Brainscape's Knowledge GenomeTM

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


See full index

OD2 Semester 2 - Applied Clinical Training > wk6: AED - Allergy 2 [DG] > Flashcards

wk6: AED - Allergy 2 [DG] Flashcards

1
Q

List the symptoms of VKC (8)

A 
intense itching/burning
watery
photophobia
FB sensation
puffy lids
mucoid discharge
blurred vision
eye rubbing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List the signs of VKC (7)

A

symptoms may worsen in spring + early summer
type 1 hypersensitivity
uncommon, bilateral, males>females
most common age @5-25yrs
most sufferers atopic (people with other allergies) or have family hx of atopy
usually affects superior tarsal conjunctiva but may affect limbal area (or could affect both)

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

List the clinical features of VKC (8)

A

bilateral
conjunctival hyperaemia + chemosis
large palpebral papillae (up to 5mm)
stringy mucus dicharge (may sit b/w papillae)
ptosis
Corneal changes: SPK, shield ulcers, subepithelial scarring, eosinophil plaques
Limbus: limbitis with limbal papillae + Horner-Trantas’ dots, and pseudogerontoxon

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

How does VKC present in the cornea? (4)

A

SPK, shield ulcers, subepithelial scarring, eosinophil plaques

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

How does VKC present at the limbus? (3)

A

limbitis with limbal papillae + Horner-Trantas’ dots, and pseudogerontoxon in area of previously inflamed limbus

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

What DDx exist for VKC? (2)

A

atopic keratoconjunctivitis

giant papillary conjunctivitis

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

How do you assess VKC? (4)

A

hx, slit lamp, fluoroscein, lid eversion

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

Describe the pathophysiology of VKC, in relation to Th2 lymphocytes and what they mediate (2)

A

Th2 lymphocytes mediate:

  • reduced IgE via IL-4
  • differentiation + activation of mast cells & eosinophils via IL-3 and IL-5 respectively
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What might explain improvement in VKC with onset of puberty?

A

over expression of oestrogen and progesterone receptors in the conjunctiva of VKC patients

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

What might VKC patients have a hypersensitivity to? (3)

A

wind, dust, sun

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

is their a genetic component behind VKC?

A

Possibly, research has found reduced level of tear film histamine

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

List tx options for VKC (6)

A

allergen avoidance (if identifiable, role for allergist)
topical MC inhibitors
corticosteroids
topical NSAIDs
topical cyclosporin
referral for superficial keratectomy to improve resolution of shield ulcer

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

Name 2 topical MC inhibitors that can tx VKC

A

Olapatidine (patanol iBD), Ketoifen (zatiden iBD)

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

Name a corticosteroid that can tx VKC, when would you schedule follow up after using it?

A

Fluorometholone (FML/Flarex iBD - iQID) - follow up one week after starting therapy

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

Name 2 topical NSAIDs that can tx VKC

A

Ketorolac (acular iQID), Diclofenac (voltaren iTDS-iQ3h)

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

How often should you follow up a VKC px if they have a shield ulcer?

A

every 1-3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How often should you follow up a VKC px during exacerbations?

A

every few weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How often should you follow up a VKC px between exacerbations? (i.e when exacerbations not happening)

A

less frequently (less frequently than every few weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What type of IOP measurement would be best for VKC patients? Why?

A

Non-contact tonometry, b/c thin cornea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When do shield ulcers form?

A

when superficial punctate keratitis (SPK) associated VKC leads to a break in the corneal epithelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Name the mechanisms that have been proposed to explain the pathogenesis of VKC-associated shield ulcers? (2)

A

Mechanical and toxin hypotheses

22
Q

Explain the mechanical hypothesis for VKC associated shield ulcer pathogenesis

A

Mechanical: suggests giant papillae on upper tarsal conjunctiva are responsible for corneal abrasion

23
Q

Explain the toxin hypothesis for VKC associated shield ulcer pathogenesis

A

Toxin: suggests that eosinophil granule major basic protein found in the inflammatory debris covering VKC shield ulcers is cytotoxic and inhibits wound healing of the corneal epithelium

24
Q

Which hypothesis of VKC associated shield ulcer pathogenesis might explain ulcer re-epithelialization after the inflammatory debris is removed?

A

Toxin hypothesis

25
Q

Which hypothesis explains the more common shield ulcers?

A

Mechanical hypothesis

26
Q

Are VKC and AKC often misdiagnosed as each other? Does it matter?

A

yes, often. DDx usually doesn’t matter at the start

27
Q

Compare the incidence of VKC with AKC in terms of ages (2)

A

VKC: 5-25yrs
AKC: early adulthood, post-puberty

28
Q

How do the symptoms of atopic keratoconjunctivitis (AKC) compare with VKC?

A

Basically the same

29
Q

In regards to AKC:

  • What type of hypersensitivity is AKC?
  • how common, unilateral or bilateral, which sex affect more?
A

type 1

uncommon, bilateral, affects males>females

30
Q

How many AKC px are atopic with associated skin disease?

A

Most

31
Q

What organisms/conditions are AKC patients prone to? (3)

A

Staph. blepharitis and HSV disease

32
Q

How does AKC affect incidence of keratoconus and retinal detachment?

A

Increases

33
Q

How common can AKC patients experience anterior subcapsular cataract?

A

rare (is usually due to these patients using strong steroids)

34
Q

What signs of AKC can present in the skin? (1)

A

atopic dermatitis (e.g. in wrists, neck, eyelids)

35
Q

What signs of AKC can present in the lids? (3)

A

eyelids thickened, crusty, ptosis

36
Q

What signs of AKC can present in the conjunctiva? (3)

A

mainly inferior involvement
papillary hypertrophy, fibrosis, scarring
limbal cystic lesions or papillae

37
Q

What signs of AKC can present in the cornea? (3)

A

SPK
shield ulcers
horner-trantas’ dot

38
Q

What DDx exists for AKC? (2)

A

VKC, GPC

39
Q

How can we assess AKC? (10)

A 
hx
slit lamp
fluoroscein
lid eversion
lid margins
lens
corneal topography
DFE
skin
referral to allergist
40
Q

List the tx options for AKC (6)

A

allergen avoidance, flushing of conj, hypoallergenic bed
topical AH, MCS, NSAIDs as per VKC
corticosteroids [aggressive]
topical cyclosporin
avoid eye rubbing
follow up regularly and as tx mode dictates (see VKC)

41
Q

What corticosteroid can be used to tx AKC?

A

Flarex/Maxidex iTDS to Q2h with aggressive taper

42
Q

Why should you not undertreat with steroids?

A

because if you do undertreat, you’ll get long term accumulation of steroid exposure, which can lead to cataract, etc.

43
Q 
Compare VKC with AKC for the following:
A: age onset
B: sex
C: seasonal variation
D; discharge
E: conj scarring
F; horner trantas dots
G; corneal neovascularisation
H:  presence of eosinophils in conj scraping
A 
VKC                AKC
A: younger    2nd-3rd decade
B: males         no sex favorite
C: spring         perennial
D: thick mucoid watery/clear
E: moderate       higher incidence
F: common          rare
G: no                    yes, generally
H: more                 less
44
Q

List the symptoms of GPC (5)

A 
redness
burning
itch
FB sensation
increased lens awareness in CL wearers
45
Q

What type of allergies is GPC associated with? (5)

A 
allergies to:
CLs
CL deposits
solution preservatives
ocular prosthesis
protruding sutures
46
Q

What advancement in tech has made GPC perhaps less common?

A

perhaps less common since advent of disposable CLs and kinder preservatives in solutions

47
Q

Describe the features of:

  • grade 1 GPC (3)
  • grade 2 GPC (3)
  • grade 3 GPC (3)
  • grade 4 GPC (3)
A

Grade 1: slight conjunctival redness with fine papillae and no symptoms
Grade 2: mild injection, 0.3mm-0.5mm papillae, mild symptoms
Grade 3: moderate injection, 0.5mm+ papillae with increasing CL awareness
Grade 4: severe injection, 0.75mm+ papillae with lens intolerance

48
Q

How can we assess GPC? (5)

A 
hx
slit lamp
fluoroscein
lid eversion
inspection of CLs/prosthesis
49
Q

List tx options for GPC (5)

A

MCS for several months (if less severe)
Topical steroid shorter term (more severe)
Advise px re CL care + overwear, non preserved sol.s
New contact lenses (refit) - daily lenses?
Removal of sutures

50
Q

Name 2 conditions that fall under the category of autoimmune conjunctivitis. How common are they?

A

Cicatricial pemphigold
Steven-Johnson syndrome

These are rare

51
Q

Continue later

A

Oh man oh man

OD2 Semester 2 - Applied Clinical Training (63 decks)

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