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Evidence Based Medicine > Week 4: GI System > Flashcards

Week 4: GI System Flashcards

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1
Q

What are the causes of toxic/ nutritional optic neuropathy?

A

alcoholism, tobacco/ substance use, certain medications, heavy metal exposure, poor nutrition

Poor nutrition: B1 deficiency; B12 malabsorption (pernicious anemia)
High risk meds: chloramphenicol, ethambutol, linezolid, isoniazid, digitalis, amiodarone, streptomycin, chlorpropamide, ethchlorvynol, disulfiram

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2
Q

What are the signs and symptoms of toxic/ nutritional optic neuropathy?

A
  • VA 20/50-20/200
  • Dyschromatopsia
  • bilateral central or cecocentral visual field defects
  • temporal disc pallor
  • optic atrophy
  • normal appearing disc initially
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3
Q

Which type of scotoma is ALWAYS associated with decreased visual acuity?

A

Central scotoma

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4
Q

Which type of scotoma involves the point of central fixatio nand the area between the blind spot and the fixation point?

A

cecocentral scotoma

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5
Q

Which type of scotoma affects an area of the visual field that is nasal or temporal to the point of central fixation?

A

paracentral scotoma

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6
Q

What leads to selective degeneration of RGCs in the region of the papillomacular bundle?

A

mitochondrial dysfunction

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7
Q

What is the recommended work up for toxic/ nutritional optic neuropathy?

A
  • case hx: medication, drug, substance use, diet history
  • color vision testing
  • optic nerve assessment
  • VF testing
  • CVC with diff and peripheral smear
  • Serum vitamin B1, B12, and folate levels
  • Heavy metal screen
  • Blood work to rule out Leber Hereditary Optic neuropathy

peripheral smear for morphologic description of RBC’s - helps ID type of anemia

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8
Q

What is the treatment for toxic/ nutritional optic neuropathy?

A
  • eliminate causative agent (alcohol, tobacco, medication)
  • Thiamine 100 mg BID
  • Folate 1.0 mg QD
  • multivitamin QD
  • Bitamin B12 1,000 mg IM injection 1x/ month for pernicious anemia
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9
Q

What is the follow up for toxic/ nutritional optic neuropathy?

A

Initially monthly, then every 6-12 months

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10
Q

What is the most commoly inherited mitochondrial disorder?

A

Leber Hereditary Optic Neuropathy

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11
Q

What is the presentation for Leber?

A

Painless progressive vision loss in one eye and then the other eye in quick succession; mild swelling of optic disc that progresses over weeks, eventually optic atrophy; small telangiectatic blood vessels near the disk- not leaky on FA

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12
Q

Hydrophoic vitamins are packaged into chylomicrons and taken to which organ for storage?

Chylomicron: lipoprotein that contains triglycerides, cholesterol, fat-soluble vitamins, targeting proteins

A

Liver

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13
Q

Which vitamin deficiency is associated with bleeding?

A

Vitamin K

blood clotting cascade

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14
Q

Which vitamin deficiency is associated with ataxia, peripheral neuropathy and myopathy?

A

Vitamin E

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15
Q

What are the vitamin A derivatives in the transduction pathway?

A

all-trans-retinal; 11-cis retinol

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16
Q

A deficiency in which vitamin is a risk factor for multiple sclerosis?

A

Vitamin D

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17
Q

Which vitamin is an antioxidant that protects cells from free radicals?

A

Vitamin E

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18
Q

What is vitamin K a coenzyme for?

A

carboxylase

enzyme required for synthesis of proteins involved in blood clotting and bone metabolism

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19
Q

Do hydrophilic or hydrophobic vitamins need to be taken more frequently?

A

hydrophilic

removed in urine and not stored in the body

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20
Q

Which type of vitamins are more likely to develop toxic symptoms?

A

hydrophobic vitamins

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21
Q

Which vitamins are water soluble?

A

B’s and C’s

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22
Q

Which vitamin is thiamine?

23
Q

What is B1 used for in the body?

Study These Flashcards
A

mitochondrial membrane development, enzymatic processes in brain function, interneuronal communication and regulation of immune cells and proteins

24
Q

Where is B1 (thiamine) absorbed?

Study These Flashcards
A

jejunum

transported in erythrocytes and plasma; stored in the liver in very small amounts

25
Which vitamin is involved int eh biosynthesis of neurotransmitters and maintains normal levels of homocysteine?
Vitamin B6 (pyridoxine)
26
What is the function of vitamin B6?
involved in gluconeogenesis, glycogenolysis, immune function and hemoglobin formation
27
Which drug inactivates vitamin B6 and is implicated in toxic/ nutritional optic neuropathy?
Isoniozid
28
What is vitamin B9/ folate needed for?
Proper cell division; DNA and purine synthesis and conversion of homocysteine to methionine ## Footnote found in leafy greens, fruits, fortified cereals and meats
29
What condition is a hallmark of folate deficiency?
megaloblastic anemia
30
Which vitamin is known as cobalamin?
Vitamin B12
31
Deficiency of which vitamin is developed in patients that follow a vegan/ vegetarian diet, have a history of bariatric surgery or have malabsorptive diseases?
cobalamin deficiency (B12)
32
What is pernicious anemia?
An autoimmune disorder that prevents that absorption of vitamin B12 (cobalamin)
33
Which vitamin is required for collagen production, plays a vital role in wound healing AND can help regenerate other antioxidants in the body?
Vitamin C ## Footnote may also slow the progression of cataracts
34
What ocular structure is believed to be protected by normal gut microbiota?
the retina
35
there are 6 normal gut microbiota, which 2 make up 80-90%?
firmicutes, bacteroidetes
36
what can result in the translocation of gut bacteria into the circulatory and lymphatic systems?
dysbiosis
37
Which systemic inflammatory conditions are associated with gut dysbiosis?
* Rheumatoid arthritis * Multiple sclerosis * Inflammatory bowel disease * Type 1 diabetes
38
What non-infectious eye diseases are associated with gut commensal bacteria?
* autoimune uveitis * ARMD * Glucoma * Diabetic Retinopathy
39
which ocular conditions are associated with dysbiosis of the ocular microbiota?
blepharitis, conjunctivitis, bacterial keratitis, trachoma, dry eye syndrome, meibomian gland dysfunction
40
H. pylori is implicated in what conditions?
peptic ulcer disease, glaucoma
41
What type of ulcers are a medical emergency?
perforated ulcers ## Footnote cause severe, acute abdominal pain
42
What are the signs and symptoms of peptic ulcer disease?
1. epigastric pain related to meals 2. bleeding
43
what two conditions make up inflammatory bowel syndrome?
ulcerative colitis and crohn's disease
44
fistulas are found in _crohn's disease/ ulcerative colitis_
Crohn's disease
45
What are the 3 classic ocular complications of IBS?
episcleritis, uveitis, scleritis
46
what are 4 secondary ocular complications that are seen in patients with IBS?
cataracts, neovascular glaucoma, nyctalopia and xerophthamia
47
What autosomal dominant condition is characterized by numerous adenomatous polyps lining the intestinal mucosal surface? ## Footnote also presents with skeletal hamartomas (tumor like growths on skull, mandible, and long bones)
gardner syndrome ## Footnote progresses to adenocarcinoma by 5th decade
48
What is an ocular manifestation of Gardner Syndrome?
presence of atypical CHRPE ## Footnote bilateral, clusters of flat, well-demarcated lesions with 3-30 in each cluster increasing in size and pigmentation anteriorly toward fundus periphery
49
Which disorders make up the seronegative spondyloarthropathies?
1. ankylosing spondylitis 2. Reiter's syndrome (reactive arthritis) 3. Inflammatory bowel disease 4. Psoriatic arthritis
50
what are ocular manifestations of inflammatory bowel disease?
episcleritis, scleritis, anterior uveitis, optic neuritis
51
xerophthalmia is the leading cause of what?
preventable blindness in developing countries ## Footnote caused by severe vitamin A deficiency
52
what are the clinical signs of xerophthalmia?
* night blindness * conjunctival xerosis * bitot spots * corneal xerosis * corneal ulceration * corneal scar * xerophthamic fundus
53
what is unique about uveitis in regards to patients with IBD when comparing to episcleritis and scleritis?
Uveitis does not parallel the disease activity of IBD

Evidence Based Medicine (4 decks)

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