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NBEO Part 2 > Systemic Health > Flashcards

Systemic Health Flashcards

1
Q

What is the primary causative agent of Lyme disease?

A

Borrelia burgdorferi

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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

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3
Q

What is the most common ocular manifestation of Lyme disease?

A

Conjunctivitis

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4
Q

Fill in the blank: Lyme disease can lead to __________, a condition characterized by inflammation of the optic nerve.

A

Optic neuritis

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5
Q

What is the recommended treatment for ocular manifestations of Lyme disease?

A

Antibiotics such as doxycycline (50s tetracycline)

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6
Q

Which lab tests do you order to confirm Lyme disease? (2)

A
  • Western blot
  • ELISA (enzyme-linked immunosorbent assay)
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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

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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)

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9
Q

What is a carotid bruit?

A

Whooshing sound that can be heard between quick beats of the heart.

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10
Q

What does a carotid bruit indicate?

A

Irregular blood flow around a thrombus in carotid artery

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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

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12
Q

Ocular complications of Accutane

A

Dry eyes
Myopic shift
Blurred vision
Decreased night vision
—rare—> increased intracranial pressure causing papilledema

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13
Q

New cases of which infectious diseases need to be reported to the CDC?

A

Syphilis
Gonorrhea
Chlamydia
Trachomatis

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14
Q

Ehlers-Danlos syndrome ocular sequelae (5)

A
  1. Lens subluxation
  2. Blue sclera
  3. High myopia
  4. Keratoconus
  5. Retinal detachments
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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

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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)
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17
Q

Opportunistic FUNGAL infections in AIDS patients

A
  • Histoplamosis
  • Candida
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18
Q

Opportunistic bacterial infections in AIDS patients

A
  • staphylococci
  • streptococci
  • mycobacterium avium
  • Haemophilus
  • Mycobacterium tuberculosis
  • bartonella henselae
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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

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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

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21
Q

Ocular manifestations of Reye syndrome (3)
* swelling of brain and liver

A
  1. Dilated pupils with sluggish reaction to light
  2. cortical blindness (loss of vision in normal eye due to damage to occipital lobe)
  3. papilledema (bilateral optic nerve swelling)
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22
Q

What is the pathophysiology of Sjogren syndrome?

A

Autoimmune disease in which inflammation and destruction of the salivary and lacrimal glands occur

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23
Q

Pathophysiology of lupus

A

Connective tissue disease in which circulating autoantibodies and immune complexes cause widespread vasculitis and tissue damage

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24
Q

Pathophysiology of systemic sclerosis
Hint: idiopathic

A

Idiopathic chronic tissue disease that affects the skin and internal organs

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25
Q

True or false
Increase in IOP and increase in corneal sensitivity occurs in pregnancy

A

FALSE!!!
* decreased IOP and decreased corneal sensitivity

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26
Q

What does ELISA testing detect?

A

Serum Toxocara canis antibodies

ELISA stands for Enzyme-Linked Immunosorbent Assay, a common laboratory technique.

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27
Q

Does a positive titer guarantee a diagnosis of toxocariasis?

A

No

A positive titer must be considered alongside lab results and relevant clinical findings.

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28
Q

What is FTA-ABS testing useful for?

A

Suspected syphilis infection

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
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29
Q

What can serum anti-Toxoplasma antibody titers confirm?

A

Presence of Toxoplasmosis

These titers help in the diagnosis of the infection but are not definitive.

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30
Q

Can a negative titer rule out Toxoplasmosis?

A

No

A negative titer does not exclude the possibility of Toxoplasmosis.

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31
Q

What does ultrasonography help to discern regarding retinal masses?

A

Amount of elevation and internal reflectivity

It does not determine the exact etiology of the lesion.

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32
Q

What is fluorescein angiography useful for?

A

Detection of neovascularization, areas of ischemia, or vascular leakage

Smoke stack: CSR
Petaloid pattern: cystoid macular edema
Lacy: choroidal neovascular membrane

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33
Q

Fill in the blank: A positive titer for Toxocara canis does not reflect an absolute diagnosis of _______.

A

toxocariasis

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34
Q

True or False: Ultrasonography is diagnostic for Toxocariasis.

A

False

Ultrasonography assists in assessing retinal masses but does not provide a diagnosis.

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35
Q

What is Gilbert syndrome?

A

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

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36
Q

What causes the yellowing of the sclera in Gilbert syndrome?

A

Buildup of unconjugated bilirubin in the blood.

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37
Q

What is bilirubin?

A

A yellowish-orange substance produced when red blood cells are broken down.

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38
Q

What is the difference between unconjugated and conjugated bilirubin?

A

Unconjugated bilirubin is toxic, while conjugated bilirubin is innocuous.

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39
Q

How is bilirubin excreted from the body?

A

After undergoing a chemical reaction in the liver.

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40
Q

What percentage of patients with Gilbert syndrome show no signs or symptoms?

A

Approximately 30%.

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41
Q

What triggers episodes of hyperbilirubinemia in individuals with Gilbert syndrome?

A

Stressors such as dehydration, fasting, illness, vigorous exercise, menstruation, or lack of sleep.

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42
Q

Does Gilbert syndrome require treatment?

A

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
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43
Q

Fill in the blank: Gilbert syndrome is characterized by elevated levels of _______ in the blood.

A

bilirubin

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44
Q

True or False: Yellowing of the skin and eyes occurs in individuals with Gilbert syndrome.

A

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)

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45
Q

What is COPD?

A

COPD is an irreversible, progressive narrowing of the pulmonary airways that leads to fibrosis and destruction of alveolar tissue.

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46
Q

List common symptoms of COPD.

A
  • Cough (with or without sputum)
  • Shortness of breath that worsens with activity
  • Wheezing
  • Fatigue
  • Difficulty catching one’s breath
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47
Q

What is the biggest risk factor for the development of COPD?

A

Smoking cigarettes.

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48
Q

Name other risk factors for COPD.

A
  • 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
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49
Q

What hypotheses suggest additional risk factors for COPD?

A
  • Dutch hypothesis: history of atopy and hyper-responsive airway
  • British hypothesis: persistent bronchopulmonary infections
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50
Q

How do COPD and asthma differ in terms of airflow limitation?

A

COPD causes irreversible airflow constriction, while asthma causes reversible airflow constriction.

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51
Q

What triggers the inflammatory response in COPD?

A

Cigarette smoke leads to the release of alveolar macrophages, neutrophils, and CD8 T-cells.

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52
Q

Which areas of the lungs are primarily affected by COPD?

A

COPD typically affects the peripheral pulmonary pathways.

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53
Q

What are the pathological changes associated with COPD?

A
  • Parenchymal destruction
  • Metaplasia of squamous cells
  • Mucous production
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54
Q

Does COPD respond well to steroid therapy?

A

No, COPD does not respond well to steroid therapy.

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55
Q

What immune cells are involved in asthma?

A
  • Mast cells
  • Eosinophils
  • Macrophages
  • CD4 T-cells
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56
Q

How does asthma affect the pulmonary pathways?

A

Asthma affects the proximal pulmonary pathways leading to bronchoconstriction and fragile epithelial tissue.

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57
Q

In severe asthma, what is the overlap in cellular involvement with COPD?

A

Neutrophils, macrophages, CD4, and CD8 T-cells are involved.

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58
Q

True or False: Severe asthma responds well to steroid therapy.

A

False, severe asthma responds mildly to steroid therapy.

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59
Q

Fill in the blank: COPD leads to _______ airflow constriction.

A

irreversible

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60
Q

Fill in the blank: Asthma leads to _______ airflow constriction.

A

reversible

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61
Q

What is sarcoidosis?

A

A granulomatous inflammatory condition characterized by the collection of macrophages, multinucleated giant cells, and epithelial cells.

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62
Q

Which demographic is more commonly affected by sarcoidosis?

A

African-American women between the ages of 20-40.

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63
Q

What is the most common ocular manifestation of sarcoidosis?

A

Iritis with large mutton-fat-like keratic precipitates.

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64
Q

List some ocular manifestations of sarcoidosis.

A
  • 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
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65
Q

What are some systemic findings associated with sarcoidosis?

A
  • Enlargement of salivary, lacrimal, and parotid glands
  • Bilateral hilar adenopathy
  • Seventh nerve palsy
  • Lymphadenopathy
  • Arthritis
  • Hepatosplenomegaly
  • Erythema nodosum
  • Lupus pernio
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66
Q

What is lupus pernio?

A

A purplish skin rash visible on the cheeks and nose.

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67
Q

Name some systemic conditions commonly associated with non-granulomatous anterior uveitis.

A
  • 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

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68
Q

What are some systemic causes of granulomatous anterior uveitis?

A
  • Sarcoidosis
  • Tuberculosis
  • Herpes zoster
  • Syphilis
  • Leptospirosis
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69
Q

What does ACE blood work stand for?

A

Angiotensin-converting enzyme
* elevated levels seen in sarcoidosis, TB and histoplasmosis

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70
Q

True or false
ACE serum levels are decreased in sarcoidosis

A

FALSE
* they are elevated

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71
Q

Reiter’s syndrome

A

Reactive arthritis
* joint pain and pain on urination
* HLA-B27 positive

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72
Q

Triad of reactive arthritis (Reiter’s syndrome)

A
  1. Uveitis (can’t see)
  2. Urthetritis (can’t pee)
  3. Poly arthritis (can’t bend a knee)
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73
Q

Which condition is associated with the mnemonic “can’t see, can’t pee, can’t bend a knee”?

A

Reactive arthritis
* HLA-B27 positive

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74
Q

HLA-B27 positive conditions include?

A

UCRAP!
U: ulcerative colitis
C: Crohn’s disease
R: reactive arthritis
A: ankylosing spondylitis
P: psoriatic arthritis

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75
Q

What are the common symptoms of Nongranulomatous Uveitis?

A

Reduced vision, pain, photophobia, and epiphora

Epiphora refers to excessive tearing.

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76
Q

What signs may be present in the anterior chamber of a patient with Nongranulomatous Uveitis?

A

Cells/Flare and stellate Keratic Precipitates

Stellate Keratic Precipitates are small, star-shaped deposits on the corneal endothelium.

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77
Q

What is the most common cause of Nongranulomatous Uveitis?

A

Idiopathic (up to 50%)

Idiopathic means that the cause is unknown.

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78
Q

How does HLA-B27 associated uveitis typically present?

A

Usually bilateral

Bilateral means affecting both eyes.

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79
Q

What condition is characterized by a stiff, painful lower back after exercise and may be associated with HLA-B27?

A

Ankylosing Spondylitis

The term ‘bamboo spine’ is used to describe the appearance of the vertebrae in X-rays.

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80
Q

Which gastrointestinal disease is more commonly associated with uveitis, Crohn’s Disease or Ulcerative Colitis?

A

Crohn’s Disease

Crohn’s Disease can affect the entire gastrointestinal tract and is characterized by skip lesions and cobblestone mucosa.

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81
Q

What should be done if Crohn’s Disease is suspected in a patient with uveitis?

A

Refer the patient for a colonoscopy

A colonoscopy can help visualize the gastrointestinal tract and confirm the diagnosis.

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82
Q

What are the characteristic features of Psoriatic Arthritis?

A

Erythematous rash, arthritis of the phalanges, and nail pitting

Erythematous rash refers to red, inflamed skin, while nail pitting involves small depressions on the nails.

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83
Q

Fill in the blank: The appearance of the vertebrae in Ankylosing Spondylitis is described as a _______.

A

bamboo spine

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84
Q

What is the classic triad of Reiter’s Syndrome (Reactive Arthritis)?

A

Uveitis, urethritis, polyarthritis

Remembered as ‘can’t see, can’t pee, can’t climb a tree.’

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85
Q

What is Ulcerative Colitis a subset of?

A

Inflammatory Bowel Disease

It specifically afflicts the colon or the most inferior portion of the GI tract.

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86
Q

What is the most common cause of uveitis in children?

A

Juvenile Rheumatoid Arthritis (JRA)

Typically bilateral and seen more in females.

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87
Q

What percentage of Juvenile Rheumatoid Arthritis cases are pauciarticular?

A

90%

Pauciarticular cases afflict large joints.

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88
Q

What are the typical test results for JRA?

A

RF negative and ANA positive

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89
Q

What causes Lyme Disease?

A

Infection with Borrelia burgdorferi after a tick bite

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90
Q

What is a characteristic lesion associated with Lyme Disease?

A

Bullseye lesion

Appears at the site of the tick bite.

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91
Q

How long does it typically take for systemic findings of Lyme Disease to present?

A

1-3 months after the bite

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92
Q

What systemic findings can Lyme Disease present with?

A

Encephalitis, meningitis, uveitis

These are signs of inflammation in the brain and spinal cord.

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93
Q

What is Glaucomatocyclitic Crisis also known as?

A

Posner-Schlossman Syndrome

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94
Q

What are the characteristics of Glaucomatocyclitic Crisis?

A

Unilateral mild recurrent uveitis, markedly elevated IOP, usually self-limiting

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95
Q

What is Fuch’s Heterochromic Iridocyclitis characterized by?

A

Unilateral, small stellate keratic precipitates, abnormal anterior chamber vessels, mild heterochromia

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96
Q

What is a common complication of Fuch’s Heterochromic Iridocyclitis?

A

Cataracts

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97
Q

What treatment is required for Glaucomatocyclitic Crisis?

A

Treatment to reduce IOP

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98
Q

What is required for the treatment of Lyme Disease?

A

Systemic antibiotics

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99
Q

What does SLE stand for?

A

Systemic Lupus Erythematosus

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100
Q

What type of disease is SLE?

A

Autoimmune disease

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101
Q

What can SLE affect if left untreated?

A

Many organs of the body

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102
Q

What do immune complexes in SLE lead to?

A

Vasculitis and potential thrombus formation

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103
Q

List three complications of SLE.

A
  • Skin rashes
  • Alopecia
  • Oral ulcers
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104
Q

What is a potential severe complication of SLE related to the eyes?

A

Severe vaso-occlusive retinopathy

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105
Q

What may severe vaso-occlusive retinopathy lead to?

A

Retinal or optic disc neovascularization

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106
Q

What are concurrent eye conditions associated with SLE typically secondary to?

A

Complications from medications

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107
Q

What medications are commonly used to manage SLE?

A
  • Oral corticosteroids
  • Anti-malarials
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108
Q

How may retinal disease associated with SLE present?

A

Mimic diabetic or hypertensive retinopathy

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109
Q

What types of retinal vascular occlusions may patients with SLE develop? List two.

A
  • Central Retinal Vein Occlusion (CRVO)
  • Branch Retinal Vein Occlusion (BRVO)
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110
Q

Fill in the blank: Patients with SLE may develop _______ and toxic maculopathies.

A

[Central Retinal Artery Occlusion (CRAO)]

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111
Q

What type of retinal detachments may patients with SLE experience?

A

Exudative retinal detachments

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112
Q

What is a potential cause of toxic maculopathies in SLE patients?

A

Pharmaceutical intervention

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113
Q

Pinpoint bleeding that occurs when a scale is removed from the skin in psoriasis

A

Auspitz sign

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114
Q

According to American Diabetes Associatoon what is the criteria for diagnosing diabetes?

A
  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
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115
Q

What does a two-hour postprandial glucose measure?

A

The serum level of glucose two hours after a meal

Commonly measured in pregnant women to assist in the diagnosis of gestational diabetes.

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116
Q

What are the normal, prediabetes, and diabetes levels for two-hour postprandial glucose?

A
  • Normal: <140 mg/dL
  • Prediabetes: 140-199 mg/dL
  • Diabetes: 200 or greater mg/dL
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117
Q

What is fasting blood glucose?

A

The amount of glucose in the blood after refraining from eating or drinking anything but water for at least eight hours

Measured in mg/dL.

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118
Q

What are the normal, prediabetes, and diabetes levels for fasting blood glucose?

A
  • Normal: <100 mg/dL
  • Prediabetes: 100-125 mg/dL
  • Diabetes: 126 or greater mg/dL
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119
Q

What does glycosylated hemoglobin (HbA1c) reflect?

A

The percentage of free glucose bound to hemoglobin in red blood cells

Good estimate of average blood sugar over approximately 3 months.

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120
Q

What are the normal, prediabetes, and diabetes levels for glycosylated hemoglobin (HbA1c)?

A
  • Normal: <5.7%
  • Prediabetes: 5.7-6.4%
  • Diabetes: >6.4%
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121
Q

True or False: Blood glucose levels should normalize within two hours of eating in healthy patients.

122
Q

Fill in the blank: The average lifespan of a red blood cell is approximately ______ months.

123
Q

What common ocular finding is observed in patients with osteogenesis imperfecta?

A

Blue sclera

Blue sclera is a characteristic feature of osteogenesis imperfecta due to the underlying collagen abnormalities.

124
Q

What is osteogenesis imperfecta?

A

A congenital, autosomal dominant condition characterized by brittle bones due to abnormal type I collagen

Osteogenesis imperfecta has four subtypes, each with different severities and prognoses.

125
Q

What are common symptoms of osteogenesis imperfecta?

A
  • Multiple bone fractures
  • Potential hearing loss at an early age
  • Blue hue to the sclera

These symptoms result from the underlying collagen defect affecting bone and connective tissue integrity.

126
Q

What treatments are currently available for osteogenesis imperfecta?

A
  • Bisphosphonates
  • Calcium supplements

These treatments show promising results in managing symptoms but do not cure the condition.

127
Q

Management/ patient education for osteogenesis imperfecta?

A
  • Caution with high-impact activities
  • Exercises to build strong muscles and bones
  • Possible surgical reinforcement of leg bones with metal rods or braces

These strategies aim to minimize fractures and enhance physical strength.

128
Q

True or False: A cure exists for osteogenesis imperfecta.

A

False

Currently, there is no cure for osteogenesis imperfecta, only management strategies.

129
Q

Fill in the blank: Osteogenesis imperfecta is characterized by the production of _______.

A

abnormal type I collagen

The defect in type I collagen is responsible for the brittle bones seen in the condition.

130
Q

What is a potential ocular complication for patients with osteogenesis imperfecta?

A

Retinal detachment

Patients may be more prone to retinal detachment due to poor scleral rigidity associated with the condition.

131
Q

What should NOT be ingested within 2 hours of taking iron supplements?

A

Dairy products

Calcium interferes with the absorption of iron, making dairy products a food to avoid close to iron supplementation.

132
Q

What is the relationship between calcium and iron absorption?

A

Calcium interferes with the absorption of iron; the relationship is dose-dependent.

Low amounts of calcium minimally affect iron absorption.

133
Q

Which food type has been shown to minimally affect iron absorption?

A

Low amounts of calcium-containing foods

While low amounts of calcium have minimal effects, higher amounts can significantly inhibit iron absorption.

134
Q

Fill in the blank: Iron supplements should not be ingested within 2 hours of eating _______.

A

calcium-containing foods

135
Q

True or False: High fat content foods should be avoided when taking iron supplements.

A

False

The main concern is with calcium-containing foods, not high fat content foods.

136
Q

Bechet’s disease triad
(“Bitch disease”)

A
  1. Oral ulcers
  2. Genital ulcers
  3. Bilateral nongranulomatous uveitis
137
Q

Bechet’s disease demographic

A

Asians and Mediterraneans with HLA-B5 or HLA-B12

138
Q

Classic finding of Bechet’s disease

139
Q

Signs of Bechet’s disease

A
  • hypopyon
  • anterior and posterior uveitis
  • severe vitritis
  • vasculitis with hemorrhages
  • macular and disc edema with ischemic optic neuropathy in late stages
140
Q

Tx for Bechet’s

A

Topical, oral and sub-tenon’s steroids
* inflammatory disease
* treat anterior uveitis with topical steroid and cycloplegic

141
Q

Hyperthyroidism symptoms

A
  • fatigue
  • heat intolerance
  • hand tremors
  • double vision
  • bulging eyes
  • weight loss
142
Q

A goiter is present in which condition?

A

HYPERthyroidism
* enlarged thyroid gland

143
Q

Tx for syphilis

A

3-4 million units of IV penicillin G q4h for 10-15 days

144
Q

What does the CDC recommend for the treatment of neurosyphilis?

A

High-dose intravenous (IV) penicillin or a combination of intramuscular (IM) procaine penicillin and oral probenecid

Probenecid is contraindicated if a severe sulfa allergy exists.

145
Q

What is the proper dosing for IV penicillin G in the treatment of neurosyphilis?

A

3-4 million units IV q.4.h. or 24 million units IV as a continuous infusion for 10-15 days.

146
Q

What is the dosing for IM treatment of neurosyphilis?

A

2.4 million units of procaine penicillin IM, plus probenecid 500 mg p.o. q.i.d. for 10-15 days.

147
Q

What alternative treatment may be used if the patient is allergic to penicillin?

A

Ceftriaxone may be substituted if the patient is in an early stage of syphilis.

148
Q

What is necessary if a patient is in a later stage of syphilis and allergic to penicillin?

A

It may be necessary to first desensitize the patient to penicillin.

149
Q

What antibiotics are commonly used to treat
gonorrhea?

A

Ceftriaxone 1g IV or IM
*5 days for corneal involvement

And

1g po single dose azithromycin

150
Q

Which medication is frequently used for the treatment of chlamydia?

A

Doxycycline.

151
Q

What therapy is indicated in patients who are HIV positive?

A

HAART combination therapy.

152
Q

What medications are generally used in the treatment of tuberculosis?

A

Isoniazid and rifapentine.

153
Q

True or False: Probenecid can be used if a patient has a severe sulfa allergy.

154
Q

Fill in the blank: The dosing for probenecid is _______.

A

500 mg p.o. q.i.d.

155
Q

Fill in the blank: The continuous infusion of IV penicillin G is for _______ days.

156
Q

What are some systemic conditions associated with the development of scleritis?

A
  • Rheumatoid arthritis, lupus, Behcet, Sarcoidosis, gout

Wegener granulomatosis, relapsing polychondritis, polyarteritis nodosa,spondyloarthropathies

These conditions may present with varying symptoms and severities related to scleritis.

157
Q

Which systemic condition is the most common associated with scleritis?

A

Rheumatoid arthritis

It is important to recognize this condition for appropriate diagnosis and management of scleritis.

158
Q

How do patients with non-necrotizing scleritis typically present?

A

With mild joint disease

This presentation is generally less severe compared to those with necrotizing scleritis.

159
Q

What is the typical presentation of patients with necrotizing scleritis?

A

More severe, long-standing rheumatoid disease with associated extra-articular manifestations

Examples of extra-articular manifestations include rheumatoid nodules.

160
Q

What characterizes Wegener granulomatosis?

A

Idiopathic, multi-system inflammatory condition with generalized small vessel vasculitis

It is noted for the development of granulomas in various organs.

161
Q

What organs are predominantly affected by Wegener granulomatosis?

A

Respiratory tract and kidneys

It can also involve the lungs, eyes, ears, throat, and skin.

162
Q

What type of scleritis can Wegener granulomatosis be associated with?

A

Rapidly progressive, necrotizing granulomatous scleritis

This association highlights the severity of the condition.

163
Q

Can Wegener granulomatosis be localized to the eye and orbit?

A

Yes, it can occur without systemic involvement

An orbital biopsy may be required for diagnosis in such cases.

164
Q

What is relapsing polychondritis?

A

A rare idiopathic disorder characterized by small vessel vasculitis

It leads to recurrent, progressive, painful, destructive inflammation of cartilage and connective tissues.

165
Q

What type of scleritis is commonly caused by relapsing polychondritis?

A

Intractable scleritis, which may be necrotizing or non-necrotizing

This indicates the potential severity and complexity of the condition.

166
Q

What is Polyarteritis Nodosa (PAN)?

A

A collagen vascular disease affecting medium and small arteries, often with associated aneurysm formation; idiopathic and potentially lethal.

PAN may lead to severe necrotizing scleritis and can cause various types of scleritis.

167
Q

What ocular involvement may occur in Polyarteritis Nodosa (PAN)?

A

Ocular involvement may precede systemic manifestations by many years.

This highlights the importance of monitoring ocular health in patients with PAN.

168
Q

What is Systemic Lupus Erythematosus (SLE)?

A

An autoimmune disease where the immune system mistakenly attacks healthy tissue, including skin, eyes, joints, kidneys, brain, and other organs.

SLE can lead to various complications affecting multiple organ systems.

169
Q

What types of scleritis may be associated with Systemic Lupus Erythematosus (SLE)?

A

Anterior diffuse scleritis or nodular scleritis.

Necrotizing scleritis is less common but more difficult to control without early treatment.

170
Q

True or False: Necrotizing scleritis is more common and easier to treat.

A

False.

Necrotizing scleritis is much less common and much more difficult to control if treatment is delayed.

171
Q

Which condition is very rarely associated with diffuse episcleritis or scleritis?

A

Gout.

Gout’s association with scleritis is quite rare.

172
Q

What ocular manifestation can sarcoidosis rarely cause?

A

Scleral nodules.

Sarcoidosis can affect various organs, but its ocular manifestations are less common.

173
Q

What syndrome is rarely associated with diffuse anterior scleritis?

A

Behcet Syndrome.

This can occur with or without other ocular manifestations.

174
Q

Which group of diseases is occasionally associated with mild diffuse scleritis?

A

Spondyloarthropathies.

These conditions may present with ocular symptoms before joint symptoms appear.

175
Q

What is sarcoidosis?

A

A granulomatous inflammatory condition characterized by the collection of macrophages, multinucleated giant cells, and epithelial cells.

176
Q

In which demographic is sarcoidosis more commonly observed?

A

African-American women between the ages of 20-40.

177
Q

What percentage of individuals with sarcoidosis experience ocular involvement?

A

Roughly 25-50%.

178
Q

What is the most common ocular manifestation of sarcoidosis?

A

Iritis with large mutton-fat-like keratic precipitates.

179
Q

List some ocular manifestations of sarcoidosis.

A
  • 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
180
Q

True or False: Ocular involvement in sarcoidosis is rare.

181
Q

Fill in the blank: Sarcoidosis is characterized by the presence of _______ cells.

A

[macrophages, multinucleated giant cells, epithelial]

*non-caseating granulomas on lungs

182
Q

What is the term used to describe the sheathing of the peripheral retinal vasculature in sarcoidosis?

A

‘Candle-wax drippings’

183
Q

What is Sjogren syndrome?

A

An autoimmune disease that causes inflammation and destruction of both the lacrimal and salivary glands

It may manifest in isolation (primary) or in association with other diseases (secondary).

184
Q

Which demographic is primarily affected by Sjogren syndrome?

A

Adult women

This syndrome primarily affects women, particularly in middle age.

185
Q

List some diseases associated with secondary Sjogren syndrome.

A
  • Rheumatoid arthritis
  • Systemic lupus erythematosus
  • Systemic sclerosis
  • Chronic active hepatitis
  • Myasthenia gravis
  • Primary biliary cirrhosis

These diseases may occur alongside Sjogren syndrome.

186
Q

What are common signs of Sjogren syndrome? (Name at least 3)

A
  • Enlargement of salivary glands
  • Diminished salivary flow rate
  • Dry, fissured tongue
  • Decreased tear production
  • Ocular dryness and grittiness

These signs indicate dysfunction in glandular secretions.

187
Q

What tests aid in the diagnosis of Sjogren syndrome?

A
  • Serum autoantibodies
  • Schirmer tear testing
  • Biopsy of the minor salivary glands

These tests help confirm the presence of Sjogren syndrome.

188
Q

True or False: Sjogren syndrome only affects the salivary glands.

A

False

It also affects the lacrimal glands and other mucosal surfaces.

189
Q

What is systemic lupus erythematosus?

A

A connective tissue disease in which circulating autoantibodies and immune complexes cause widespread vasculitis and tissue damage

This disease is often associated with Sjogren syndrome.

190
Q

Define rheumatoid arthritis.

A

An autoimmune disease characterized by symmetrical, destructive, deforming inflammatory polyarthropathy

This condition can co-occur with Sjogren syndrome.

191
Q

What does systemic sclerosis affect?

A

The skin and internal organs

It is an idiopathic chronic connective tissue disease.

192
Q

Fill in the blank: Patients with Sjogren syndrome typically experience dryness of the mouth and _______.

A

eyes

This dryness is a hallmark symptom of the syndrome.

193
Q

What symptoms might indicate decreased tear production in Sjogren syndrome?

A
  • Ocular dryness
  • Grittiness
  • Quick tear break-up times

These symptoms suggest dysfunction in the lacrimal glands.

194
Q

Hyperthyroidism symptoms

A
  • fatigue
  • heat intolerance
  • hand tremors
  • double vision
  • bulging eyes (eyelid retraction from increased sympathetic activity)
195
Q

What is Toxocariasis caused by?

A

Toxocara canis

Toxocara canis is an intestinal roundworm commonly found in dogs.

196
Q

How can humans develop Toxocariasis?

A

Via contact with contaminated soil or food.

197
Q

What happens once Toxocara canis ova are ingested?

A

They transform into larvae that can travel to various organs.

198
Q

Which organs can Toxocara canis larvae infect in humans? (5)

A
  • Eyes
  • Liver
  • Brain
  • Lungs
  • Skin
199
Q

What type of reaction may occur when Toxocara canis larvae perish?

A

An inflammatory reaction to the remnants of their carcasses.

200
Q

What are the clinical presentations of Toxocariasis?

A

Several different presentations, including ocular infections.

201
Q

What may ocular infections from Toxocariasis appear as?

A

Uveitis with exudative material or retinal granuloma.

202
Q

How do retinal granulomas appear in Toxocariasis?

A

White or yellow and may span up to two disc diameters.

203
Q

What is a common observation if the granuloma is located more anteriorly?

A

Vitreous bands running from the granuloma to the posterior pole.

204
Q

What treatments may benefit patients with Toxocariasis-related retinal issues?

A
  • Steroid treatments
  • Surgery in case of retinal detachment
205
Q

What severe procedure may be required in extreme cases of Toxocariasis?

A

Enucleation.

206
Q

What causes Candidiasis?

A

Candida albicans.

207
Q

Where is Candida albicans frequently found?

A
  • Skin
  • Digestive tract
  • Mouth
  • Vagina
208
Q

Who is at risk for retinal involvement in Candidiasis?

A
  • Immunocompromised patients
  • IV drug users
  • Those with long-term indwelling catheters
209
Q

What symptoms may patients with Candidiasis experience?

A

Floaters and blurred vision unilaterally.

210
Q

How does retinal involvement in Candidiasis appear?

A

Small, white, round lesions with indistinct borders.

211
Q

What may happen to the lesions in Candidiasis if left untreated?

A

They may coalesce and extend into the vitreous.

212
Q

What appearance do lesions in Candidiasis cause in the vitreous?

A

Suspended ‘cotton balls’.

213
Q

What severe complications can arise from untreated Candidiasis?

A
  • Endophthalmitis
  • Retinal necrosis
  • Detachment
214
Q

What is postural hypotension also known as?

A

Orthostatic hypotension

A condition where blood pressure drops dramatically after a change in posture.

215
Q

What symptoms may occur with postural hypotension?

A

Dizziness, lightheadedness, fainting

Symptoms typically arise after standing from a sitting or lying position.

216
Q

How long does postural hypotension generally last?

A

A few seconds or minutes

It usually abates with no lasting effects.

217
Q

What conditions may require treatment for postural hypotension?

A

Dehydration, diabetes, heart problems

These underlying causes may necessitate medical intervention.

218
Q

Who is more frequently encountered with postural hypotension?

A

The elderly

This demographic is more susceptible to the condition.

219
Q

What is ketoacidosis?

A

A condition that occurs during starvation, low carbohydrate levels, or uncontrolled diabetes

It involves excessive breakdown of fats and formation of ketone bodies.

220
Q

When is carbohydrate catabolism favored over ketone body formation?

A

In normal metabolic conditions

Carbohydrate catabolism is generally prioritized unless there is excessive acetyl-CoA.

221
Q

What fuels the brain during starvation?

A

Ketones

Ketone bodies are used to maintain regulatory functions when glucose is scarce.

222
Q

What are warning signs of ketoacidosis? (4)

A

Vomiting, flushed skin, difficulty breathing, confusion

Fruity breath is a key sign to watch and/or smell for.

223
Q

What serious outcomes can ketoacidosis lead to?

A

Diabetic coma or death

It is a critical condition that requires immediate attention.

224
Q

Who is more susceptible to ketoacidosis?

A

People with type I diabetes

They are at a higher risk compared to those with type II diabetes.

225
Q

What is a myocardial infarction?

A

A blockage of blood flow to the heart causing damage to cardiac tissue

It is commonly known as a heart attack.

226
Q

What is the most common symptom of a heart attack?

A

Chest pain

This symptom is often reported by patients experiencing a myocardial infarction.

227
Q

What additional symptom may patients experience during a heart attack?

A

Difficulty breathing

However, swelling of the lips, tongue, and throat is not typical.

228
Q

What is vasovagal syncope?

A

A condition that causes fainting

It can occur in response to extreme emotional stress, trauma, or heat exposure.

229
Q

Does vasovagal syncope involve swelling of the lips, throat, or tongue?

A

No

Patients do not experience swelling in these areas.

230
Q

What is the route of administration for Epinephrine (EpiPen®)?

A

Injected intramuscularly to the upper lateral thigh

231
Q

What receptors does Epinephrine activate?

A

Both alpha and beta-adrenergic receptors

232
Q

What are the effects of Epinephrine on peripheral vascular resistance?

A

Causes an increase in peripheral vascular resistance

233
Q

What are the effects of Epinephrine on blood pressure?

A

Increases blood pressure

234
Q

What condition does Epinephrine help to reverse?

A

Vasodilation

235
Q

What symptoms does Epinephrine decrease?

A

Urticaria and angioedema

236
Q

Why is Benadryl® (diphenhydramine) not effective for severe life-threatening reactions?

A

It will not work quickly enough

237
Q

What should always be called immediately in the event of anaphylactic shock?

238
Q

What are potential complications of anaphylactic shock?

A

Apnea, syncope, and cardiac arrest

239
Q

What can rapidly increase blood sugar levels in a diabetic during a hypoglycemic event?

A

Orange juice

240
Q

What should diabetics limit due to high sugar content?

A

Ingestion of juices

241
Q

What is the purpose of administering Nitroglycerin during a myocardial infarction?

A

To relax the smooth muscles of the blood vessels

242
Q

When should Nitroglycerin not be used?

A

If the patient has low blood pressure

243
Q

What types of medications are frequently used to treat heart attacks?

A

Anticoagulants, antiplatelets, and medications that dissolve clots

244
Q

What is the most appropriate initial treatment for anaphylactic shock?

A

Immediate injection of epinephrine

245
Q

Fill in the blank: For severe life-threatening allergic reactions, _______ will not work quickly enough.

A

Benadryl® (diphenhydramine)

246
Q

What is a common cardiovascular risk associated with Marfan syndrome?

A

Aortic aneurysms and aortic dissection

Aortic dissection involves the separation of layers in the vessel wall.

247
Q

What ocular complications are commonly displayed by patients with Marfan syndrome?

A

Various ocular complications

Specific ocular complications are not detailed in the provided text.

248
Q

What are some skeletal abnormalities associated with Marfan syndrome?

A

Scoliosis and atypical rib development

These abnormalities may lead to a sunken or protruding breastbone.

249
Q

How do patients with Marfan syndrome typically compare in stature?

A

Usually taller and slender

This includes elongated arms, fingers, legs, and toes.

250
Q

What is the term for elongated fingers seen in Marfan syndrome?

A

Arachnodactyly

Arachnodactyly refers to a condition where fingers are long and slender.

251
Q

Fill in the blank: Patients with Marfan syndrome commonly have _______.

A

Flat feet

Flat feet is a common feature among individuals with Marfan syndrome.

252
Q

What type of palate is commonly found in patients with Marfan syndrome?

A

Highly arched palate

This is another physical characteristic associated with Marfan syndrome.

253
Q

What is increased in patients with Marfan syndrome that affects joint movement?

A

Joint laxity

Increased joint laxity can lead to a higher risk of joint dislocations.

254
Q

What is a common cardiovascular risk associated with Marfan syndrome?

A

Aortic aneurysms and aortic dissection

Aortic dissection involves the separation of layers in the vessel wall.

255
Q

What ocular complication is common in patients with Marfan syndrome?

A

Lens subluxation (lens is up and out)

256
Q

What are some skeletal abnormalities associated with Marfan syndrome?

A

Scoliosis and atypical rib development

These abnormalities may lead to a sunken or protruding breastbone.

257
Q

How do patients with Marfan syndrome typically compare in stature?

A

Usually taller and slender

This includes elongated arms, fingers, legs, and toes.

258
Q

What is the term for elongated fingers seen in Marfan syndrome?

A

Arachnodactyly

Arachnodactyly refers to a condition where fingers are long and slender.

259
Q

Fill in the blank: Patients with Marfan syndrome commonly have _______.

A

Flat feet

Flat feet is a common feature among individuals with Marfan syndrome.

260
Q

What type of palate is commonly found in patients with Marfan syndrome?

A

Highly arched palate

This is another physical characteristic associated with Marfan syndrome.

261
Q

What is increased in patients with Marfan syndrome that affects joint movement?

A

Joint laxity

Increased joint laxity can lead to a higher risk of joint dislocations.

262
Q

What is the main goal of systemic treatment for myasthenia gravis?

A

To increase the amount of available acetylcholine in the neuromuscular junction

This is achieved through the use of oral acetylcholinesterase inhibitors.

263
Q

Name two oral acetylcholinesterase inhibitors used for myasthenia gravis.

A
  • Pyridostigmine (trade name Mestinon)
  • Neostigmine
264
Q

What symptoms do acetylcholinesterase inhibitors relieve in myasthenia gravis patients?

A

Symptoms in small muscles innervated by cranial nerves, particularly those involved in eyelid position, ocular alignments, and speech.

265
Q

Which acetylcholinesterase inhibitor is known to have a longer duration of action?

A

Pyridostigmine

266
Q

What is the usual starting dosage of pyridostigmine?

A

60 mg qi.d.

267
Q

What is the maximum effective dosage of pyridostigmine?

A

120 mg q.2.h.

268
Q

What are some immunosuppressive agents used to suppress symptoms of myasthenia gravis?

A
  • Corticosteroids
  • Azathioprine
  • Cyclosporine
269
Q

When is a thymectomy beneficial for myasthenia gravis patients?

A

In patients who have developed myasthenia gravis as a result of a thymoma.

270
Q

How do corticosteroids typically function in the treatment of myasthenia gravis?

A

They are most effective when used as a supplement to another therapeutic regimen.

271
Q

What treatment is used for patients with severe symptoms of myasthenia gravis?

A

A short-term immunotherapy course consisting of intravenous immunoglobulin or plasmapheresis.

272
Q

What optical management options are available for ptosis and ocular misalignment symptoms?

A
  • Dark lenses
  • Ptosis crutch
  • Fresnel prisms
  • Occluded lens or eye patch
273
Q

What is a common ocular symptom of Graves’ disease?

A

double vision

Double vision is often associated with the eye changes seen in Graves’ disease.

274
Q

What gastrointestinal symptom can frequently occur in Graves’ disease?

A

frequent bowel movements

Increased bowel movements may be a sign of hyperactivity in the gastrointestinal system.

275
Q

What is a significant weight-related symptom of Graves’ disease?

A

weight loss despite increased appetite

Patients may eat more but still lose weight due to increased metabolism.

276
Q

What is a characteristic eye symptom of Graves’ disease?

A

bulging and/or swollen eyes

This condition is known as exophthalmos.

277
Q

What condition is characterized by an enlarged thyroid gland?

A

goiter

A goiter can occur due to overstimulation of the thyroid gland.

278
Q

What respiratory symptom may be associated with Graves’ disease?

A

shortness of breath

This can occur due to increased metabolic demands and potential heart issues.

279
Q

What menstrual change can occur in females with Graves’ disease?

A

lighter or no menstrual periods

This is due to hormonal imbalances caused by the disease.

280
Q

What cardiovascular symptom is common in Graves’ disease?

A

heart palpitations and/or rapid heart beat

This is a result of increased thyroid hormone levels affecting heart function.

281
Q

What mood-related changes can occur in patients with Graves’ disease?

A

mood changes

Patients may experience anxiety, irritability, or mood swings.

282
Q

What sleep-related symptom can be seen in Graves’ disease?

A

insomnia

Increased energy levels and anxiety can lead to difficulties in sleeping.

283
Q

What psychological symptoms may be present in Graves’ disease?

A

anxiety and/or restlessness

These symptoms are often linked to hyperactivity of the thyroid.

284
Q

What general state of energy is often reported by individuals with Graves’ disease?

A

hyper fatigue

Despite increased energy, individuals may feel fatigued due to the strain on the body.

285
Q

What cognitive symptom can be associated with Graves’ disease?

A

decreased attention span

This can be a result of increased anxiety and hyperactivity.

286
Q

What physical symptom involving muscles can occur in Graves’ disease?

A

muscle weakness

This may be due to increased metabolic demands on muscle tissue.

287
Q

What intolerance to temperature is often seen in Graves’ disease?

A

heat intolerance

Patients often cannot tolerate warm environments due to increased metabolism.

288
Q

What is the opposite temperature intolerance associated with hypothyroidism?

A

cold intolerance

Hypothyroidism typically leads to cold intolerance due to decreased metabolic activity.

289
Q

What is a common symptom involving the hands in Graves’ disease?

A

hand tremors

Tremors are a result of increased sympathetic nervous system activity.

290
Q

What is a common symptom related to perspiration in Graves’ disease?

A

increased perspiration

This is caused by heightened metabolic activity and heat intolerance.

291
Q

True or false
T4 and T3 are low in hyperthyroidism

A

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

292
Q

TED can lead to ophthalmoplegia, what is the EOM deficit pattern?

A

Inferior rectus
Medial rectus
Superior rectus
Lateral rectus

(Motility deficits in this order: elevation, ABduction, depression and ADDuction)

294
Q

What is GCA?

A

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

295
Q

Retinal diseases associated with SLE?

A
  • CRVO
  • BRVO
  • CRAO
  • BRAO
  • exudative RD
    -Toxic maculopathies (secondary to drug toxicity)

*mimics DR and HTN retinopathy

296
Q

Hutchinson’s triad

A
  • three signs of congenital syphilis
    1. Interstitial keratitis
    2. Notched teeth
    3. Deafness
297
Q

Involvement of tip of nose in herpes zoster ophthalmicus (nasocilliary nerve involvement)

A

Hutchinson’s sign

298
Q

What are the stages of acquired syphilis?

A
  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
299
Q

Parry-Romberg syndrome

A

Progressive, rare, gradual shrinkage and atrophy of tissues on one side of the face
*affects children and young adults
* F>M

300
Q

Carotid cavernous fistula triad

A

1) chemists
2) pulsatile proptosis
3) ocular bruit

NBEO Part 2 (23 decks)

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