Clin Med Final Review

Front 1

____________ has the classic triad: diffuse goiter, ophthalmopathy and dermopathy.

Back 1

HYPERthyroidism

Front 2

if patient has an increase in TSH, decrease in Free T3 & T4 they probably have

Back 2

hypothyroidsm

Front 3

If patient has an increased Free T3 & T4 and decrease in TSH they probably have

Back 3

HYPERthyroidism

Front 4

Thyroid Storm is:

Back 4

Thyroid Storm d. Sudden exacerbation of hyperthyroidism e. Fever, agitation f. Fast heart rate g. Low blood pressure h. Coma, death

Front 5

Parathyroid Glands-imp for blood __________ levels

Back 5

calcium

Front 6

Hyperparathyroidism – hallmark sign:

Back 6

hypercalcemia 1. Excess PTH is produced

Front 7

s: a. Tetany, muscle twitching b. Laryngeal spasm c. Seizures d. Blurry vision e. Early PSC f. Alopecia g. Trousseau’s sign

Back 7

2. Hypocalcaemia Trousseau sign of latent tetany is a medical sign observed in patients with low calcium.[1] This sign may become positive before other gross manifestations of hypocalcemia such as hyperreflexia and tetany, but is generally believed to be more sensitive than the Chvostek sign for hypocalcemia. To elicit the sign, a blood pressure cuff is placed around the arm and inflated to a pressure greater than the systolic blood pressure and held in place for 3 minutes. This will occlude the brachial artery. In the absence of blood flow, the patient's hypocalcemia and subsequent neuromuscular irritability will induce spasm of the muscles of the hand and forearm. The wrist and metacarpophalangeal joints flex, the DIP and PIP joints extend, and the fingers adduct.

Front 8

80% of blood traveling to the eye goes to the

Back 8

CHORIOD cools down retina and supplies it with neutreints. SYMPATHETIC control

Front 9

an example of sympathetic control in terms of blood travelling to the eye involves

Back 9

blood flow to choriod

Front 10

15% of blood traveling to the eye goes to

Back 10

the iris and ciliary body to make aqueous --> AUTOREGULATION

Front 11

The retina functions in _________ mode and therefore must extract every amount of oxygen possible in the 5% of blood that travels to the eye

Back 11

starvation

Front 12

T/F Optic nerve and choiriod circulatio nare BOTH under SYMPATHETIC control

Back 12

T

Front 13

T/F The retina blood supply is controlled by SYMPATHETIC control

Back 13

FALSE AUTOREGULATION

Front 14

Outer blood barrier is the

Back 14

tight junctions between RPE cells

Front 15

Inner blood barrer is the

Back 15

tight junctiosn between endothelial cells surrounding branches of CRA

Front 16

A pre-hypertensive patient would have a blood presure of

Back 16

120-139 mm Hg 80-89 mmHg

Front 17

HTN Stage 1 blood pressure:

Back 17

140-159 mm Hg 90-99 mm Hg

Front 18

HTN Stage 2 blood pressure:

Back 18

>160 mm Hg >100 mm Hg

Front 19

rade 1 HTN retinopathy

Back 19

Retinal vessel narrowing >.90 and <110 distolic BP

Front 20

Grade 2 HTN retinopathy

Back 20

Nicking of vessles >90 and < 110 diastolic BP

Front 21

Grade 3 HTN retinopathy

Back 21

CWS, hemes, lipid exudeates >110-115 diastolic BP

Front 22

Grade 4 HTN retioapthy

Back 22

CWS, hemes, lipid exdues, AND optic disc sweeling >130 diastolic BP

Front 23

AS 3

Back 23

copper wiring

Front 24

AS 4

Back 24

silver wiring

Front 25

A hemmorrage with a white center is known as a

Back 25

Roth Spot

Front 26

3 ways that HTN presents in the eye

Back 26

autoregulation is altered --> HTN retinopathy sympathetics are altered leading to ischemia --> HTN choroidopathy HTN neuropathy

Front 27

When HTN effects sympathetics and causs ischemia of choriocapiris, RPE dies and changes shape, which leads to

Back 27

Seigrist streaks (sleroised vessles) or Elshnig spots (RPE scar)

Front 28

T/F Vision loss depends on how long BP has been elevated

Back 28

T elevation is chronic, photoreceptors can die and result in scotoma

Front 29

T/F Macular edema due to HTN is treated with focal grid laser

Back 29

FALSE only therapy is to decrease BP!!

Front 30

HTN that occurs during pregnancy is known as

Back 30

pre-eclampsia

Front 31

Malignant Hypertension occurs when BP is

Back 31

> 210/110 It differs from other complications of hypertension in that it is accompanied by papilledema.

Front 32

T/F You must decrease BP SLOWLY or you can cause a stroke of te choriod and optic nerve

Back 32

T

Front 33

S HTN urgency occurs when there is a large increase in BP with a diastolic elevation greater tha

Back 33

120-130 mmHg

Front 34

________ has been associated with malignant arterial hypertension

Back 34

HLA-B15

Front 35

Elevated BP leads to what three prevelant diseases?

Back 35

coronary heart disease, stroek, and renal disease

Front 36

Most common cause of HTN

Back 36

ESSENTIAL/no known cause

Front 37

T/F In elderly patients, HTN is more common in females

Back 37

T

Front 38

If you see grade 3/4 HTN in patient you must think

Back 38

secondary problems exists

Front 39

Retinal Arterial Macroanyuersm

Back 39

vessel wall is weak troughout life, when bP increases, it ballons out and may bleed, which can cause exudates

Front 40

The optic nerve swells by the _________ rule

Back 40

ISNT inferior (thickest) swells first

Front 41

HTN is a risk factor for

Back 41

Carotid artery disease CRVO RVO NAION Retinal Arterial MAcroaneurysm Glaucoma worsen diabetic retinopathy AMD

Front 42

In DM, BP gial is to be under

Back 42

130/75

Front 43

First line of treatment for high blood pressure

Back 43

diuretics Especially beneficial for african americans, and people who have HEART failure

Front 44

The site of Central Retinal Vein occlusion is the

Back 44

lamina crbrosa

Front 45

The site of Branch Retinal Vein occlusion is in

Back 45

the retina at A/V crossings

Front 46

T/F Ischemic CRVO is morelikely to develop neo of the iris

Back 46

T BRVO neo is more likely to occur in retina

Front 47

In ischemic _____, the VA is 20/200 or worse, APD is present and blood blocks ability to see choroid

Back 47

CRVO

Front 48

According to the BRVO study, if macula edema is present after 4 months and VA is worse than 20/40 ___ will improve edema and VA

Back 48

focal grid therapy

Front 49

Perfusion pressure is

Back 49

the mean blood pressure in the OHTHALMIC artery- IOP BLood pressure of ophthalmic artery is usually around 65

Front 50

BLood pressure of ophthalmic artery is usually around

Back 50

65 mm Hg

Front 51

T/F an IOP of 70 can cause atery or vin occlusion

Back 51

T

Front 52

What can result from Pheochromocytoma?

Back 52

Hypertensive choroidpathy

Front 53

What grade of HR is a medical emergency?

Back 53

4

Front 54

What does AS correlate to? KNOW

Back 54

age and HTN

Front 55

What is diastolic bp seen in grade 3?

Back 55

110-115 mm Hg

Front 56

What diastolic bp is seen in HTN grade 4?

Back 56

> 130 mm Hg

Front 57

T/F You do not tend to get AS of 3 or 4 in essential HTN, but you do see it in malignant

Back 57

T

Front 58

____- blockage of carotid artery is required to cause effects in the eye, but may occur at 70% of patient has carotid artery disease

Back 58

90%

Front 59

Cause of HIV/Aids

Back 59

retro virus that depletes CD4 population of T lymphocytes

Front 60

AIDS occurs when CD4 counts is less than ________ in a person who is HIV positive

Back 60

200 ul

Front 61

Normal CD4 ratio is around

Back 61

800-1400 mm

Front 62

3 transmission routes of HIV

Back 62

1. SExual contact 2. Percutaneous inolcuation of blodo or other infected materials 3. Exposure to infected blood and tissues during birth or infected breast milk

Front 63

______% of AIDS cases globally are heterosexual

Back 63

60%

Front 64

Initial Stage of HIV

Back 64

become HIV + during this phase Mild influenza like illness, 4-12 eeks after becoming infected may not have a positive test for the inital 6 weeks

Front 65

Chronic stage of IV

Back 65

latent period, may last ov average for 10 years

Front 66

THe most common systemic opportunistic infection of AIDS

Back 66

Pneumocystitis carinii pneumonia PCP Choroidal pneumocytosis appears as MULTIFOFCAL, yellow, round deep choroidal lesions on-half to two disc diametser in size located in posterior ole.

Front 67

Bacterial diseases that are common in HIV/AIDS

Back 67

Staph, strep Tuberculosis Pulmonary Tuberculosis (>80%) Extrapulmonary TB

Front 68

Ocular manifestations of TB include

Back 68

Tubercules (granulomas) Phylcyenulosis, smal unilateral or ilateral white nodules in bulbar conj (Treatment: topical steriod) Uvetitis Scleritis Optic neuropathy

Front 69

In order to diagnosis TB patient must get

Back 69

a PPD and chest x ray

Front 70

First line treatment of TB

Back 70

Rifampin, isoniazid. Therapy is a minimum of 6 motnhs for standard, 9 motnhs for those with HIV and AIDS,

Front 71

_______________- is common in immunocompetant self limited infection and causes unremitting diarrhea in AIDS

Back 71

cryptosporidium

Front 72

prevalance of in HIV patients is higher than in general population. It is known as the GREAT MAQUERADER

Back 72

Syphilis due to a spirochete infection passes through many stages

Front 73

Primary stage of sphyilis

Back 73

skin leasions, painless papule, heals in 2-6 weeks see bilateral lymphadenopathy

Front 74

secondary stage of Sphyllis

Back 74

see conjunctivitis, interstitial keratitis, ANTERIOR uveitis (most common), posterior uveitits, optic nerve head involvement BRVO, CRVO CRAO

Front 75

Treatment for sphyilis includes

Back 75

Benzathine PCN Doxycycline or tetracline

Front 76

Most cmmon fungal infection is located

Back 76

oral, esophageal

Front 77

Most common neuroplasm in AIDS

Back 77

Karposi sarcoma, caused by papiloma virus lesions interfere with eyelids, tear film, cornea, mitility

Front 78

This infection found commonly in HIV has a lag between infection and developing antibody 6 weeks to 6 months

Back 78

Non-hogkin's lymphoma

Front 79

________ is used to track the progression of HIV

Back 79

Viral Load testing two types of viral load tests measure HIV RNA in a sample. THESE ARE NOT DIAGNOSTIC tests, just used in adjuct to CD4 count. VIRAL load test ONE measure RNA INDIRECTLY Viral load test TWO measure RNA DIRECTLY

Front 80

VIRAL load test ONE measure _________-

Back 80

RNA INDIRECTLY

Front 81

Viral load test TWO measure _________

Back 81

RNA DIRECTLY

Front 82

The low baseline viral load HIV RNA test is __________ The high baseline viral laod is any number hier than

Back 82

500 or fewer 40,000 to 100,000 copies Testing should include 2 viral load tests taken 2-4 weeks apart

Front 83

______% of AIDS patients have eye signs

Back 83

75

Front 84

Most common ocular opportunistic infection that effects approximately 30% of patients and is the LEADING cause of AIDS related blindess is

Back 84

Cytomeglaovirius Retinitis usually seen when CD4 is below 100 cheese and ketchup fundus

Front 85

Indolent form of CMV is

Back 85

peripheral granular opacities with hemorrhages

Front 86

Fulminant form of CMV is

Back 86

confluent area of necrosis with associated hemorrages along vascular arades

Front 87

Retinal detachmesn occur in ______ of pateitns with CMV retinitis

Back 87

1/3

Front 88

What treatment is used with CMV

Back 88

Valgemcclovir Gancyclovir

Front 89

The most common form of retinoschoroiditis in AIDS patient

Back 89

CMV

Front 90

The second most common form of retinochoroiditis in aids is

Back 90

Toxoplasmosis

Front 91

How does Toxoplasmosis appear in AIDS patient differently than the rest of the population

Back 91

BILATERALLY in pts with AIDS

Front 92

t/f systemic steriods are contrainidcated for AIDS patients

Back 92

T

Front 93

What is PORN?

Back 93

Progressive Outer REtinal Necrosis diffuse uvetitis characterized by posterior pole and peripheral necrotizing retinitis and vasculitis in AIDS patients HZV is a major cause of PORN See it bilaterally and more progressive than CMV retinitis in aIDS patients They are multifocal deep yellow/white, retinal infiltrates with minimal vitritis leading to rapid confluence and full thickness retinal necrosis Treat with gancyclovir with foscarnet

Front 94

How do you treat PORN?

Back 94

Progressive Outer REtinal Necrosis treat with gancyclovir and foscarnet

Front 95

Where is Histoplasmosis most prevalent?

Back 95

Ohio/Mississippi river valleys See granulomatous reaction, caseating necrosis, or calcification. Looks like TB Triad inclues: Exudative maculopathy, atophic peripheral chioretinal lesions, peripaillary scars

Front 96

What is the Triad of pathology for ocular histoplasmosis syndrome?

Back 96

Triad inclues: Exudative maculopathy, atophic peripheral chioretinal lesions, peripaillary scars MAY see neovascular membrane from breaks in BRUCH's membrane

Front 97

How is Histoplasmos treated?

Back 97

Amphotericin B, primary antifungal drug IV Ketoconazole, oral Pred Forte can be used with stromal involvement

Front 98

What do we typically see with patients who have Molluscum contagiosum?

Back 98

Raised vesicular lsion with chronic filicular conjunctivitis Tend to be multiple and bilateral in AIDS patients. Usually need to be lanced

Front 99

If you see Herpes Zoster Varicella in a patient younger than 40 what must you think?

Back 99

Immunocompromised patient, possible AIDS See Hutchinson sign Treated with Acyclovir Valacyclovir Bacitracin or erythromycin topically

Front 100

If your pt has a CD4 count of 200-500 when should you see them? IF pt has less than 200?

Back 100

every 6-12 months Every 2-6 months

Front 101

How is AIDS treated?

Back 101

HAART, highly active antiretroviral therapy

Front 102

Adverse side effects with HAART?

Back 102

Lactic acidosis/hepatic steatosis Hepatotoxicity Hyperglycemia ROIL3H Fat maldistribution Hyperlipidemia Increased bleeding in hemophiliacs Osteonecrosis Rash

Front 103

Grave's triad consists of

Back 103

triad: 1. Hyperthyroidism with diffuse hyperplasia of the thyroid gland (goiter) 2. Infiltrative dermatopathy 3. Infiltrative ophthalmopathy (invading orbit)

Front 104

Cause of Grave's

Back 104

Autoimmune disease Hypersensitivity reaction with thyroid stimulation by the circulation of Abnormal thyroid stimulating immunoglobulins (TSI)

Front 105

T/F When pt has Grave's, inflammatory infiltrate of the orbital contents exclusive of the globe!

Back 105

T

Front 106

What tests should you order for someone who you think has Grave's?

Back 106

. Laboratory testing: 1. Serum T4 (Thyroxine)* (KNOW) 2. Serum T3 (Triiodithyronine)* (KNOW) 3. Sensitive serum TSH test* (Thyroid stimulating hormone) (KNOW)

Front 107

How do you treat someone with Graves?

Back 107

First line of treatment. a. Tapazole, methimazol b. Propylthiouracil (PTU) c. Inderal, Propranolol (controls sympathetic over-activity; nervousness, eyelid twitching) 2. Surgery is last resort*

Front 108

_________ is the single most common cause of all bilateral and unilateral proptosis.

Back 108

Grave's

Front 109

Unilateral or bilateral proptosis (Hertel or Lute Results) a. Minimal: ______ b. Moderate: __________ c. Marked: ______ d. ___difference between the eyes is clinically significant.

Back 109

a. 21mm – 23 mm b.24 mm – 27 mm c. 28mm or more d. 2mm

Front 110

Grave's Eyelid retraction. Possible mechanisms include: (KNOW)

Back 110

a. Direct inflammatory involvement of the levator muscle b. Hyperactivity of the sympathetic nervous system with activation of Mueller’s muscle. c. Secondary over-action of the levator/ superior rectus complex in response to involvement and tethering of the inferior rectus muscle.

Front 111

Why would someone with Grave's show decreased VA?

Back 111

Compressive optic neuropathy due to the thickened extraocular muscles at the orbital apex. Look for an APD when testing pupils.

Front 112

T/F Grave's Disease can show a APD

Back 112

T Compressive optic neuropathy due to the thickened extraocular muscles at the orbital apex. Look for an APD when testing pupils

Front 113

How can you tell if Grave's disease is responsible for APD and decreased VA?

Back 113

A CT scan will reveal why the patient has optic nerve compression. Thick, enlarged muscle will be seen especially at the orbital apex. Usually the EOM’s are barely visible on CT.

Front 114

How do you treat GRave's disease proptosis

Back 114

a. Prednisone 100 mg PO QD x 1-2 days with taper b. Consider orbital decompression surgery

Front 115

How do you treat the optic neuropathy present in some pt's with Graves?

Back 115

a. Prednisone 60-100mg PO QD with taper b. Super voltage orbital radiation therapy c. Orbital decompression: Sight threatening infiltrative disease may need surgical compression including i. Removal of orbital floor and medial wall of the orbital cavity. ii. Once the floor of the orbit is removed the pt has an increased chance of developing orbital cellulitis with sinus problems

Front 116

What are the six classes of Grave's disease?

Back 116

1 Class 0: No signs or symptoms 2 Class 1: Only signs – Upper lid retraction 3 Class 2: Soft Tissue involvement with symptoms 4 Class 3: Proptosis 5 Class 4: EOM involvement 6 Class 5: Corneal Involvement 7 Class 6: Sight Loss due to ONH

Front 117

All of the followingg diseases are commonly found in patients with AIDS except: a. Xerosis b. Oral Candidiasis c. Vasculitis d. Seborrheic dermatitis

Back 117

C

Front 118

A pt with hyperthyroidism may exhibit all of these physical signs except: a. nervousness b. bulging eyes c. sweating d. weight gain e.lid lag

Back 118

D