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*BCSC deck > Uveitis > Flashcards

Uveitis Flashcards

1
Q

% patients with primary CNS lymphoma who have ocular involvement

A

25%

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2
Q

% patients with primary intraocular lymphoma who will develop CNS disease within 2 years of diagnosis

A

50-67%

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3
Q

% patients with PCNSL who have CSF seeding

A

30-40%

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4
Q

Triple therapy for toxo

A
  1. Pyrimethamine (loading 50-100 mg, treatment 25-50 mg daily)
  2. Sulfadiazine (1g QID)
  3. Prednisone (0.5-1 mg/kg/day depending on severity of inflammation)

+Folinic acid (15 mg daily) to prevent myelosuppression while on pyrimethamine!

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5
Q

What needs to be monitored while patients are on triple therapy?

A

CBC (leukopenia and thrombocytopenia due to myelosuppression)

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6
Q

Alternatives to triple therapy for toxo

A

Bactrim, azithromycin, clindamycin (if sulfa allergy)

For pregnant patients, can use atovaquone (750 mg QID), sulfonamides (first 2 trimesters), or local injections (clindamycin and dexamethasone)

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7
Q

Lymphocytic choriomeningitis virus presents most similarly to what other infection?

A

Toxoplasmosis (differentiated by diffuse nature of intracerebral calcifications in toxo, vs periventricular in LCMV)

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8
Q

Organism that causes ocular larval migrans?

A

Toxocara canis or cati (tissue invasion by second-stage larvae)

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9
Q

Diagnosis for seizures, chorioretinal scars, intracranial calcifications in area with mouse droppings

A

Lymphocytic choriomeningitis virus

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10
Q

Major risk factor for the development of primary CNS lymphoma and primary intraocular lymphoma

A

Immunosuppression

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11
Q

Introducing HAART in patients with CMV and AIDS reduces incidence of CMV retinitis and associated complications by ___%.

A

Introducing HAART in patients with CMV and AIDS reduces incidence of CMV retinitis and associated complications by 80%.

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12
Q

Diagnosis for patient from Mexico with uveitis, seizures, and CNS calcifications

A

Acquired cysticercosis

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13
Q

Mechanism of inflammation in autoimmune regulator-deficient mice

A

Lack transcription factor used by thymus to develop T-cell self-tolerance -> T-cells that are autoreactive to retinal photoreceptor proteins cause posterior uveitis

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14
Q

What condition mimics human T-lymphotropic virus type 1 uveitis?

A

Adult T-cell leukemia/lymphoma

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15
Q

Mechanism of action of methotrexate

A

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

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16
Q

Differential for intermediate uveitis

A

Pars planets, sarcoidosis, syphilis, toxocariasis, Lyme disease, multiple sclerosis, tuberculosis

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17
Q

Diagnosis for anterior uveitis with papular skin lesions, conjunctival nodules, RPE atrophy, optic atrophy

A

Onchocerciasis (Central America, South America, sub-Saharan Africa)

Transmitted by black flies -> larvae mature into worms that migrate to skin and form subcutaneous nodules

Treat with ivermectin

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18
Q

What further testing is required in patient with nongranulomatous anterior uveitis with hypopyon and HLA-B27+ ankylosing spondylitis?

A

CXR, TTE (risk of pulmonary apical fibrosis and cardiovascular disease due to aortic insufficiency)

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19
Q

Differentiate between c-ANCA and p-ANCA

A

c-ANCA: cytoplasmic immunofluorescence pattern, antibodies to proteinase 3, associated with GPA

p-ANCA: perinuclear immunofluorescence pattern, antibodies to myeloperoxidase, associated with PAN, microscopic polyangiitis, Churg-Strauss

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20
Q

Differentiate between ARN and CMV retinitis

A

ARN has more profound vitritis, progresses more rapidly, demonstrates less hemorrhage

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21
Q

Side effects of cyclosporine

A

Gingival hyperplasia, paresthesia, GI upset, fatigue, hypertrichosis, hypertension, renal dysfunction, hirsutism

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22
Q

Side effects of cyclophosphamide

A

Leukopenia, hemorrhagic cystitis, sterility, reversible alopecia

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23
Q

What condition has cyclosporine proven effective in controlled studies for?

A

Behcet disease-related uveitis

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24
Q

Mechanism of cyclosporine

A

calcineurin inhibitor that eliminates T-cell receptor signal transduction, down-regulates interleukin-2 (IL-2) gene transcription and receptor expression of CD4+ T-lymphocytes

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25
Q

In contrast to other white dot syndromes, what is absent in PIC?

A

Vitritis

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26
Q

Why might a patient with acute leptospirosis have resolution of systemic symptoms but continuing uveitis?

A

The eye and brain are immunologically privileged sites (symptoms may persist longer in immunologically privileged sites).

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27
Q

What is the earliest and most common sign of ocular leptospirosis?

A

Circumcorneal conjunctival hyperemia

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28
Q

What is the most common presentation of uveitis caused by tuberculosis?

A

Disseminated choroiditis

29
Q

What supplement interferes with prescribing oral doxycycline, rifampin, and high-dose prednisone to patient for disseminated bartonellosis and neuroretinitis?

A

Calcium (administer 2 hours before or after tetracycline administration because medications mutually prevent each other’s GI absorption)

30
Q

Side effects of tetracyclines

A

Potentiate blood thinners (-> bleeding diathesis), teeth discoloration in young, photosensitivity, decrease efficacy of birth control medication, interferes with GI absorption of calcium

31
Q

What animal model of uveitis most closely resembles VKH syndrome in humans?

A

Experimental autoimmune uveoretinitis (panuveitis)

32
Q

Animal models that cause:

  • Anterior uveitis
  • Posterior uveitis
  • Panuveitis
A

Anterior: equine recurrent uveitis, endotoxin-induced (or experimental immune) uveitis (transient anterior uveitis)

Posterior: autoimmune regulator deficient mice

Panuveitis: experimental autoimmune uveoretinitis

33
Q

Compare and contrast MHC class I molecule structure from MHC class II

A

Similar: heterodimers made of alpha and beta chains, alpha units encoded by MHC gene

Different: MHC class II beta units encoded by MHC gene, MHC class I beta unit is constant (beta-2-microglobulin)

34
Q

Most common findings for primary vitreoretinal lymphoma

A

Creamy yellow/white subretinal and sub-RPE infiltrates and vitritis

35
Q

Mechanism of cyclophosphamide

A

Alkylating agent that permanently crosslinks DNA

36
Q

Mechanism of azathioprine

A

Purine nucleoside analogue that interferes with DNA replication and transcription

37
Q

Mechanism of mycophenolate mofetil

A

Inhibits inosine monophosphate dehydrogenase and DNA replication

38
Q

Diagnosis of parotitis, fever, facial nerve palsy, and uveitis

A

Sarcoidosis (Heerfordt syndrome or uveoparotid fever)

39
Q

What is Lofgren syndrome?

A

Erythema nodosum, febrile arthropathy, bilateral hilar adenopathy, and acute uveitis

40
Q

What medication is associated with scleritis?

A

Pamidronate

41
Q

Name for antigenic sites on antibodies

A

Idiotopes

42
Q

HLA association for tubulointerstitial nephritis and uveitis

A

HLA-DRB1*0102

43
Q

What virus or virus family is most often implicated in glaucomatocyclitic crisis?

A

Herpesvirus (CMV)

44
Q

Most common ocular manifestation associated with inflammatory bowel disease

A

Anterior uveitis

45
Q

Presentation and transmission of chikungunya viral uveitis

A

Anterior uveitis and retinitis; ssRNA alpha virus transmitted by infected mosquitos

46
Q

What is suggested by anterior chamber cells that move very slowly?

A

Fibrinous inflammation from platelet degranulation

47
Q

In what stage does Lyme uveitis occur most commonly?

A

Stage 2, disseminated disease

Most commonly intermediate uveitis

48
Q

Typical presentation of serpiginous choroiditis

A

Sudden onset of central or paracentral scotoma

49
Q

What receptor is strongly involved in lipopolysaccharide-induced uveitis?

A

Toll-like receptor 2 on macrophages

50
Q

Most likely causative organism in postoperative hypopyon, corneal infiltrate, iris mass, necrotizing scleritis, vitreous snowballs

A

Fungus

51
Q

__% of all blindness in the US attributed to inadequately treated uveitis.

A

10% of all blindness in the US attributed to inadequately treated uveitis.

52
Q

HLA association with Behcet disease

A

HLA-B51

53
Q

Appearance of fungi on stains:

  • Aspergillus
  • Cryptococcus
  • Candida
A

Aspergillus: septate, dichotomously branching hyphae

Cryptococcus: round capsules with a halo (India ink)

Candida: budding yeast with pseudohyphae appearance

54
Q

How do patients with Whipple disease present? How is this diagnosed?

A

Panuveitis or retinal vasculitis in patients with abdominal pain, diarrhea, steatorrhea, weight loss, neurologic dysfunction

Duodenal biopsy demonstrating PAS+ bacillus in macrophages within intestinal villi

55
Q

Most common autofluorescence pattern in patient with multifocal choroiditis

A

Multiple punctate hypoAF spots more numerous than clinical appearance

56
Q

Autofluorescence pattern in patient with AZOOR

A

Central hypoAF with peripheral hyperAF

57
Q

Autofluorescence pattern in patient with APMPPE

A

HyperAF corresponding to areas of blockage on FA

58
Q

What regulates anterior chamber associated immune deviation?

A

TGF-beta, vasoactive intestinal peptide

59
Q

Interferon gamma causes ___ and macrophage infiltration.

A

Interferon gamma causes neutrophil and macrophage infiltration.

60
Q

Substance P plays a role in vascular permeability and causes ___ infiltration.

A

Substance P plays a role in vascular permeability and causes leukocyte infiltration.

61
Q

Tumor necrosis factor-alpha is involved in ___ cell infiltration.

A

Tumor necrosis factor-alpha is involved in mononuclear cell infiltration.

62
Q

> 5mm induration from PPD test considered positive in what populations?

A

Exposure to active TB, HIV, or radiographic evidence of healed TB lesions

63
Q

> 10mm induration from PPD test considered positive in what populations?

A

DM, renal failure, systemic IMT, immigrants from TB-endemic areas, health care workers

64
Q

Most common ocular manifestation of human T-cell lymphotropic virus 1 infection?

A

Intermediate uveitis

65
Q

For how long does fluocinolone implant release therapeutic levels of corticosteroids to vitreous cavity?

A

30 months

66
Q

Causes of chronic indolent postoperative inflammation

A

Propionibacterium acnes, Candida parapsilosis

67
Q

Hypersensitivty reaction in atopic keratoconjunctivitis? AKC-related dermatitis?

A

AKC: type IV (mast cell stabilizers are therefore less effective in these patients)

Dermatitis: type I

68
Q

Treatment for human T-lymphotropic virus type-1 associated retinal vasculitis?

A

Systemic corticosteroids

69
Q

What finding in VKH disease suggests chronicity?

A

Choroidal depigmentation, or sunset glow fundus

*BCSC deck (10 decks)

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