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White Dot Syndrome 2 Flashcards

1
Q

PIS BAMA

A

Punctate Inner Chorioretinopathy
Idiopathic Multifocal Choroiditis
Serpiginous Chorioretinopathy
Birdshot Chorioretinopathy
Acute Zonular Occult Outer Retinopathy
Multiple Evanescent WDS
Acute Posterior Multifocal Placoid Pigment Epitheliopathy

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2
Q

Which WDS has the acronym PIC?

A

Punctate Inner Chorioretinopathy

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3
Q

Which WDS has the acronym IMFC?

A

Idiopathic Mulifocal Choroiditis

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4
Q

Which WDS has the acronym AZOOR?

A

Acute Zonular Occult Outer Retinopathy

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5
Q

Which WDS has the acronym MEWDS?

A

Multiple Evanescent White Dot Syndrome

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6
Q

Which WDS has the acronym APMPPE?

A

Acute Posterior Multifocal Placoid Pigment Epitheliopathy

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7
Q

Which two WDSs appear similar to POHS?

A

MCP (aka IMFC) and PIC

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8
Q

Which two WDSs are most prevalent in older (middle-aged) patients?

A

Birdshot and Serpiginous

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9
Q

Birdshot lesions are predominantly located ______ (superior, inferior, nasal, or temporal) to the ONH

A

Nasal

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10
Q

Serpiginous lesions normally appear in the ________ region of the retina with _______ spread.

A

Peripapillary region of the retina with centrifugal spread

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11
Q

Which two WDSs present unilaterally?

A

MEWDS and AZOOR (remember: both contain the “U” sound for unilateral)

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12
Q

Unilateral WDSs can result in what clinical finding?

A

RAPD

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13
Q

Which of the two WDSs that typically present as unilateral eventually end up bilateral?

A

AZOOR

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14
Q

MEWDS is most easily visualized during which diagnostic test?

A

FA

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15
Q

AZOOR is most easily visualized during which diagnostic test?

A

FAF

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16
Q

MEWDS is most often found in which part of the retina?

A

Perifoveal

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17
Q

A lesion in MEWDS is shaped like ______

A

A wreath

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18
Q

Which WDS is likely to be “unrevealing” under DFE?

A

AZOOR

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19
Q

AZOOR is most often found in which part of the retina?

A

Peripapillary

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20
Q

What does “serpiginous” mean and how does it relate to the clinical signs of Serpiginous Choroidopathy?

A

“Snake-like”; refers to the centrifugal spread that appear like a slithering snake

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21
Q

Which two WDSs have the largest lesions?

A

APMPPE and Serpiginous

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22
Q

Which WDSs affect males and females equally?

A

APMPPE, Serpiginous,and Relentless Placoid Chorioretinitis

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23
Q

Most WDSs predominantly affect _______ (females/males)?

A

Females

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24
Q

Which two WDSs specifically affect young myopic females?

A

PIC and AZOOR

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25
Q

Which three WDSs have the worst prognoses?

A

Serpiginous, Birdshot, and MCP (aka IMFC)

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26
Q

What is an appropriate treatment for the WDSs with the least amount of risk for vision loss?

27
Q

What is an appropriate treatment for the WDSs with higher risk of vision loss?

A

Steroids + Immunomodulatory Therapy (IMT)

28
Q

What is the “ultimate/long-term management goal for all forms of uveitis?”

A

No inflammation on no steroids

29
Q

Which two WDSs always presents with vitreous cells?

A

Birdshot and MCP (aka IMFC)

30
Q

Which WDS has a strong association with a specific Human Leukocyte Antigen (HLA) and which one is it?

A

Birdshot; associated with HLA—A29

31
Q

True/False: it is possible to test positive for the HLA protein (that has a strong association with a particular WDS) and not have the WDS

A

TRUE; 7% of the general population are (+) HLA-A29 and will not develop birdshot

32
Q

Which WDS is associated with cerebral vasculitis?

33
Q

True/False: due to the nature of APMPPE, headaches may indicate a sight-threatening complication and requires an urgent MRI.

A

FALSE; headaches are common in APMPPE due to its viral prodrome nature and does not require urgent medical attention

34
Q

What APMPPE finding requires urgent medical attention and what intervention is indicated?

A

A peripheral neuro deficit; requires urgent MRI of brain and treatment with systemic steroids

35
Q

Which two WDSs are associated with viral prodrome?

A

APMPPE and MEWDS

36
Q

Which 4 WDSs are recurrent?

A

Birdshot, Serpiginous, IMFC, and Relentless Placoid Chorioretinitis

37
Q

What is the classic FA pattern of APMPPE?

A

Blocks early, stains late (initially hypofluorescent behind the lesions, and in later stages, absorb the fluorescein and become hyperfluorescent)

38
Q

What other WDSs show similar FA patterns to APMPPE?

A

MCP (aka IMFC) and Serpiginous

39
Q

What infectious pathology shows a similar FA pattern to APMPPE?

A

Syphilis, Tuberculosis, and Sarcoidosis (should always be DDx for uveitis)

40
Q

When syphilis causes uveitic lesions, it is referred to as…

A

Acute Syphilitic Posterior Placoid Chorioretinopathy (ASPPC)

41
Q

What is one way to differentiate APMPPE and ASPPC?

A

ASPPC patients will typically be immunocompromised (APMPPE patients will not)

42
Q

Patients with Birdshot are at particular risk for what vision-threatening complication? What does the presence of this complication indicate?

A

Cystoid Macular Edema, which indicates an active lesion

43
Q

3 Signs of Active Birdshot

A

Cystoid Macular Edema, ONH inflammation, and retinal vasculitis (usually phlebitis)

44
Q

True/False: If a Birdshot patient presents with none of the signs of active lesion, it is not likely to progress and the management plan is to monitor.

A

FALSE; Birdshot can be insidious (even if seemingly dormant)

45
Q

What diagnostic tests should be routinely performed for Birdshot patients?

A

Full-field ERG and HVF 30-2

46
Q

What is the most classic symptom of AZOOR?

47
Q

What visual field defect would you expect in an AZOOR patient?

A

It’s highly variable but typically connected to blind spot

48
Q

What is the classic VF defect with MEWDS?

A

Enlarged blind spot

49
Q

What sign is pathognomonic for MEWDS?

A

Granular pigment changes after resolution of white dots

50
Q

Most common cause of vision loss in MCP (IMFC) patients?

A

Choroidal neovascularization

51
Q

What infectious pathology has a similar appearance to Serpiginous? This is referred to as…

A

Tuberculosis; referred to as Serpiginous-like Choroiditis (SLC)

52
Q

What population is particular vulnerable to SLC?

53
Q

In what ways is Relentless Placoid Choroiditis similar to APMPPE?

A

Multifocal/numeros lesions located throughout posterior pole and near periphery

54
Q

In what ways is Relentless Placoid Choroiditis similar to Serpiginous?

A

Recurrent nature and leaves pigmented areas of chorioretinal scarring/atrophy

55
Q

In what ways is Relentless Placoid Choroiditis NOT like Serpiginous?

A

Even though they are both recurrent, with RPC, the lesions recur in new areas, whereas Serpiginous recurs at the edge of previous lesions

56
Q

When suspecting WDS, what 4 infectious etiologies should always be considered?

A

Syphilis, Tuberculosis, Sarcoidosis, and Diffuse Unilateral Subacute Neuroretinitis (DUSN)

57
Q

What pathogen is responsible for DUSN? What are the most common types?

A

Nematode (aka Roundworm); Baylisacaris (most common of all), Anclyostoma, and Toxocara

58
Q

True/False: a single pathogen can illicit a DUSN response

A

TRUE; infectious load is 1 single roundworm

59
Q

Who is most likely affected by DUSN?

A

Healthy adolescent/young adult

60
Q

How will the patient present in the Acute Stage of DUSN?

A

Decreased VA and pain with vitritis, disc edema, and multiple lesions (but the signs/symptoms come and go)

61
Q

How will the patient present in the Late Stage of DUSN?

A

Poor VA, Depigmented RPE, disc pallor/atrophy, and attenuated retinal vessels

62
Q

True/False: once DUSN reaches late stage, it’s untreatable

A

TRUE; this highlights the importance of properly diagnosing at the acute stage

63
Q

How do you treat DUSN?

A

Locate the worm and laser it

Y. Post Seg 2 (13 decks)

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