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48 Cards in this Set
- Front
- Back
ARN
6 major sign 2 possible signs |
1. One or more foci or retinal necrosis with discrete borders in the peripheral retina
2. Rapid progression in the absense of therapy 3. Circumferential spread of disease 4. Occlusive arteriolar vasculopathy 5. Vitritis 6. AC reaction scleritis and pain possible |
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Presenting symptoms of ARN
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pain
severe vitritis |
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3 Findings of ARN on DFE
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Vitritis
Discrete areas of retinal whitening Vasculitis |
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Final complication of ARN
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RD b/c retina is thin and develops holes
Optic neuropathy |
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ARN age less than 20 think what?
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Think reactivated congenital HSV 2
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T/F ARN is more common in immunocompitant pts
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True
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Treatment for ARN
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Tap and Inject with foscarnet
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What is the difference between HSV 1 and 2 with ARN
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HSV 1 is much more severe can have encephalitis, assume systemic disease, need IV acyclovir 1500mg/day in 3 divided doses
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Acyclovir toxicity
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renal
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Treatment time for ARN
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6 weeks antiviral systemically
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Prognosis of ARN without treatment
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1/3 retain 20/200 or better
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Prognosis with ARN
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1/2 are better than 20/40, 90% 20/200 or better
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What is the time course of other eye involvement for ARN
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up to 35 yrs later, need long term antivirals
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Presentation of PORN
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Posterior pole can be affected on presentation
Little Vitritis - b/c immunocomp Vasculitis may have area of clearing around vessels |
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T/F PORN is more common in immunocompitant pts
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False
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RX for PORN
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Intravit foscarnet
and systemic antivirals, acyclovir |
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CMV retinitis happens in who
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immunocompromised pts
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CMV retinal 4 findings
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Lacy white retinal necrosis
Pizza fundus Sectoral necrosis Frosted angitits |
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CMV treatment
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oral valgancyclivir, 3 weeks of induction
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risk of valgancyclovir
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marrow suppression
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problems with valgancyclovir rx
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resistance at 6 months
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When can stop valgancyclivir in CMV retinitis
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6 months after immune reconsitution
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2nd line agent for CMV retinitis
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systemic foscarnet
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cidofovir eye problems
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hypototony and uveitis
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Immune reconstitution uveitis
3 signs Who gets it What is the cause Treatment |
CME
AC cell Vit cell Pt who had CMV retinitis get it Cause: autoimmune Treatment: steroids |
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What is required in PPV in CMV RD
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silicone oil b/c retina is very thin
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Ocular toxoplasmosis 2 sx
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Floaters
Scotomas |
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Ocular toxoplasmosis
3 signs |
Dense vitritis
Old scars with loss of choriocapilaris New retinal lesions |
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What is the chance of congenital toxo if mom converts during pregnancy
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40% chance
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Incidence of congenital toxo in the US
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0.1% in the US
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What are sources of Toxo
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Undercooked Meat
Water Cats |
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3 forms of toxo
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oocyts, tachyzoites, bradyzoits
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4 indications for treatment of ocular toxoplasmosis
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Foveal or optic nerve
AIDS Transplant pts Chronic recurrences 2-3x/year |
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Treatment for Toxoplasmosis
Primary Monitoring 2 alternatives |
triple sulfa
Sufadiazine Trimetoprim folinic acid follow platelets can also use Clindamycin or Zithromax or Septra |
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Length of resolution of Toxoplasmosis
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Can take months/year for center or lesion to scar
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Toxocariasis is caused by what
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toxocara canis, 80% of puppies have this worm
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3 fundus findings in toxocariasis
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eosinophilic retinal reaction
subretinal granulomatous lesion with traction bands to optic nerve dense vitritis |
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Dx of Toxocariasis
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ELISA because there is a low pretest probability
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Treatment of Toxocariasis
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antiinflammatories, antihelminthic agents case worm death and more inflammation
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DUSN is
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Diffuse unilateral neuroretinitis
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Late finding after DUSN
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RP like picture
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Rx for DUSN
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laser the worm
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3 Lupus findings
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cotton wool spots
vasculopathy arteriolitis |
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Polyarteritis nodosa
2 findings How to diagnose |
elevated ESR
vasculitis tissue dx |
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Wegeners
2 Findings 1 Diagnostic test |
scleritis and nephritis
C-ANCA |
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Ocular candida found in who
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Indwelling lines
immunocopromised |
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Ocular candida findings
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Retinitis and Vit fluff balls
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Rx candida
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Voriconazole or Diflucan
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