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82 Cards in this Set
- Front
- Back
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what is the name of the proliferative state when toxoplasma gondii invades cells
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tachyzoite
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what is the name of the incystid form of toxoplasma gondii
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bradyzoite
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what is the most common cause of retinal infection and posterior uveitis. this is all in bold know this for sure
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ocular toxoplasmosis
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what are some possible ways of contracting toxoplasmosis
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drinking raw milk, cat poo, ingesting undercooked meat, blood transfusion, or mother to baby.
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roughly about what percent of the US population is seropositive for toxoplasmosis
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30 to 70. just remember 50%
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what type of systemic conditions would you expect with toxoplasmosis
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flu like symptoms and a rash
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is a mother able to transfer toxoplasmosis to the baby through the placenta?
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yes
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what percent of people that congenitally acquired toxoplasmosis will get retinitis?
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80%
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a posterior pole examination shows white spots with an overlying vitritous that makes the lesions on the retina look like headlights in a fog. what could this possibly be
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retinitis due to toxoplasmosis
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a person with toxoplasmosis will often have an anterior rxn of what type
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granulomatous anterior uveitis
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what are some of the symptoms of a person with toxoplasmosis
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blur, floaters, red eye, no pain, vf loss if papillitis is present
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true or false a positive serologic test is a good reason to diagnose some one with toxoplasmosis
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false remember that about 50% of the US population is positive.
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what is the most common way that a person is diagnosed with toxoplasmosis
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just by diagnostic clinical findings
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if you suspect a person has toxoplasmosis but you want to rule out syphilis what test should you perform?
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fta-abs
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what are some factors that determine if you should treat (or refer) a patient that has toxoplasmosis
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if the lesion threatens the ON or macula, the lesion is large regardless of location, 2 line drop in VA's, hemorrhage, or it has been present for a month
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most doctors prefer to treat toxoplasmosis with the "triple treatment" what drugs are used in this?
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pyrimethamine, sulfadiazine, and prednisone (folinic acid should also be added, in systemic dz prednisone was not part of the triple treatment only folinic acid)
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how is ocular toxocariasis acquired?
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eating dirt.
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what are some symptoms of the visceral form of toxocariasis
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cough, chest pain intermittent fever, loss of appetite.
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what is the classic presentation of ocular toxocariasis
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round raised white granulomas in the posterior pole that are about 1 DD in size. often with RPE hyperplasia, and fibrotic bands radiating from the lesion.
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is it possible to see anterior uveitis, vitritis, and or a RD with toxocariasis
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yes you could possibly see any of these but they are not as common as the white lesions.
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what are some lab tests you could run to test for toxocariasis
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ELISA for toxocara antibody titers or ultrasound?
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what age is toxocariasiss commonly seen in
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7 to 8 but has been seen in 2 yo
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because of the age of onset what is a DDx that needs to be considered when you think a pt has toxocariasis
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retinoblastoma ( age of onset of this is usually 2 yo)
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how do you manage toxocariasis systemically
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with steroids such as prednisilone and antihelmintic drugs like thiabendazole, and diethylcarbamazine
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what is the etiology of toxocariasis and what type of organism is it
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toxocara canis and it is a nemontode
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what are some systemic symptoms of presumed ocular histoplasmosis syndrome (POHS)
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flu like symptoms with spontaneous resolution and pulmonary problems that could lead to respiratory failure
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what are the "big three" signs with presumed ocular histoplasmosis syndrome (POHS) in the eye
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circumpapillary choroidal scarring, peripheral choroidal punched out histo spots (1mm in size in mid periphery focal areas of RPE atrophy), and macular compromise secondary to neovascular net (vessels growing through bruchs)
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in presumed ocular histoplasmosis syndrome (POHS) can you see anterior uveitis, posterior uveitis, both or neither?
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neither
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what is a good clinical test you can perform on pt's you suspect presumed ocular histoplasmosis syndrome (POHS)
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amsler grid, good to send them home with also
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DDx of presumed ocular histoplasmosis syndrome (POHS)
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sarcoid, VKH, myopic degeneration, ARMD, white dot syndromes
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what are some systemic drugs a person could be on for presumed ocular histoplasmosis syndrome (POHS)
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steroids? amphotericin b? or ketoconazole?
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possible treatment for ocular problems associated with presumed ocular histoplasmosis syndrome (POHS)
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photocoagulation
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what is the visual Px for presumed ocular histoplasmosis syndrome (POHS)
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poor 75% will have visual reduction, with sub retinal neovascular membrane
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AKA the great inhibitor is what?
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syphilis
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what is the organism that causes syphilis and type
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treponema pallidum which is a spirochete
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what are the 3 stages of syphilis according to Dr. Williams
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early infectious stage, latent stage, and the late tertiary stage.
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you suspect syphilis in a person that has a chacre and a rash on the palms and soles of their feet what stage are they most likely in
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early infectious stage dont touch the rash with your bare hands
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what are the symptoms associated with latent stage of syphilis and how long does it last
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the name says it all - its asymptomatic. last ~two years or indefinitely
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is a person in the tertiary stage of syphilis contageous or not
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no
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what are some systems that are affected in tertiary syphilis
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skin, bone, viscera, cardio, and neuro
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what type of lesions are seen on the posterior pole with acquired syphilis
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myltiple nonelevated yellowixh grey ill defined chorioretinal lesions that heal and cause chorioretinal atrophy with hyperpigmentation.
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could anterior and or posterior uveitis be present with acquired syphilis?
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both
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explain how glaucoma could be caused by syphilis (either acquired or congenital)
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secondary to uveitis
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what does the fundus look like in general description terms in a person that has congenital syphilis
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salt and pepper fundus
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what triad is present in a person with congenital syphilis (name the triad and the three things that it consists of)
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hutchinsons triad. notched incisors, hearing loss, and interstitial keratitis
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what are the two most reliable lab tests for syphilis
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FTA-ABS or the MHA-TP
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what test will show positive for syphilis even if they are not active
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VDRL ro RPR
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what will a VF look like in a person that has syphilis
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"constricted"
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what is the systemic treatment for syphilis
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penicillin G IV followed by long term tetracycline 250mg PO qd OR doxy in immune compromised pts
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what is the visual recovery like for a pt with syphilis
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if Tx is promp then full recovery is likely
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in pt with TB when could the pulmonary problems reactivate after they have been latent.
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it could reactivate at any time often after long periods of latency
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what are some symptoms of Tb
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cough, night sweats, recurrent fever, weight loss, pleurisy
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are ocular problems common or uncommon with TB
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uncommon but possible
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ocular problems associated with TB tend to inflammations. name the possibilities
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anterior and posterior uveitis, choroiditis (tubercles), periphlebitis, phlyctenular keratoconjunctivitis
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what is the drug of choice to treat TB
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isoniazide (INH) (although in systemic we were told it was the combo of INH, rifampin, pyrazinamide, and ethambutol
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are steroids effective on TB
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no they will aggravate the dz
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what gender and race is sarcoid generally seen in
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Black females
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sarcoid granulomatous or non
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granulomatous
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a chest x ray of a person with sarcoid will show what
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hilar adenopathy
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a person comes in with a facial nerve palsy, arthritis, hepatomegaly, spleenomegaly, lymphadenopathy cardio problems and lastly you see skin granulomas what does she have
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sarcoidosis
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70%of the females with this dz will have lacrimal gland disorders
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sarcoid
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describing factors for the anterior uveitis associated with sarcoid
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it is usually alternating and granulomatous
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looking in the eye of a pt you see posterior uveitis, periphlebitis (candle wax dripping), vitreal opacities (string of pearls), ONH edema and macular edema what is a possible dx for this pt
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sarcoid you will also see nodules on the iris, conj and choroidal granulomas
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what would be the outcome of the following lab tests on a person with sarcoid ESR, serum lysozyme, serum ACE, and Ca++.
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ESR - elevated
serum lysozyme - increased serum ACE increased Ca++ - increased. |
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what is the best test to perform on a person with sarcoid
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chest x ray
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iris nodules associated with sarcoid need to be DDx from what
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TB and syphilis
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chorioretinitis associated with sarcoid needs to be DDx from what
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Hist, toxo, syphilis and tb
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retinal involvment associated with sarcoid needs to be DDx from what
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vascualr problems
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how do you cure systemic tb
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you dont all you can do is manage it with prednisone 60 to 100 mg po qd for systemic
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what drug is used in ocular manifestation of tb
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triamcinalone acetonide 40 mg/ml
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what is the prognosis of pts with tb
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most recover with out any significant impairment
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name three names that pars planitis is AKA.
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intermediate uveitis, cyclitis and peripheral uveitis
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what is pars planitis an inflammation of
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vitreous and the pars
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in 10 to 15% of people with pars planitis it is associated with what
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MS
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would there be pain, redness, or photophobia associated with pars planitis
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no none of the above.
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"snowbanking" is often seen with what
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pars planitis. note that some of the exudates here could break off into the vitreous.
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what is the most common finding or complication with pars planitis when studies look at individual eyes or pt's
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CME (cystoid macular edema) 52% of eyes, and the most common is cataract when you look at pt's. note that one study also found cataracts to the most common when looking at eyes.
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with an FA the CME in a pars planitis pt will show up as hyper or hypo fluoresce
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hyper
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what sign would you use cryotherapy for on a person that has pars planitis
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the areas of snowbanking
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what type of drugs would you use on a pt with pars planitis
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steroids oral and or periocular like kenolog
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in a pt with pars planitis what is photocoagulation used to treat
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the neovascularization
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how do you treat ocular toxocariasis
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photocoagulation (kill the worm?), RD repair, manage the anterior uveitis if present, vitrectomy. note that there will be a big reaction after the worm dies and is still in the eye
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