Download Prompt diagnosis, treatment, referral essential for giant cell arteritis

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QUIZ
PRIMARY CARE OPTOMETRY NEWS | JULY 2014 | Healio.com/Optometry
Prompt diagnosis, treatment, referral essential for giant cell arteritis
Which is not true in ESR testing/finding?
c. HLA 1 and 2 genes and encoding play a
b. Environmental, infectious
ents with vision loss.
a. Fibrinogen levels increase during inflam-
role in the etiology of GCA.
c. Genetic
d. Vision loss is strictly defined as loss in
mation.
d. Environmental factors and infection play
d. Multifactorial, including all of the above
visual acuity.
b. Erythrocytes resist sedimentation.
a role in the etiology of GCA.
c.ESR is elevated in severe anemia.
12. Which is not true?
a. GCA risk increases with each decade
of life.
a. It is a promising method of diagnosing
a. Diabetes mellitus, hypertension, Cush-
b. GCA rate is 0.0019%.
GCA.
Which is true according to Kermani and
colleagues?
ing syndrome
c. GCA is more prevalent in men than in
b. It serves as an important tool for diag-
b. Osteoporosis, muscle wasting, gastro-
women.
nosing GCA, determining effectiveness
a. ESR and CRP have high sensitivity and
intestinal disturbances (dyspepsia, peptic
d. GCA is two to three times more com-
of treatment and determining schedule of
specificity.
ulceration), avascular necrosis of the
mon in women.
taper.
b. ESR and CRP have low sensitivity and
femoral head.
specificity.
c. Mental disturbances (depression, psy-
c. A low percentage of GCA cases have
chosis, euphoria)
a. TAB is the gold standard for diagnosis
normal ESR.
d. All of the above
of GCA.
systemic medications.
2.
d. The positive predictive values of ESR
and CRP for GCA are high.
3.
4.
8.
c. It is the standard of care for diagnosing
every patient suspected of having GCA or
d. It is a noninvasive diagnostic tool.
18. According to a study conducted by Hayreh
and colleagues, the leading most useful
signs and symptoms correctly identifying
GCA are:
a. The best way to diagnose GCA is by
anterior AION.
Which statement is true?
having a high degree of clinical suspicion.
c. The result is not affected if TAB is
a. A normal ESR and CRP rules out GCA.
b. It can easily be managed by a general
a. Jaw claudication, neck pain and el-
delayed a few days after treatment of GCA
b. A normal TAB rules out GCA.
ophthalmologist.
evated CRP
is initiated.
c. TAB is the gold standard for diagnosing
c. It can easily be managed by an optom-
b. Jaw claudication, elevated ESR and
d. A and C
GCA.
etrist with oral privileges.
weight loss
d. TAB is done without risk to the patient.
d. B and C
9.
c. Neck pain, elevated ESR and anorexia
14. Which is not true regarding the epidemiology
of GCA?
d. Jaw claudication, advanced age and
elevated ESR
Which is not true of GCA?
a. The prevalence increases with each
a. Inflammation is granulomatous and af-
a. TAB is the gold standard for diagnosis
decade of life, peaking at 70.
fects large- and medium-sized arteries.
of GCA.
b. It is more prevalent in women.
b. Intracranial arteries are normally spared.
b. It must be performed as soon as pos-
c. It has the same prevalence across all
a. It is imperative to initiate corticoste-
c. Ophthalmic and posterior ciliary arteries
sible in every patient suspected of having
ethnic groups.
roid therapy immediately once GCA is
are affected.
GCA or in the presence of an anterior
d. A and B
suspected.
d. Post mortem studies confirmed the
AION to establish the diagnosis without
systemic low risk of GCA.
delaying treatment.
Which is not true in GCA?
Which is not true about systemic vasculature
in GCA?
a. Elastic lamina becomes progressively
d. A negative TAB rules out GCA.
10. Which raises the suspicion of the presence of
a. Headache, myalgia, neck pain, scalp
above
scarred.
tenderness, jaw claudication, anorexia,
c. Tunica intima becomes hyperelastic and
weight loss
allows for better blood flow.
b. Transient ischemic attacks, stroke, ab-
d. Ophthalmic artery involvement may
normal temporal arteries (tender, nodular
result in retinal ischemia.
or nonpulsating)
c. Relapses during treatment taper and
recurrences after discontinuing treatment
are common.
d. There are minimal side effects from
corticosteroid use.
16. Which is not true about GCA?
a. Near normal visual acuity does not rule
20. Which retinal finding is true in GCA?
it out.
b. The “silent form” occurs in the presence
of profound systemic symptoms accompanied with fever of unknown origin in the
absence of the typical cranial symptoms.
a. GCA is not an antigen-driven auto-
c. The “occult form” of GCA occurs in the
11. GCA etiologies are:
a. Cotton-wool spots are secondary to
ophthalmic artery ischemia.
b. Choroidal hemorrhage may be present.
c. Arterial occlusion is present in more
than 30% of cases.
d. A and B
absence of systemic symptoms, but pres-
a. Autoimmune
b. GCA etiology is multifactorial.
require lifelong maintenance doses.
c. Myocardial infarctions
b. Smooth muscle becomes gradually
immune disease.
take months to years. Some patients may
b. Cerebrovascular accidents
d. Not limited to, but includes all of the
d. All of the above
b. Treatment with corticosteroids may
a. Aneurysms, aortic dissection
GCA?
Which is not true of GCA?
19. All of the following is true about the
treatment of GCA except:
15. Life-threatening complications from GCA
include:
fragmented.
c. Ocular muscle palsy or diplopia
6.
GCA.
13. Which is true?
b. TAB must be performed immediately in
Which is true?
c. A positive TAB confirms the diagnosis.
5.
17. Which is not true about duplex
ultrasonography?
Possible side effects of systemic prednisone
use include:
d. Sedimentation rate is not affected by
7.
PCON July 2014
This condition, which manifests in the eye as arteritic ischemic optic neuropathy,
can be blinding and fatal if left untreated.
by Joseph Hallak, OD, PhD; Veronica Khaimov, OD; Joseph Bacotti, MD
COPE Course ID: 41257-SD
This course is jointly sponsored by PCON and the State University of New York State College of
Optometry. It is COPE-approved for 2 continuing education credits.
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