

What are the causes of scleritis?

A

RA; Wegener’s; relapsing polychond; PAN; sarcoidosis; SLE; HLAB27; SINS; infect (HZO, TB; Syphilis)

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

What are the ocular manifestations of Wegener’s granulomatosis.

A

Ocular involvement in 30-50%

(1) orbital inflammation
(2) episcleritis
(3) PUK
(4) AION
(5) CRAO

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

What is the classic clinical triad of Wegener’s granulomatosis?

A

(1) Small vessel vasculitis (cANCA Sn 91%, Sp 99% in active disease; Sn 60% in inactive disease)
(2) Necrotizing granulomatous inflammation of upper (95% ENT saddle nose) + lower respiratory tract (45% cavitation Air-Fluid levels)
(3) Necrotizing glomerulonephritis (18% leads to ARF - death)

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

What are the diagnostic features of Vogt-Koyanagi-Harada syndrome?

A

DEFINITION: Systemic idiopathic granulomatous condition with bilateral panuveitis; Autoimmune reaction against melanocytes, melanin & RPE
FEATURES:
(1) Vogt-Koyanagi: Skin (alopecia, poliosis, vitiligo); AAU
(2) Harada: Neuro (headache, encephalopathy, CSF pleocytosis); Auditory (tinnitus, deafness, vertigo); Post uveitis
POSTERIOR UVEITIS PHASES:
(1) Prodromal – flu-like illness, meningism - photophobia, conjunctivits, CSF pleocytosis
(2) Uveitic (few weeks) – bilat uveitis – Disc swelling, exudative RD, Dalen-Fuch’s nodules
(3) Chronic (3/12 after onset) – fundus dePigmentation (sunset glow), PPAtrophy, subretinal/OD CNVM, Poliosis

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

What are the clinical classification of syphilis?

A

(1) PRIMARY: Painless chancre (eyelid or conj) with regional LN [10-90/7 post exposure (for 4-6/52)]
(2) SECONDARY: Symmetrical maculopapular rash on palms & sole (condyloma latum); fever malaise; 6-8/52. Rare features: iridocyclitis, neuroretinitis, chorioretinitis (Natural history: 1/3 cured; 1/3 latent; 1/3 tertiary)
(3) LATENT: Asymptomatic - early vs late; punctuate retinitis rare but pathognomonic
(4) TERTIARY: Cardiovascular (10% AscAA/AR); gummas (16%; of skin & bone); neurosyphilis (6%) 1-10yrs

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

What are the ocular manifestations of syphilis?

A

(1) Cornea: IK with ghost vessels
(2) Uvea: granulomatous or non-granulomatous
(3) Iris: roseola (visible dilated capillaries); patchy hyperaemia with pink nodules
(4) Retina: vasculitis with exudation (uni/bil/multifoc); oedema (CWS); chorioretinitis (pig retinopat)
(5) Optic: Disc oedema with h’ge and exudate; ?late optic atrophy
(6) Pupils: Argyll Robinson pupil

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

What are the manifestations of neurosyphilis?

A

(1) Asymptomatic neurosyphilis: Reactive RPR /VDRL
(2) Meningovascular: MCA stroke
(3) General paresis: Frontotemporal meningoencephalitis (personality/affect/refexes/ eye/sensorium/intellect/speech)
(4) Tabes dosages: Demyelination of post columns – loss of pain/reflexes/position; ataxia; Argyll-Robertson pupil

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

What serological tests are available for Syphilis?

A

(1) VDRL or RPR: Response to Rx; current disease; used for screening clinical activity of disease
(2) FTA-ABS or TPHA: detect ever infected; used to confirm diagnosis

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

What are the common ocular HLA associations?

A

(1) HLA-A29: Birdshot choroidopathy
(2) HLA-B27: AAU (Ankylosing spondylitis 95%; Crohn’s (AAU:2%) & UC (AAU:5-12%); Reiter’s 80%; Psoriatic arthritis(AAU:7%))
(3) HLA-B51: Behçets Disease (new: IL10, IL23)
(4) HLA-DR3: Primary Sjögren’s; SLE; Myasthenia gravis
(5) HLA-DR4B1: Prolonged VKH

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

List causes of a hypertensive uveitis.

A

Viral (HSV/HZVsectorial iris atropy); toxoplasmosis; FHIC; Posner-Schlossman (CMV); Phacolytic; Steroid;

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

What proportion of patients with Behçet’s Disease manifest each symptom?

A

98-100% - Painful oral ulcers - 3x in 12/12 (last 10/7 heal without scars)
80-90% - Painful genital ulcers
80% - Erythema nodosum; Papulopustular lesion; pseudo-folliculitis; acneiform nodules
50% - Ocular signs – AAU, Post uveitis,vasculitis
50% - GI ulceration
15% - Arthritis/Joint Effusions
5-10% - CNS involvement (obliterative vasculitis, meningoencephalitis)
5-10% - Positive Pathergy Test - 20G oblique needle

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

What are the ocular manifestations of Behçet’s Disease?

A

(1) Bilat non-granulomatous no fibrinous AAU (80% bilat 20% unilat) +/- hypopyon (25%)
(2) Posterior: peri-arteritis/phlebitis (occlusive BRVO/BRAO), vitritis, retinitis, choroiditis, optic neuritis/papilloedema, CMO

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

What drugs can cause an anterior uveitis?

A

Bisphosphonates, rifabutin, cidofovir, metlpropranolol, sulphonamides

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

What are the causes for a panuveitis?

A

GRANULOMATOUS:
(1) Inf: HSV/VZV, Tb, Syphilis, Leprosy, Lyme; (2) NonInf - sarcoid, SO, VKH, phacoanaphylactic
NON-GRANULOMATOUS:
(1) Inf: endophthalmitis, toxop, candida;
(2) NonInf - Behçet’s, lymphoma

17
Q

What are the causes of inflammatory vasculitis?

A

PRIMARY ARTERITIS:
SLE, PAN, Churg-Strauss Syn, Syphilis, HSV/VZV (ARN/BARN/PORN), IRVAN
PRIMARY PHLEBITIS:
Sarcoidosis, Adamantiades-Behcet’s Disese, Eales Disease (TB), MS, Birdshot, HIV
MIXED:
Toxoplasmosis, Relapsing Polychondritis, Wegener’s, Crohns, Frosted Branch Angiitis

18
Q

What are the ocular manifestations of HIV?

A

(1) Opportunistic Infection: HZO; molluscum contagiosum; viral/bact keratisis; CMV retinitis; PORN/ARN; toxoplasmosis; Cryptococcus choroiditis; TB; syphilis
(2) Tumour: Kaposi sarcoma; SCC; non-Hodgkin lymphoma;
(3) Other: conj/retinal microvasculopathy; optic neuritis; optic atrophy
(4) HAART immune recovery uveitis (20% when CD4>100)

19
Q

Describe the life cycle of Toxoplasmosis gondii.

A

(1) Sporocysts – excreted by cats – ingested from soil (3/12 till resolves)
(2) Bradyzoite – encyted in tissue (retina) ingested from beef (3 recurrences)
(3) Tachyzoite – Active proliferation form – transplacental spread (50% chance in 3yrs)
Cats definitive hosts, other animals intermediate hosts

20
Q

What are the clinical features of Reiter’s Syndrome?

A 
NAZI: 
N - Non-specific urethritis;
A - polyArthritis
Z - Zones of Inflammation (circinate balanitis, keratoderma belnnohagicum); 
I - Inflammation of conjunctiva
21
Q

How do you treat ARN?

A

(1) FOSCARNET
• Intravit foscarnet 2.4mg in 0.1ml (↓ RRD by 40% for VZV ARN; Wong Ophthal 2008)
(2) ACICLOVIR
• IV ACN 10mg/kg TDS for 10-14/7 then oral valtrex 1g TDS for 8 weeks (↓ BARN by 50%; Palay AJO 1991)
(3) PREDNISOLONE
• Oral pred 1mg/kg after antivirals commenced
(4) SURGERY
• Barrier laser / Vitrectomy + Silicone oil (60% detach despite laser)

22
Q

How do you treat CMV retinitis?

A

FOSCARNET
• IV foscarnet 90mg/kg +/- intravitreal foscarnet (foscarnet-ganciclovir CMV retinitis treatment trial)
• If poor renal function use Ganciclovir (resistance can be screened for UL97)
• If patient HIV, beware Zidovudine (used for HIV) + ganciclovir = severe myelosuppression

23
Q

How do you treat Candida retinitis?

A

(1) AMPHOTERICIN B
• Intravitreal amphotericin B 5μg in 0.1mL
(2) VORICONAZOLE
• IV voriconazole 200mg BD for 4/52

24
Q

How do you treat postoperative endophthalmitis?

A

(1) IF VA = LP or NLP
• Vitrectomy (3x greater chance of reaching 6/12 – 33% vs 11%)
(2) IF VA better than LP:
• Intravitreal ceftazidime 2.25mg in 0.1mL
• Intravitreal vancomyocin 1mg in 0.1mL
• Intravitreal dexamethasone 0.4mg in 0.1mL – for severe vit inflammation to limit PMN enzymatic destruction
• g Atropine 1% BD
• Review BD; should improve after 48/24

25
Q

What were the drugs used in the Endophthalmitis Vitrectomy Study?

A

(1) Intravitreal amikacin 0.4mg in 0.1mL
(3) Intravitreal vancomyocin 1mg in 0.1mL
(2) IV amikacin 6mg/kg BD after loading
(4) IV ceftazidime 2g TDS

26
Q

How do you treat toxoplasmosis?

A 
(1) SULPHUR
•	4-6 weeks with sulfabased therapy
•	Trimethoprim/sulfamethoxazole 160/800 BD  			
(2) PREGNANCY	
•	If pregnant Atovaquone proguanil HCl 1g D
(3) CLINDAMYCIN
•	Clindamycin 300 to 450 mg QID 
•	But risk of pseudomembranous colitis
•	Intravitreal clindamycin 1mg reported
(4) PREDNISOLONE
•	Prednisolone after 24/24 60mg D 
•	Not in AIDS
•	Tapered before stopping antibiotics
27
Q

How do you treat retinal syphilis?

A 
As per neurosyphilis:
(1) IV PENICILLIN G
•	10-14-day course of iv penicillin G 
•	2 to 5 million units QID
(2) IM BEN PENICILLIN
•	Then Benzathine penicillin 
•	2.4 million units im weekly for 3/52
•	If allergic, need ICU desensitisation
28
Q

How do you treat mucormyocisis?

A

(1) ENT review
(2) Physician review (diabetic ketoacidosis; Fe overload; Burns)
(3) Amphotericin B up to 1mg/kg/Day in D5W (check UECr) – lipid preparation 5mg/kg/Day
(4) Debridement of nectrotic tissue (may require excenteration)
(5) Hyperbaric O2 therapy

29
Q

How do you treat toxocaria?

A

(1) Corticosteroids to reduce inflammation
(2) Antihelmiths – but no proven role
(3) Vitrectomy if traction

30
Q

How do you treat cat-scratch?

A

(1) None may be necessary
(2) Clindamycin 300mg QID
(3) RCT has revealed benefit from azithromycin 500mg o QID for 5/7

31
Q

How do you treat scleritis?

A

(1) Exclude infective causes
(2)
If Diffuse or Nodular or Posterior:
• NSAIDs – ibuprofen 400mg oral QID (try 3 separate NSAIDs before giving up)
• Prednisone 60-100mg oral daily for 1/52 then taper over 6/52
• Immune suppression (cyclophosphamide/MTX /cyclosporine/azathioprine)
If Necrotizing
• Straight to steroids + immune suppression
• Scleral patch graft

32
Q

How do you treat Onchocerca volvulus infection?

A

Ivermectin 12mg PO yearly for 10 years

33
Q

What is the treatment for TB?

A

RIPE:

Rifampicin; Isoniazid; Pyraxinamide; Ethambutol

34
Q

How do you treat HZO?

A
  1. If 1/12 after HZO)
    • Controversial role for corticosteroids in reducing PHN
    • Educate - 70% with pain at 1/12 will be pain free at 1yr
    • Gabapentin 100-600mg TDS; Tegretol 100-200mg TDS; lignocaine patch; opioids

Uveitis (1 decks)

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