MCQs on Uveitis

1. The matching of the following diseases and their HLA association are true:
 

a. sympathetic ophthalmitis      HLA-A11

b. par planitis    HLA-DR2

c. cicatricial pemphigoid     HLA-B5

d. Posner-Schlosmann syndrome     HLA-BW5

e. Vogt-Koyanagi-Harada     HLA-B22

answer1.    a.T    b.T    c.F    d.T    e.THLA and diseases:HLA A11     sympathetic ophthalmitisHLA A29     bird-shot retinochoroidopathyHLA B5       Behcet's diseaseHLA B7       presumed ocular histoplasmosisHLA B12     cicatricial pemphigoidHLA B22     Vogt-Koyanoagi's syndromeHLA B27     ankylosing spondylitis                    psoriatic arthritis                    Crohn's disease                    ulcerative colitis                    Reiter's diseaseHLA BW5   Posner-Schlosmann syndormeHLA DR2    pars planitis
 

2. Severe vitritis is a feature of:

a. cytomegalovirus retinitis

b. serpigionous choroidpathy

c. presumed ocular histoplasmosis

d. acutre retinal necrosis

e. toxoplasma retinochoroidopathy

answer2.    a.F    b.F    c.F    d.T    e.TSevere vitiris is a feature of acute retinal necrosis and toxoplasmaretinochoroidopathy.The vitritis is mild in cytomegalovirus retinitis and serpiginouschoroidopathyVitiritis is typically absent in presumed ocular histoplasmosis.
 

3. In ocular toxocarisis:

a. a history of visceral larva migrans is always present

b. examination of the patient's stool is useful in diagnosing
    the disease

c. bilateral ocular involvement should make one doubt the
    accuracy of the diagnosis

d. ultrasound of the granuloma typically shows calcification

e. oral thiabendazole is useful

answer3.    a.F    b.F    c.T    d.F    e.FOcular toxocariaisis:caused by Toxocara canisas the worm does not complete its life cycle in human, examination of thestool is not helpfulbilateral cases have not been reported and its presence should make one doubtthe diagnosispresents as an endophthalmitis or a peripheral or macular granulomamay simulate retinoblastoma but unlike retinoblastoma calcification is not seeninflammation is due to reaction to the worm and therefore steroid and notthiabendazole should be given in ocular inflammation
 

4.In juvenile chronic arthritis-related uveitis:

a. the uveitis is usually granulomatous

b. the eyes are typically white

c. the uveitis usually precedes arthritis

d. it is associated with positive rheumatoid factor

e. cystoid macular oedema is an important cause of poor
    vision

answer4.    a.F    b.T    c.F    d.F    e.FJuvenile chronic arthritis-related uveitis:asymtomaticchronic and non-granulomatous uveitiscommoner in females than malesassociated with pauciarticular types, earlly onset of arthritis andpositive anti-nuclear antibodiesdecreased vision is caused by cataract, glaucoma and band keratopathyposterior segment is almost never involved
 

5. The following are true with regard to cataract in juvenile chronic arthritis:

a. cataract should not be performed before the patients is
    8 year-old

b. operation should be performed only when the anterior
    chamber is free of flare

c. removal of the cataract should be combined with
    anterior vitrectomy

d. hypotony is a known post-operative complication in
    these patients

e. only heparin-coated intraocular lens should be
    implanted.

answer5.    a.F    b.F    c.T    d.T    e.FCataract in juvenile chronic arthritis:the decision to operation depends on the visual acuity and the risk of amblyopiaoperation should be performed only when the anterior chamber is free of cellsand this is achieved with increased steroids in the pre-operative periodthe operation should be combined with removal of the capsules and anteriorvitreous so as to remove any scaffold for future inflamamtory membraneshypotony may occur in the post-operative periodintraocular implanet is not at present recommended.
 

6. The following are true about cytomegaloviral retinitis:

a. it is rarely seen in patients with a CD 4+ counts of
    more than 50 cells/ul

b. it causes full thickness retinal necrosis

c. frosted branch retinitis is a known clinical feature

d. spontaneous resolution in about 30% of patients
    without treatment

e. anti-CMV antibody is useful for diagnosis

answer6.    a.T    b.T    c.T    d.F    e.FCMV retinitis:it is rarely seen in patients with CD4+ of more than 50 cells/ulit causes full thickness retinal necrosisit may simulate branch retinal vein occlusion, frosted branch retintisand retinal detachmentwithout treatment, the condition is relentlessly progressivepositive CMV antibody is common in normal population and thereforeof little value in diagnosis which is mainly clinical
 

7. In the treatment of CMV retinitis:

a. ganciclovir, foscanet and cidofovir are all virostatic

b. ganciclovir causes bone marrow suppression

c. foscanet is associated with renal impairment

d. cidofovir is associated with hepatic dysfunction

e. recurrent CMV retinitis is rare in patients on a
    maintenance dose of ganciclovir, foscanet or cidofovir

answer7.    a.T    b.T    c.T    d.F    e.FTreatment of CMV retinitis:ganciclovir, foscanet and cidofovir all inhibit DNA polymerase and are virostaticganciclovir causes bone marrow suppressionfoscanet and cidofovir cause nephrotoxicityrecurrent CMV retinitis can occur even when the patient is on maintenance doseof anti-viral treatment
 

8.True statements about HAART (highly active anti-retroviral therapy) include:

a. it reduces the recurrent rate of CMV retinitis

b. it is useful in maintaining a high level of CD 4+ counts

c. it is useful in treating acute retinal necrosis

d. it causes increased vitritis

e. there is an increased risk of cystoid macular oedema

answer8.    a.T    b.T    c.F    d.T    e.THAART:has been used to maintain a high level of serum CD 4+ countsthe relapsed rate of CMV retinitis is reduced in patients on HAARTis associated with increased vitritis and cystoid macular oedema
 

9. In AIDS patients with toxoplasma retinitis:

a. brain abscess occurs in 40% of cases

b. the retinitis is more severe than immunocompetent
    patients

c. treatment is only needed in patients with impaired vision

d. retinal detachment is a common cause of visual loss

e. steroid is contraindicated

answer9.    a.T    b.T    c.F    d.F    e.TToxoplasmosis retinitis in AIDS:brain abscess occurs in 40% of casesthe retintis is more widespread in AIDS than immunocopetent patientstreatment is important with anti-toxoplasma medicationsteroid is contraindicated due to the presence of immunosuppressionretinal detachment is rare
 

10. A pregnant woman develops toxoplasmosis in her first trimester of pregnancy. The following are true:

a. there is a 40% chance of the fetus acquiring the infection

b. subsequent offsprings are at risk of infections

c. the Ig M antibody will be raised

d. abortion is advised due to the high risk of fetal
    malformation

e. sulphadiazine is the preferred treatment than clindamycin

answer10.    a.T    b.F    c.T    d.F    e.FToxoplasmosis in pregnancy:the risk of fetal transmission is highest in the first trimester of pregnancyonce infected, an immunocompetent mother develops immunity andsubsequent transmission to the fetus does not occurdespite the risk of transmission most fetus are born healthyclindamycin is preferred to sulphadiazine as it is safer during pregnancy
 

11. True statements about pars planitis include:

a. it is associated with multiple sclerosis in 5% of cases

b. sheathing of the vein is caused by perivascular cuffing
    of lymphocytes

c. snowbanking is the result of hard exudate

d. vitreous balls are composed of epitheloid cells and
    multinucleated giant cells

e. vitreous haemorrhage is the most common cause of
    visual loss

answer11.    a.T    b.T    c.F    d.T    e.FPars planitis:is associated with multiple sclerosis in 5 % of casessheating of the veins are caused by perivascular cuffing of lymphocytessnowbanking is caused by preretinal membrane and is made up of fibroglialand vascular elements which may occasionally bleedvitreous balls are made up of fibroglial cells and multinucleated giant cellsthe main cause of visual loss is cystoid macular oedema
 

12. A 20 year-old man complains of decreased right vision. Four weeks earlier, he had undergone an extensive bowel operation for Crohn's disease and had received hyperalimentationa dn intravenous antibiotics since the operation. On fundal examination, a fluffy white choroidal lession is seen near the macula. There is minimal vitritis. The following are true about the organisms most likely to be responsible for this condition:

a. culture of the blood is usually positive

b. although commonly seen in the respiratory tract, it
    rarely causes pneumonia

c. this organism will grow on the Sabouraud's culture
    within 48 hours

d. the organism rarely invade the retina

e. intravenous vancomycin is the treatment of choice

answer12.    a.F    b.T    c.T    d.F    e.FEndogenous endophthalmitis caused by Candida albicans:the history of hyperalimentation and intravenous antibiotics suggestan infection caused by Candida albicansmost of the cases occur without positive blood culturesCandida usually grouws on blood agar and Sabouraud's culture within48 hours as large creamy white colonyalthough initially involves the choroid Candida rapidly invades the retina causing retinitistreatment is with fluorocytosine and ketoconazole or intravenous amphotericin Bpars plana vitrectomy is indicated in moderate to severe vitritis
 

13. In serpiginous choroiditis:

a. there is loss of retinal pigment epithelium and the choroid

b. the lesion typically begins near the optic disc

c. visual loss is caused chiefly by cystoid macular oedema

d. fluorescein angiography in the acute phase reveals early
    hyperfluorescence of the lesions

e. systemic cyclosporine is the treatment of choice

answer13.    a.T    b.T    c.F    d.F    e.FSerpiginous choroiditis:a rare disorder of unknown cause.typically affects middle-aged people and tends to be recurrent.lesion typically begins near the optic disc.visual loss is due to involvement of the fovea by the lesion, cystoid macularoedema is rare.subretinal neovascularization is another important cause of visual loss in this patient.fluorescein angiography in the acute phase shows hypofluorescence of the lesionsbut later the lesions become hyperfluorescenttreatment is with systemic or periocular steroid but the result is variable.
 

14. True statements about APMPPE (acute posterior multifocal placoid pigment epitheliopathy)

a. females are more commonly affected than males

b. recurrence does not occur

c. in the later phase of the fluorescein angiography, the
    lesions appears hyperfluorescent

d. pigmentary disturbance is common in the recovery
    phase

e. most patients maintain normal vision on recovery

answer14.    a.F    b.F    c.T    d.T    e.TAPMMPE:there is no sex predilectionrecurrence has been reported in some casesfluorescein angiography shows blockage by the lesions in theearly phase but the lesions become hyperfluorescent in the late phasepigmentary changes are common due to disturbance of the RPEvisual acuity is typically maintained on recovery
 

15. The following drugs are known to cause anterior uveitis:

a. topical alphagan

b. rifabutin

c. rifampicin

d. digoxin

e. alpha-chymotrypsin

answer15.    a.T    b.T    c.F    d.F    e.TMedications associated with anterior uveitis:rifambutinalpha-chymotrypsintopical alphagananticholinesterase

16. In Schwartz's syndrome:

a. there is raised intraocular pressure

b. the underlying cause is rhegmatogenous retinal
    detachment

c. granulomatous uveitis is a feature

d. there is forward movement of the lens-iris diaphragm

e. macular oedema is a main cause of visual loss

answer16.    a.T    b.T    c.F    d.F    e.FSchwartz's syndrome:anterior uveitis and raised intraocular pressure related to rhegmatogenous retinal detachmentthe raised pressure is thought to be caused by blockage of the trabecular meshwork by the outer retinal pigments

17. In Fuch's heterochromic cyclitis:

a. Koeppe's nodules are seen

b. abnormal vessels are seen bridging the angle of the
    trabecular meshwork

c. cataract is seen in 50% of the cases

d. glaucoma is seen in 15% of the cases

e. there is an increased vitreous loss during
    phacoemulsification

answer17.    a.T    b.T    c.T    d.F    e.FFuch's heterochromic cyclitis:abnormal vessels are seen but neovascular glaucoma with angle closure does not occurglaucoma occurs in 60% of casesthere is no increased risk of vitreous loss during phacoemulsification

18. Posner-Schlossman syndrome:

a.  is painless

b. does not cause glaucomatous field loss

c. is associated with hypopyon in the majority of cases

d. is a self-limiting condition

e. should be treated with systemic steroid

answer18.    a.F    b.F    c.F    d.T    e.FPosner-Schlossman syndrome:causes red eye with mild anterior uveitis and very high intraocular pressurethe trabecular meshwork is openis self-limitingtreatment is with mild steroid and anti-glaucoma treatment

19.The following immunosupprassants and their side-effects are true:

a. cyclophophamide - haemorrhagic cystitis

b. cyclosporine - bone marrow dysplasia

c. azathioprine - nephrotoxicity

d. methotrexate - hepatic fibrosis

e. tacrolimus (FK506) - hyperglycaemia

answer19.    a.T    b.F    c.F    d.T    e.TCyclosporine causes nephrotoxicity and azathioprine causes bone marrow suppression.

20. A 25 year-old man from the Middle East complains of blurred right vision. On examination, he was found to have a small hypopyon in the right anterior chamber. Posterior segment of the right eye reveals sheathing of the blood vessels with retinal haemorrhages. He gave a past history of painful lesions in his mouth and his genitals. The following are true about this condition:

a. histopathology of the painful lesion reveals
    pathognomonic feature

b. puncturing the skin with an hypodermic needle may be
    useful in diagnosis

c. the posterior segment pathology is caused by
    inflammation of the retina and choroid

d. oral steroid alone is usually effective in preventing
    relapse of the ocular inflammation

e. unless treated aggressively, the ocular inflammation will
    become chronic

answer20.    a.F    b.T    c.F    d.F    e.FThe diagnosis is Behcet's disease.Puncturing the skin with an hypodermic needle (pathergy test) will show cutaneous hypersensitivity.Retina is primarily involved whereas choroid is rarely affected.Steroid can control the initial inflammation but to prevent recurrence agent such as cyclosporine should be given.The ocular inflammation is typically acute and sudden lasting 2 to 4 weeks unless treated.
 

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