Systemic Health Flashcards
(285 cards)
1
Q
What is the primary causative agent of Lyme disease?
A
Borrelia burgdorferi
2
Q
True or false: Lyme disease is transmitted to humans through the bite of infected mosquitoes.
A
False
** it’s via a hard shell tick
3
Q
What is the most common ocular manifestation of Lyme disease?
A
Conjunctivitis
4
Q
Fill in the blank: Lyme disease can lead to __________, a condition characterized by inflammation of the optic nerve.
A
Optic neuritis
5
Q
What is the recommended treatment for ocular manifestations of Lyme disease?
A
Antibiotics such as doxycycline (50s tetracycline)
6
Q
Which lab tests do you order to confirm Lyme disease? (2)
A
- Western blot
- ELISA (enzyme-linked immunosorbent assay)
7
Q
Treatment for Early stages of Lyme disease
A
*Treat with oral antibiotic
Oral doxycycline 100mg po BID
Or
Tetracycline 500 mg po BID
Or
Amoxicillin 500 mg BID or TID po
8
Q
Hepatitis A is spread via?
A
Mouth (fecal-oral)
* consuming contaminated food or water
* contaminated by fecal matter from infected person
(Food most commonly contained are fruit, vegetables, shellfish, ice and water)
9
Q
What is a carotid bruit?
A
Whooshing sound that can be heard between quick beats of the heart.
10
Q
What does a carotid bruit indicate?
A
Irregular blood flow around a thrombus in carotid artery
11
Q
What range of arterial stenosis will likely produce a sound of carotid bruit on auscultation (listening to internal sounds with stethoscope)?
A
50 to 90% occlusion
12
Q
Ocular complications of Accutane
A
Dry eyes
Myopic shift
Blurred vision
Decreased night vision
—rare—> increased intracranial pressure causing papilledema
13
Q
New cases of which infectious diseases need to be reported to the CDC?
A
Syphilis
Gonorrhea
Chlamydia
Trachomatis
14
Q
Ehlers-Danlos syndrome ocular sequelae (5)
A
- Lens subluxation
- Blue sclera
- High myopia
- Keratoconus
- Retinal detachments
15
Q
If CD4 count is less than ___ cells/mm3, the patient should have DFE every 3 months to ensure absence of retinopathy
A
50 cells/mm3
16
Q
AIDS patients with high viral loads or CD4 count less than ____ cells/mm3 are more likely to suffer from adverse effects of _____.
A
- 50 cells/mm3
- CMV (Cytomegalovirus)
17
Q
Opportunistic FUNGAL infections in AIDS patients
A
- Histoplamosis
- Candida
18
Q
Opportunistic bacterial infections in AIDS patients
A
- staphylococci
- streptococci
- mycobacterium avium
- Haemophilus
- Mycobacterium tuberculosis
- bartonella henselae
19
Q
True or false
In pregnant women, after drop installation, the eyelids should be squeezed together to reduce changes of systemic absorption
A
FALSE
* compression of nasolacrimal duct by temporary punctual occlusion should be performed to minimize systemic drug absorption
20
Q
Reye syndrome
A
Rare
- affects brain and liver
- in kids and young adults
- associated with previous Hx of viral infection (influenza or herpes)
- aspirin use
21
Q
Ocular manifestations of Reye syndrome (3)
* swelling of brain and liver
A
- Dilated pupils with sluggish reaction to light
- cortical blindness (loss of vision in normal eye due to damage to occipital lobe)
- papilledema (bilateral optic nerve swelling)
22
Q
What is the pathophysiology of Sjogren syndrome?
A
Autoimmune disease in which inflammation and destruction of the salivary and lacrimal glands occur
23
Q
Pathophysiology of lupus
A
Connective tissue disease in which circulating autoantibodies and immune complexes cause widespread vasculitis and tissue damage
24
Q
Pathophysiology of systemic sclerosis
Hint: idiopathic
A
Idiopathic chronic tissue disease that affects the skin and internal organs
25
True or false
Increase in IOP and increase in corneal sensitivity occurs in pregnancy
FALSE!!!
* decreased IOP and decreased corneal sensitivity
26
What does ELISA testing detect?
Serum Toxocara canis antibodies
## Footnote
ELISA stands for Enzyme-Linked Immunosorbent Assay, a common laboratory technique.
27
Does a positive titer guarantee a diagnosis of toxocariasis?
No
## Footnote
A positive titer must be considered alongside lab results and relevant clinical findings.
28
What is FTA-ABS testing useful for?
Suspected syphilis infection
## Footnote
FTA-ABS stands for Fluorescent Treponemal Antibody Absorption test.
* positive results: history of syphilis infection but does not confirm active infection need RPR and VDRL to confirm active infection
29
What can serum anti-Toxoplasma antibody titers confirm?
Presence of Toxoplasmosis
## Footnote
These titers help in the diagnosis of the infection but are not definitive.
30
Can a negative titer rule out Toxoplasmosis?
No
## Footnote
A negative titer does not exclude the possibility of Toxoplasmosis.
31
What does ultrasonography help to discern regarding retinal masses?
Amount of elevation and internal reflectivity
## Footnote
It does not determine the exact etiology of the lesion.
32
What is fluorescein angiography useful for?
Detection of neovascularization, areas of ischemia, or vascular leakage
Smoke stack: CSR
Petaloid pattern: cystoid macular edema
Lacy: choroidal neovascular membrane
33
Fill in the blank: A positive titer for Toxocara canis does not reflect an absolute diagnosis of _______.
toxocariasis
34
True or False: Ultrasonography is diagnostic for Toxocariasis.
False
## Footnote
Ultrasonography assists in assessing retinal masses but does not provide a diagnosis.
35
What is Gilbert syndrome?
An inherited autosomal recessive condition characterized by bouts of elevated levels of bilirubin in the blood.
*** remember Gilbert is Yellow!!! High levels of bilirubin lead to jaundice, yellowing of sclera
36
What causes the yellowing of the sclera in Gilbert syndrome?
Buildup of unconjugated bilirubin in the blood.
37
What is bilirubin?
A yellowish-orange substance produced when red blood cells are broken down.
38
What is the difference between unconjugated and conjugated bilirubin?
Unconjugated bilirubin is toxic, while conjugated bilirubin is innocuous.
39
How is bilirubin excreted from the body?
After undergoing a chemical reaction in the liver.
40
What triggers episodes of hyperbilirubinemia in individuals with Gilbert syndrome?
Stressors such as dehydration, fasting, illness, vigorous exercise, menstruation, or lack of sleep.
41
Does Gilbert syndrome require treatment?
No, it does not require treatment.
* Gilbert syndrome is a mild liver disorder in which the liver does not properly process bilirubin. Leading to jaundice, yellowing of the skin and eyes
42
Fill in the blank: Gilbert syndrome is characterized by elevated levels of _______ in the blood.
bilirubin
43
True or False: Yellowing of the skin and eyes occurs in individuals with Gilbert syndrome.
True
* liver unable to process bilirubin efficiently leads to buildup in blood causing skin and conjunctiva to have yellow tinge
(Bilirubin from breakdown of RBC)
44
What is COPD?
COPD is an irreversible, progressive narrowing of the pulmonary airways that leads to fibrosis and destruction of alveolar tissue.
45
List common symptoms of COPD.
* Cough (with or without sputum)
* Shortness of breath that worsens with activity
* Wheezing
* Fatigue
* Difficulty catching one's breath
46
What is the biggest risk factor for the development of COPD?
Smoking cigarettes.
47
Name other risk factors for COPD.
* Low birth weight
* Age
* Dusty work environment
* Decreased levels of alpha-1 antitrypsin
* Damp housing quarters
* Low diet in fish, fruits and antioxidants
* Frequent childhood infections
* Exposure to environmental pollution
48
How do COPD and asthma differ in terms of airflow limitation?
COPD causes irreversible airflow constriction, while asthma causes reversible airflow constriction.
49
What triggers the inflammatory response in COPD?
Cigarette smoke leads to the release of alveolar macrophages, neutrophils, and CD8 T-cells.
50
Which areas of the lungs are primarily affected by COPD?
COPD typically affects the peripheral pulmonary pathways.
51
What are the pathological changes associated with COPD?
* Parenchymal destruction
* Metaplasia of squamous cells
* Mucous production
52
Does COPD respond well to steroid therapy?
No, COPD does not respond well to steroid therapy.
53
What immune cells are involved in asthma?
* Mast cells
* Eosinophils
* Macrophages
* CD4 T-cells
54
How does asthma affect the pulmonary pathways?
Asthma affects the proximal pulmonary pathways leading to bronchoconstriction and fragile epithelial tissue.
55
In severe asthma, what is the overlap in cellular involvement with COPD?
Neutrophils, macrophages, CD4, and CD8 T-cells are involved.
56
True or False: Severe asthma responds well to steroid therapy.
False, severe asthma responds mildly to steroid therapy.
57
Fill in the blank: COPD leads to _______ airflow constriction.
irreversible
58
Fill in the blank: Asthma leads to _______ airflow constriction.
reversible
59
What is sarcoidosis?
A granulomatous inflammatory condition characterized by the collection of macrophages, multinucleated giant cells, and epithelial cells.
60
Which demographic is more commonly affected by sarcoidosis?
African-American women between the ages of 20-40.
61
What is the most common ocular manifestation of sarcoidosis?
Iritis with large mutton-fat-like keratic precipitates.
62
List some ocular manifestations of sarcoidosis.
* Iris nodules
* Conjunctival nodules
* Dry eyes
* Enlargement of the lacrimal gland
* Posterior synechiae
* Cataracts
* Posterior uveitis
* Secondary glaucoma
* Sheathing of the peripheral retinal vasculature
* Macular edema
* Fundus granulomas
* Neovascularization of the disc and retina
63
What are some systemic findings associated with sarcoidosis?
* Enlargement of salivary, lacrimal, and parotid glands
* Bilateral hilar adenopathy
* Seventh nerve palsy
* Lymphadenopathy
* Arthritis
* Hepatosplenomegaly
* Erythema nodosum
* Lupus pernio
64
What is lupus pernio?
A purplish skin rash visible on the cheeks and nose.
65
Name some systemic conditions commonly associated with non-granulomatous anterior uveitis.
* Juvenile rheumatoid arthritis
* Inflammatory bowel disease
* Trauma
* Posner-Schlossman
* Fuchs heterochromic iridocyclitis
* HLA B27 conditions (ankylosing spondylitis, Reiter syndrome)
UCRAP
Ulcerative colitis
Crohns
Reactive arthritis (can’t see, can’t pee, can’t bend a knee)
Ankylosing spondylitis
Psoriatic arthritis
66
What are some systemic causes of granulomatous anterior uveitis?
* Sarcoidosis
* Tuberculosis
* Herpes zoster
* Syphilis
* Leptospirosis
67
What does ACE blood work stand for?
Angiotensin-converting enzyme
* elevated levels seen in sarcoidosis, TB and histoplasmosis
68
True or false
ACE serum levels are decreased in sarcoidosis
FALSE
* they are elevated
69
Reiter’s syndrome
Reactive arthritis
* joint pain and pain on urination
* HLA-B27 positive
70
Triad of reactive arthritis (Reiter’s syndrome)
1. Uveitis (can’t see)
2. Urthetritis (can’t pee)
3. Poly arthritis (can’t bend a knee)
71
Which condition is associated with the mnemonic “can’t see, can’t pee, can’t bend a knee”?
Reactive arthritis
* HLA-B27 positive
72
HLA-B27 positive conditions include?
UCRAP!
U: ulcerative colitis
C: Crohn’s disease
R: reactive arthritis
A: ankylosing spondylitis
P: psoriatic arthritis
73
What are the common symptoms of Nongranulomatous Uveitis?
Reduced vision, pain, photophobia, and epiphora
## Footnote
Epiphora refers to excessive tearing.
74
What signs may be present in the anterior chamber of a patient with Nongranulomatous Uveitis?
Cells/Flare and stellate Keratic Precipitates
## Footnote
Stellate Keratic Precipitates are small, star-shaped deposits on the corneal endothelium.
75
What is the most common cause of Nongranulomatous Uveitis?
Idiopathic (up to 50%)
## Footnote
Idiopathic means that the cause is unknown.
76
How does HLA-B27 associated uveitis typically present?
Usually bilateral
## Footnote
Bilateral means affecting both eyes.
77
What condition is characterized by a stiff, painful lower back after exercise and may be associated with HLA-B27?
Ankylosing Spondylitis
## Footnote
The term 'bamboo spine' is used to describe the appearance of the vertebrae in X-rays.
78
Which gastrointestinal disease is more commonly associated with uveitis, Crohn's Disease or Ulcerative Colitis?
Crohn's Disease
## Footnote
Crohn's Disease can affect the entire gastrointestinal tract and is characterized by skip lesions and cobblestone mucosa.
79
What should be done if Crohn's Disease is suspected in a patient with uveitis?
Refer the patient for a colonoscopy
## Footnote
A colonoscopy can help visualize the gastrointestinal tract and confirm the diagnosis.
80
What are the characteristic features of Psoriatic Arthritis?
Erythematous rash, arthritis of the phalanges, and nail pitting
## Footnote
Erythematous rash refers to red, inflamed skin, while nail pitting involves small depressions on the nails.
81
Fill in the blank: The appearance of the vertebrae in Ankylosing Spondylitis is described as a _______.
bamboo spine
82
What is the classic triad of Reiter's Syndrome (Reactive Arthritis)?
Uveitis, urethritis, polyarthritis
## Footnote
Remembered as 'can't see, can't pee, can't climb a tree.'
83
What is Ulcerative Colitis a subset of?
Inflammatory Bowel Disease
## Footnote
It specifically afflicts the colon or the most inferior portion of the GI tract.
84
What is the most common cause of uveitis in children?
Juvenile Rheumatoid Arthritis (JRA)
## Footnote
Typically bilateral and seen more in females.
85
What are the typical test results for JRA?
RF negative and ANA positive
86
What causes Lyme Disease?
Infection with Borrelia burgdorferi after a tick bite
87
What is a characteristic lesion associated with Lyme Disease?
Bullseye lesion
## Footnote
Appears at the site of the tick bite.
88
How long does it typically take for systemic findings of Lyme Disease to present?
1-3 months after the bite
89
What systemic findings can Lyme Disease present with?
Encephalitis, meningitis, uveitis
## Footnote
These are signs of inflammation in the brain and spinal cord.
90
What is Glaucomatocyclitic Crisis also known as?
Posner-Schlossman Syndrome
91
What are the characteristics of Glaucomatocyclitic Crisis?
Unilateral mild recurrent uveitis, markedly elevated IOP, usually self-limiting
92
What is Fuch's Heterochromic Iridocyclitis characterized by?
Unilateral, small stellate keratic precipitates, abnormal anterior chamber vessels, mild heterochromia
93
What is a common complication of Fuch's Heterochromic Iridocyclitis?
Cataracts
94
What treatment is required for Glaucomatocyclitic Crisis?
Treatment to reduce IOP
95
What is required for the treatment of Lyme Disease?
Systemic antibiotics
96
What does SLE stand for?
Systemic Lupus Erythematosus
97
What type of disease is SLE?
Autoimmune disease
98
What can SLE affect if left untreated?
Many organs of the body
99
What do immune complexes in SLE lead to?
Vasculitis and potential thrombus formation
100
List three complications of SLE.
* Skin rashes
* Alopecia
* Oral ulcers
101
What is a potential severe complication of SLE related to the eyes?
Severe vaso-occlusive retinopathy
102
What may severe vaso-occlusive retinopathy lead to?
Retinal or optic disc neovascularization
103
What are concurrent eye conditions associated with SLE typically secondary to?
Complications from medications
104
What medications are commonly used to manage SLE?
* Oral corticosteroids
* Anti-malarials
105
How may retinal disease associated with SLE present?
Mimic diabetic or hypertensive retinopathy
106
What types of retinal vascular occlusions may patients with SLE develop? List two.
* Central Retinal Vein Occlusion (CRVO)
* Branch Retinal Vein Occlusion (BRVO)
107
Fill in the blank: Patients with SLE may develop _______ and toxic maculopathies.
[Central Retinal Artery Occlusion (CRAO)]
108
What type of retinal detachments may patients with SLE experience?
Exudative retinal detachments
109
What is a potential cause of toxic maculopathies in SLE patients?
Pharmaceutical intervention
110
Pinpoint bleeding that occurs when a scale is removed from the skin in psoriasis
Auspitz sign
111
According to American Diabetes Associatoon what is the criteria for diagnosing diabetes?
1. FBG of 126 mg/dL or greater
2. A1c of 6.5% or greater
3. 2 hours postprandial glucose of 200 mg/dL or greater
112
What does a two-hour postprandial glucose measure?
The serum level of glucose two hours after a meal
## Footnote
Commonly measured in pregnant women to assist in the diagnosis of gestational diabetes.
113
What are the normal, prediabetes, and diabetes levels for two-hour postprandial glucose?
* Normal: <140 mg/dL
* Prediabetes: 140-199 mg/dL
* Diabetes: 200 or greater mg/dL
114
What is fasting blood glucose?
The amount of glucose in the blood after refraining from eating or drinking anything but water for at least eight hours
## Footnote
Measured in mg/dL.
115
What are the normal, prediabetes, and diabetes levels for fasting blood glucose?
* Normal: <100 mg/dL
* Prediabetes: 100-125 mg/dL
* Diabetes: 126 or greater mg/dL
116
What does glycosylated hemoglobin (HbA1c) reflect?
The percentage of free glucose bound to hemoglobin in red blood cells
## Footnote
Good estimate of average blood sugar over approximately 3 months.
117
What are the normal, prediabetes, and diabetes levels for glycosylated hemoglobin (HbA1c)?
* Normal: <5.7%
* Prediabetes: 5.7-6.4%
* Diabetes: >6.4%
118
True or False: Blood glucose levels should normalize within two hours of eating in healthy patients.
True
119
Fill in the blank: The average lifespan of a red blood cell is approximately ______ months.
3
120
What common ocular finding is observed in patients with osteogenesis imperfecta?
Blue sclera
## Footnote
Blue sclera is a characteristic feature of osteogenesis imperfecta due to the underlying collagen abnormalities.
121
What is osteogenesis imperfecta?
A congenital, autosomal dominant condition characterized by brittle bones due to abnormal type I collagen
## Footnote
Osteogenesis imperfecta has four subtypes, each with different severities and prognoses.
122
What are common symptoms of osteogenesis imperfecta?
* Multiple bone fractures
* Potential hearing loss at an early age
* Blue hue to the sclera
## Footnote
These symptoms result from the underlying collagen defect affecting bone and connective tissue integrity.
123
What treatments are currently available for osteogenesis imperfecta?
* Bisphosphonates
* Calcium supplements
## Footnote
These treatments show promising results in managing symptoms but do not cure the condition.
124
Management/ patient education for osteogenesis imperfecta?
* Caution with high-impact activities
* Exercises to build strong muscles and bones
* Possible surgical reinforcement of leg bones with metal rods or braces
## Footnote
These strategies aim to minimize fractures and enhance physical strength.
125
True or False: A cure exists for osteogenesis imperfecta.
False
## Footnote
Currently, there is no cure for osteogenesis imperfecta, only management strategies.
126
Fill in the blank: Osteogenesis imperfecta is characterized by the production of _______.
abnormal type I collagen
## Footnote
The defect in type I collagen is responsible for the brittle bones seen in the condition.
127
What is a potential ocular complication for patients with osteogenesis imperfecta?
Retinal detachment
## Footnote
Patients may be more prone to retinal detachment due to poor scleral rigidity associated with the condition.
128
What should NOT be ingested within 2 hours of taking iron supplements?
Dairy products
## Footnote
Calcium interferes with the absorption of iron, making dairy products a food to avoid close to iron supplementation.
129
What is the relationship between calcium and iron absorption?
Calcium interferes with the absorption of iron; the relationship is dose-dependent.
## Footnote
Low amounts of calcium minimally affect iron absorption.
130
Which food type has been shown to minimally affect iron absorption?
Low amounts of calcium-containing foods
## Footnote
While low amounts of calcium have minimal effects, higher amounts can significantly inhibit iron absorption.
131
Fill in the blank: Iron supplements should not be ingested within 2 hours of eating _______.
calcium-containing foods
132
True or False: High fat content foods should be avoided when taking iron supplements.
False
## Footnote
The main concern is with calcium-containing foods, not high fat content foods.
133
Bechet’s disease triad
(“Bitch disease”)
1. Oral ulcers
2. Genital ulcers
3. Bilateral nongranulomatous uveitis
134
Bechet’s disease demographic
Asians and Mediterraneans with HLA-B5 or HLA-B12
135
Classic finding of Bechet’s disease
Hypopyon
136
Signs of Bechet’s disease
- hypopyon
- anterior and posterior uveitis
- severe vitritis
- vasculitis with hemorrhages
- macular and disc edema with ischemic optic neuropathy in late stages
137
Tx for Bechet’s
Topical, oral and sub-tenon’s steroids
* inflammatory disease
* treat anterior uveitis with topical steroid and cycloplegic
138
Hyperthyroidism symptoms
- fatigue
- heat intolerance
- hand tremors
- double vision
- bulging eyes
- weight loss
139
A goiter is present in which condition?
HYPERthyroidism
* enlarged thyroid gland
140
What does the CDC recommend for the treatment of neurosyphilis?
High-dose intravenous (IV) penicillin or a combination of intramuscular (IM) procaine penicillin and oral probenecid
## Footnote
Probenecid is contraindicated if a severe sulfa allergy exists.
141
Treatment of neurosyphilis?
1. Systemic penicillin G (2.4 million U IV q4h for 10-14 days
2. Then 2.4 million U IM q week for 3 weeks
* or use tetracycline if pt allergic to penicillin
142
What alternative treatment may be used if the patient is allergic to penicillin?
Ceftriaxone may be substituted if the patient is in an early stage of syphilis.
143
What antibiotics are commonly used to treat
gonorrhea?
Ceftriaxone 1g IV or IM
*5 days for corneal involvement
And
1g po single dose azithromycin
144
Treatment/management of chlamydial inclusion conjunctivitis
1. Azithromycin 1 g po single dose, doxycycline 100 mg po bid or erythromycin 500 mg po QID for 7 days
2. Topical erythromycin or tetracycline ointment bid to tid for 2-3 weeks
3. Sexual partners should be informed and treated
RTC: 2-3 weeks, 6 week course of doxycycline
145
What therapy is indicated in patients who are HIV positive?
HAART combination therapy.
146
What medications are generally used in the treatment of tuberculosis?
Isoniazid and rifapentine.
147
True or False: Probenecid can be used if a patient has a severe sulfa allergy.
False.
148
Fill in the blank: The continuous infusion of IV penicillin G is for _______ days.
10-15.
149
What are some systemic conditions associated with the development of scleritis?
* Rheumatoid arthritis, lupus, Behcet, Sarcoidosis, gout
Wegener granulomatosis, relapsing polychondritis, polyarteritis nodosa,spondyloarthropathies
## Footnote
These conditions may present with varying symptoms and severities related to scleritis.
150
Which systemic condition is the most common associated with scleritis?
Rheumatoid arthritis
## Footnote
It is important to recognize this condition for appropriate diagnosis and management of scleritis.
151
How do patients with non-necrotizing scleritis typically present?
With mild joint disease
## Footnote
This presentation is generally less severe compared to those with necrotizing scleritis.
152
What is the typical presentation of patients with necrotizing scleritis?
More severe, long-standing rheumatoid disease with associated extra-articular manifestations
## Footnote
Examples of extra-articular manifestations include rheumatoid nodules.
153
What characterizes Wegener granulomatosis?
Idiopathic, multi-system inflammatory condition with generalized small vessel vasculitis
## Footnote
It is noted for the development of granulomas in various organs.
154
What organs are predominantly affected by Wegener granulomatosis?
Respiratory tract and kidneys
## Footnote
It can also involve the lungs, eyes, ears, throat, and skin.
155
What type of scleritis can Wegener granulomatosis be associated with?
Rapidly progressive, necrotizing granulomatous scleritis
## Footnote
This association highlights the severity of the condition.
156
Can Wegener granulomatosis be localized to the eye and orbit?
Yes, it can occur without systemic involvement
## Footnote
An orbital biopsy may be required for diagnosis in such cases.
157
What is relapsing polychondritis?
A rare idiopathic disorder characterized by small vessel vasculitis
## Footnote
It leads to recurrent, progressive, painful, destructive inflammation of cartilage and connective tissues.
158
What is Polyarteritis Nodosa (PAN)?
A collagen vascular disease affecting medium and small arteries, often with associated aneurysm formation; idiopathic and potentially lethal.
## Footnote
PAN may lead to severe necrotizing scleritis and can cause various types of scleritis.
159
What ocular involvement may occur in Polyarteritis Nodosa (PAN)?
Ocular involvement may precede systemic manifestations by many years.
## Footnote
This highlights the importance of monitoring ocular health in patients with PAN.
160
What is Systemic Lupus Erythematosus (SLE)?
An autoimmune disease where the immune system mistakenly attacks healthy tissue, including skin, eyes, joints, kidneys, brain, and other organs.
## Footnote
SLE can lead to various complications affecting multiple organ systems.
161
What types of scleritis may be associated with Systemic Lupus Erythematosus (SLE)?
Anterior diffuse scleritis or nodular scleritis.
## Footnote
Necrotizing scleritis is less common but more difficult to control without early treatment.
162
True or False: Necrotizing scleritis is more common and easier to treat.
False.
## Footnote
Necrotizing scleritis is much less common and much more difficult to control if treatment is delayed.
163
Which condition is very rarely associated with diffuse episcleritis or scleritis?
Gout.
## Footnote
Gout’s association with scleritis is quite rare.
164
What ocular manifestation can sarcoidosis rarely cause?
Scleral nodules.
## Footnote
Sarcoidosis can affect various organs, but its ocular manifestations are less common.
165
What syndrome is rarely associated with diffuse anterior scleritis?
Behcet Syndrome.
## Footnote
This can occur with or without other ocular manifestations.
166
Which group of diseases is occasionally associated with mild diffuse scleritis?
Spondyloarthropathies.
## Footnote
These conditions may present with ocular symptoms before joint symptoms appear.
167
What is sarcoidosis?
A granulomatous inflammatory condition characterized by the collection of macrophages, multinucleated giant cells, and epithelial cells.
168
In which demographic is sarcoidosis more commonly observed?
African-American women between the ages of 20-40.
169
What percentage of individuals with sarcoidosis experience ocular involvement?
Roughly 25-50%.
170
What is the most common ocular manifestation of sarcoidosis?
Iritis with large mutton-fat-like keratic precipitates.
171
List some ocular manifestations of sarcoidosis.
* Iritis with large mutton-fat-like keratic precipitates
* Iris nodules
* Conjunctival nodules
* Dry eyes
* Enlargement of the lacrimal gland
* Posterior synechiae
* Cataracts
* Posterior uveitis
* Secondary glaucoma
* Sheathing of the peripheral retinal vasculature
* Macular edema
* Fundus granulomas
* Neovascularization of the disc and retina
172
True or False: Ocular involvement in sarcoidosis is rare.
False
173
What is the term used to describe the sheathing of the peripheral retinal vasculature in sarcoidosis?
'Candle-wax drippings'
174
What is Sjogren syndrome?
An autoimmune disease that causes inflammation and destruction of both the lacrimal and salivary glands
## Footnote
It may manifest in isolation (primary) or in association with other diseases (secondary).
175
Which demographic is primarily affected by Sjogren syndrome?
Adult women
## Footnote
This syndrome primarily affects women, particularly in middle age.
176
List some diseases associated with secondary Sjogren syndrome.
* Rheumatoid arthritis
* Systemic lupus erythematosus
* Systemic sclerosis
* Chronic active hepatitis
* Myasthenia gravis
* Primary biliary cirrhosis
## Footnote
These diseases may occur alongside Sjogren syndrome.
177
What are common signs of Sjogren syndrome? (Name at least 3)
* Enlargement of salivary glands
* Diminished salivary flow rate
* Dry, fissured tongue
* Decreased tear production
* Ocular dryness and grittiness
## Footnote
These signs indicate dysfunction in glandular secretions.
178
What tests aid in the diagnosis of Sjogren syndrome?
* Serum autoantibodies
* Schirmer tear testing
* Biopsy of the minor salivary glands
## Footnote
These tests help confirm the presence of Sjogren syndrome.
179
True or False: Sjogren syndrome only affects the salivary glands.
False
## Footnote
It also affects the lacrimal glands and other mucosal surfaces.
180
What is systemic lupus erythematosus?
A connective tissue disease in which circulating autoantibodies and immune complexes cause widespread vasculitis and tissue damage
## Footnote
This disease is often associated with Sjogren syndrome.
181
Define rheumatoid arthritis.
An autoimmune disease characterized by symmetrical, destructive, deforming inflammatory polyarthropathy
## Footnote
This condition can co-occur with Sjogren syndrome.
182
What does systemic sclerosis affect?
The skin and internal organs
## Footnote
It is an idiopathic chronic connective tissue disease.
183
Fill in the blank: Patients with Sjogren syndrome typically experience dryness of the mouth and _______.
eyes
## Footnote
This dryness is a hallmark symptom of the syndrome.
184
What symptoms might indicate decreased tear production in Sjogren syndrome?
* Ocular dryness
* Grittiness
* Quick tear break-up times
## Footnote
These symptoms suggest dysfunction in the lacrimal glands.
185
Hyperthyroidism symptoms
- fatigue
- heat intolerance
- hand tremors
- double vision
- bulging eyes (eyelid retraction from increased sympathetic activity)
186
What is Toxocariasis caused by?
Toxocara canis
## Footnote
Toxocara canis is an intestinal roundworm commonly found in dogs.
187
How can humans develop Toxocariasis?
Via contact with contaminated soil or food.
188
What happens once Toxocara canis ova are ingested?
They transform into larvae that can travel to various organs.
189
Which organs can Toxocara canis larvae infect in humans? (5)
* Eyes
* Liver
* Brain
* Lungs
* Skin
190
What type of reaction may occur when Toxocara canis larvae perish?
An inflammatory reaction to the remnants of their carcasses.
191
What are the clinical presentations of Toxocariasis?
Several different presentations, including ocular infections.
192
What may ocular infections from Toxocariasis appear as?
Uveitis with exudative material or retinal granuloma.
193
How do retinal granulomas appear in Toxocariasis?
White or yellow and may span up to two disc diameters.
194
What is a common observation if the granuloma is located more anteriorly?
Vitreous bands running from the granuloma to the posterior pole.
195
What treatments may benefit patients with Toxocariasis-related retinal issues?
* Steroid treatments
* Surgery in case of retinal detachment
196
What severe procedure may be required in extreme cases of Toxocariasis?
Enucleation.
197
What causes Candidiasis?
Candida albicans.
198
Where is Candida albicans frequently found?
* Skin
* Digestive tract
* Mouth
* Vagina
199
Who is at risk for retinal involvement in Candidiasis?
* Immunocompromised patients
* IV drug users
* Those with long-term indwelling catheters
200
What symptoms may patients with Candidiasis experience?
Floaters and blurred vision unilaterally.
201
How does retinal involvement in Candidiasis appear?
Small, white, round lesions with indistinct borders. “Puff balls”
202
What may happen to the lesions in Candidiasis if left untreated?
They may coalesce and extend into the vitreous.
203
What appearance do lesions in Candidiasis cause in the vitreous?
Suspended 'cotton balls'.
204
What severe complications can arise from untreated Candidiasis?
* Endophthalmitis
* Retinal necrosis
* Detachment
205
What is postural hypotension also known as?
Orthostatic hypotension
## Footnote
A condition where blood pressure drops dramatically after a change in posture.
206
What symptoms may occur with postural hypotension?
Dizziness, lightheadedness, fainting
## Footnote
Symptoms typically arise after standing from a sitting or lying position.
207
How long does postural hypotension generally last?
A few seconds or minutes
## Footnote
It usually abates with no lasting effects.
208
What conditions may require treatment for postural hypotension?
Dehydration, diabetes, heart problems
## Footnote
These underlying causes may necessitate medical intervention.
209
Who is more frequently encountered with postural hypotension?
The elderly
## Footnote
This demographic is more susceptible to the condition.
210
What is ketoacidosis?
A condition that occurs during starvation, low carbohydrate levels, or uncontrolled diabetes
## Footnote
It involves excessive breakdown of fats and formation of ketone bodies.
211
When is carbohydrate catabolism favored over ketone body formation?
In normal metabolic conditions
## Footnote
Carbohydrate catabolism is generally prioritized unless there is excessive acetyl-CoA.
212
What fuels the brain during starvation?
Ketones
## Footnote
Ketone bodies are used to maintain regulatory functions when glucose is scarce.
213
What are warning signs of ketoacidosis? (4)
Vomiting, flushed skin, difficulty breathing, confusion
## Footnote
Fruity breath is a key sign to watch and/or smell for.
214
What serious outcomes can ketoacidosis lead to?
Diabetic coma or death
## Footnote
It is a critical condition that requires immediate attention.
215
T1DM or T2DM is more susceptible to ketoacidosis?
People with type I diabetes
## Footnote
They are at a higher risk compared to those with type II diabetes.
216
What is a myocardial infarction?
A blockage of blood flow to the heart causing damage to cardiac tissue
## Footnote
It is commonly known as a heart attack.
217
What is the most common symptom of a heart attack?
Chest pain
## Footnote
This symptom is often reported by patients experiencing a myocardial infarction.
218
What additional symptom may patients experience during a heart attack?
Difficulty breathing
## Footnote
However, swelling of the lips, tongue, and throat is not typical.
219
What is vasovagal syncope?
A condition that causes fainting
## Footnote
It can occur in response to extreme emotional stress, trauma, or heat exposure.
220
Does vasovagal syncope involve swelling of the lips, throat, or tongue?
No
## Footnote
Patients do not experience swelling in these areas.
221
What is the route of administration for Epinephrine (EpiPen®)?
Injected intramuscularly to the upper lateral thigh
222
What receptors does Epinephrine activate?
Both alpha and beta-adrenergic receptors
223
What are the effects of Epinephrine on peripheral vascular resistance?
Causes an increase in peripheral vascular resistance
224
What are the effects of Epinephrine on blood pressure?
Increases blood pressure
225
What condition does Epinephrine help to reverse?
Vasodilation
226
Why is Benadryl® (diphenhydramine) not effective for severe life-threatening reactions?
It will not work quickly enough
227
What should always be called immediately in the event of anaphylactic shock?
9-1-1
228
What are potential complications of anaphylactic shock?
Apnea, syncope, and cardiac arrest
229
What can rapidly increase blood sugar levels in a diabetic during a hypoglycemic event?
Orange juice
230
What should diabetics limit due to high sugar content?
Ingestion of juices
231
What is the purpose of administering Nitroglycerin during a myocardial infarction?
To relax the smooth muscles of the blood vessels
232
When should Nitroglycerin not be used?
If the patient has low blood pressure
233
What types of medications are frequently used to treat heart attacks?
Anticoagulants, antiplatelets, and medications that dissolve clots
234
What is the most appropriate initial treatment for anaphylactic shock?
Immediate injection of epinephrine
235
Fill in the blank: For severe life-threatening allergic reactions, _______ will not work quickly enough.
Benadryl® (diphenhydramine)
236
What is a common cardiovascular risk associated with Marfan syndrome?
Aortic aneurysms and aortic dissection
## Footnote
Aortic dissection involves the separation of layers in the vessel wall.
237
What ocular complications are commonly displayed by patients with Marfan syndrome?
Various ocular complications
## Footnote
Specific ocular complications are not detailed in the provided text.
238
What are some skeletal abnormalities associated with Marfan syndrome?
Scoliosis and atypical rib development
## Footnote
These abnormalities may lead to a sunken or protruding breastbone.
239
How do patients with Marfan syndrome typically compare in stature?
Usually taller and slender
## Footnote
This includes elongated arms, fingers, legs, and toes.
240
What is the term for elongated fingers seen in Marfan syndrome?
Arachnodactyly
## Footnote
Arachnodactyly refers to a condition where fingers are long and slender.
241
What type of palate is commonly found in patients with Marfan syndrome?
Highly arched palate
## Footnote
This is another physical characteristic associated with Marfan syndrome.
242
What is increased in patients with Marfan syndrome that affects joint movement?
Joint laxity
## Footnote
Increased joint laxity can lead to a higher risk of joint dislocations.
243
What is a common cardiovascular risk associated with Marfan syndrome?
Aortic aneurysms and aortic dissection
## Footnote
Aortic dissection involves the separation of layers in the vessel wall.
244
What ocular complication is common in patients with Marfan syndrome?
Lens subluxation (lens is up and out)
245
What are some skeletal abnormalities associated with Marfan syndrome?
Scoliosis and atypical rib development
## Footnote
These abnormalities may lead to a sunken or protruding breastbone.
246
How do patients with Marfan syndrome typically compare in stature?
Usually taller and slender
## Footnote
This includes elongated arms, fingers, legs, and toes.
247
What is the term for elongated fingers seen in Marfan syndrome?
Arachnodactyly
## Footnote
Arachnodactyly refers to a condition where fingers are long and slender.
248
What is the main goal of systemic treatment for myasthenia gravis?
To increase the amount of available acetylcholine in the neuromuscular junction
## Footnote
This is achieved through the use of oral acetylcholinesterase inhibitors.
249
Name two oral acetylcholinesterase inhibitors used for myasthenia gravis.
* Pyridostigmine (trade name Mestinon)
* Neostigmine
250
What symptoms do acetylcholinesterase inhibitors relieve in myasthenia gravis patients?
Symptoms in small muscles innervated by cranial nerves, particularly those involved in eyelid position, ocular alignments, and speech.
251
Which acetylcholinesterase inhibitor is known to have a longer duration of action?
Pyridostigmine
252
What is the usual starting dosage of pyridostigmine?
60 mg qi.d.
253
What is the maximum effective dosage of pyridostigmine?
120 mg q.2.h.
254
What are some immunosuppressive agents used to suppress symptoms of myasthenia gravis?
* Corticosteroids
* Azathioprine
* Cyclosporine
255
When is a thymectomy beneficial for myasthenia gravis patients?
In patients who have developed myasthenia gravis as a result of a thymoma.
256
How do corticosteroids typically function in the treatment of myasthenia gravis?
They are most effective when used as a supplement to another therapeutic regimen.
257
What treatment is used for patients with severe symptoms of myasthenia gravis?
A short-term immunotherapy course consisting of intravenous immunoglobulin or plasmapheresis.
258
What optical management options are available for ptosis and ocular misalignment symptoms?
* Dark lenses
* Ptosis crutch
* Fresnel prisms
* Occluded lens or eye patch
259
What is a common ocular symptom of Graves' disease?
double vision
## Footnote
Double vision is often associated with the eye changes seen in Graves' disease.
260
What gastrointestinal symptom can frequently occur in Graves' disease?
frequent bowel movements
## Footnote
Increased bowel movements may be a sign of hyperactivity in the gastrointestinal system.
261
What is a significant weight-related symptom of Graves' disease?
weight loss despite increased appetite
## Footnote
Patients may eat more but still lose weight due to increased metabolism.
262
What is a characteristic eye symptom of Graves' disease?
bulging and/or swollen eyes
## Footnote
This condition is known as exophthalmos.
263
What condition is characterized by an enlarged thyroid gland?
goiter
## Footnote
A goiter can occur due to overstimulation of the thyroid gland.
264
What respiratory symptom may be associated with Graves' disease?
shortness of breath
## Footnote
This can occur due to increased metabolic demands and potential heart issues.
265
What menstrual change can occur in females with Graves' disease?
lighter or no menstrual periods
## Footnote
This is due to hormonal imbalances caused by the disease.
266
What cardiovascular symptom is common in Graves' disease?
heart palpitations and/or rapid heart beat
## Footnote
This is a result of increased thyroid hormone levels affecting heart function.
267
What mood-related changes can occur in patients with Graves' disease?
mood changes
## Footnote
Patients may experience anxiety, irritability, or mood swings.
268
What sleep-related symptom can be seen in Graves' disease?
insomnia
## Footnote
Increased energy levels and anxiety can lead to difficulties in sleeping.
269
What psychological symptoms may be present in Graves' disease?
anxiety and/or restlessness
## Footnote
These symptoms are often linked to hyperactivity of the thyroid.
270
What general state of energy is often reported by individuals with Graves' disease?
hyper fatigue
## Footnote
Despite increased energy, individuals may feel fatigued due to the strain on the body.
271
What cognitive symptom can be associated with Graves' disease?
decreased attention span
## Footnote
This can be a result of increased anxiety and hyperactivity.
272
What physical symptom involving muscles can occur in Graves' disease?
muscle weakness
## Footnote
This may be due to increased metabolic demands on muscle tissue.
273
What intolerance to temperature is often seen in Graves' disease?
heat intolerance
## Footnote
Patients often cannot tolerate warm environments due to increased metabolism.
274
What is the opposite temperature intolerance associated with hypothyroidism?
cold intolerance
## Footnote
Hypothyroidism typically leads to cold intolerance due to decreased metabolic activity.
275
What is a common symptom involving the hands in Graves' disease?
hand tremors
## Footnote
Tremors are a result of increased sympathetic nervous system activity.
276
What is a common symptom related to perspiration in Graves' disease?
increased perspiration
## Footnote
This is caused by heightened metabolic activity and heat intolerance.
277
True or false
T4 and T3 are low in hyperthyroidism
FLASE!!
T4 & T3 are HIGH
* TSI binds to TSH receptors leads to enlargement of thyroid gland (goiter) and causes T4 and T3 to increase with low TSH
*because T4&T3 are high, causes pituitary gland to slow down
278
TED can lead to ophthalmoplegia, what is the EOM deficit pattern?
Inferior rectus
Medial rectus
Superior rectus
Lateral rectus
(Motility deficits in this order: elevation, ABduction, depression and ADDuction)
279
What is GCA?
Giant cell arteritis
* chronic inflammatory, affects large and medium sized arteries in head, neck and arms
*testing to confirm dx: ESR, CRP, temporal artery dissection
280
Retinal diseases associated with SLE?
- CRVO
- BRVO
- CRAO
- BRAO
- exudative RD
-Toxic maculopathies (secondary to drug toxicity)
*mimics DR and HTN retinopathy
281
Hutchinson’s triad
* three signs of congenital syphilis
1. Interstitial keratitis
2. Notched teeth
3. Deafness
282
Involvement of tip of nose in herpes zoster ophthalmicus (nasocilliary nerve involvement)
Hutchinson’s sign
283
What are the stages of acquired syphilis?
1. Primary syphilis: chancre at site of infection (2-4 week incubation)
2. Secondary syphilis: occurs 6-8 weeks after chancre, mucous membrane lesions (ocular manifestations occur)
* granulomatous panuveitis (anteiror, intermediate and posterior uveitis)
* salt and pepper fundus, yellow-white chorioretinal lesions, flame hemes, vascular sheathing, papillitis, neuroretinitis
* ARGYLL Robertson pupil (light near dissociation) , episcleritis, scleritis
3. Tertiary syphilis: manifests in untreated pts , occurs after latent period (several years) cardiovascular and CNS disease
284
Parry-Romberg syndrome
Progressive, rare, gradual shrinkage and atrophy of tissues on one side of the face
*affects children and young adults
* F>M
285
Carotid cavernous fistula triad
1) chemists
2) pulsatile proptosis
3) ocular bruit
