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Medicine > Infections of the Sensory System > Flashcards

Infections of the Sensory System Flashcards

1
Q

what is innate immunity

A

non-specific diseases

1st line
skin
mucous membranes
secretions

2nd line
phagocytic leukocytes
antimicrobial proteins
inflammatory response
fever

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2
Q

what is adaptive immunity

A

third line

lymphocytes
antibodies
memory cells

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3
Q

what are ocular defence mechanisms

A

innate
-eyelids- sweep away dirt, small microbes
-tears, mucin
-ocular epithelium
-ocular bacterial flora
-antibacterial factors
-macrophages and NK cells
-BONY ORBIT

oil later
water layer
mucin layer
corneal epithelium-non keratanised with goblet cells for lubrication of eye

adaptive defence
-eye associated lymphoid tissue
-langerhan’s cells
-immunoglobins
-t lymphocytes
-b-lymphocytes

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4
Q

what makes up the bony orbit

A

frontal, sphenoid, maxillary, zygomatic, palatine, ethmoid, and lacrimal

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5
Q

what are langerhan’s cells

A

sub-population of dendritic cells
catch and report to t and b lymphocytes
sit on cornea and in transplant causes rejection

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6
Q

what is a blow out fracture

A

-high pressure in sinus and blow nose
-trauma

fractured maxillary bone
eyeball fall into maxillary sinus
stress and damage on optic nerve and extraocular eye muscles

lets infection from sinus into orbit

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7
Q

discuss role of lysozome and lactoferrin

A

enzymes found in tears

lysozyme cleaves PEPTIDOGLYCANS (found in bacteria walls)– good with gram positive who has it in their outer wall

lactoferrin binds IRON- STARVES bacteria and fungi blocks viral lipoprotein bonds
-alters the permeability of the lipopolysaccaride later giving access for lysozyme

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8
Q

what is found in the ocular biome

A

staphylococcus
streptococcus
propionbacterium
corynebacterium

collection of commensals
keep immune system prime
competitively inhibit growth of pathogenic organisms
-takes up all resources

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9
Q

what pathogens are found in common viral conjunctivits

A

coronaviruses
rhinoviruese
respiratory syncytial virus
parainfluenza

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10
Q

what are the different kinds of conjunctivitus

A

common viral
adenovirus related
common bacterial
neonatal

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11
Q

symptoms of common viral conjunctivits
how to help

A

sticky
watery
pink
discomfort
slef limiting
rarely cause seious damage
1 eye until spreads

cold compress
artificial tears
sterile water
paracetamol

step in if longer than a week

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12
Q

what are symptoms of adenovirus conjuctivits

A

bilateral
very sticky
red
painful
6-8 weeks
visual blurring– PUNCTUATE KERATITIS
sore throat and cough

same as common viral conjunct for treatment

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13
Q

what are the symptoms for bacterial conjunctivitis
what treatments

A

discharge more yellow than viral
go away with ANTIBIOTICS

-CHLORAMPHENICOL
-FUSIDIC ACID

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14
Q

what can cause bacterial conjunctivitis

A

haemophilus influezae
streptococcus pneumoniae
moraxella

if discharge very xs– may be ghonnorea

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15
Q

what causes neonatal conjunctivits

A

may be normal bacterial/viral/sti from birth canal

0 days
neisseria gonorrhoeae

5 days
chlamydia trachomatis

5 weeks
haemophilus influenza
streptococcus

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16
Q

what is keratitis
what can cause it

A

corneal abrasion
inflammation of cornea

bacterial- staph. aureus, strept. pne, pseudomonas species
viral- HSV, HZO
fungi

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17
Q

what happens in keratitis

A

inflammation seeps through into different corneal layers
causes noxious response which dissolves cornea epithelium and stroma
–ulceration and scarring

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18
Q

what is hypopynum

A

an accumulation of leukocytes in the anterior chamber due to severe intraocular inflammation

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19
Q

how is the cornea weakened

A

more issues if dry-> keratoconjunctivitis sicca DRY EYE DISEASE

tear film deficiencies
eyelid malformation- exposure of cornea
endogenous cause-mechanical abrasion
exogenous cause- TRAUMA (foreign bodies, cat scratches)

if can’t close eye eg. after stroke

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20
Q

how do HSV keratitis occur
what are the symptoms
how do you treat

A

usually direct contact
(like from cold sore)
UNILATERAL

painful
red
watery
photophobic

topical and oral ACICLOVIR

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21
Q

what are the different types of ulcer found in HSV keratitis

A

dendritic ulcer
geographic ulcer

these cause new vessels, loss of sensation, scarring

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22
Q

what is the leading infectious cause of blinding

A

trachoma

23
Q

how does trachoma come about
what is the infective cause

A

between close contact from lack of hygiene, sanitisation
flies

eyelids turn in– trachomatous trichiasis
–scarring
which causes permanent blindness
(fixed with corrective surgery)

CHLAMYDIA TRACHOMATIS

24
Q

what is trachomatis trichiasis

A

in turned lash that rubs the cornea
causes recurrent inflammation in conjunctiva

25
Q

what is trachoma eradication trying to do

A

to clear trachoma from endemic populations

Surgery
Antibiotics
Facial cleanliness
Environmental change

26
Q

what is ONCHOCERCIASIS

A

river blindness
2nd leading causing of infection blindness
CENTRAL AFRICA

parasitic disease
onchocerca larvae carried by black flies
worm bites
birth larvae
which spreads to different tissues like eye and die which causes inflammation

27
Q

what is the treatment for river blindness

A

IVERMECTIN
-yearly for 10-15 years
clear from population

28
Q

what is orbital cellulitis
signs
how it presents

A

ophthalmological med emergency

2 types- pre and post septal cellulitis
post is more dangerous:
spread of infection into deeper structures
orbital abscess (push eyeball out)
meningitis
cavernous sinus thrombosis
optic nerve damage
bacteremia/sepsis

pre (just area around eye)

signs?
swelling
red
pain
proptosis
RAPD
tenderness
photophobia

29
Q

what infections cause orbital cellulitis

A

haem. influenza
staph. a
strept. pn
neta-haemolytic streptococci

30
Q
A
31
Q

what is toxoplasmosis retinochoroidits
what species causes it

A

infectious condition

retinochoroidal lesions
postior uveitis
FOG IN HEADLIGHT SIGN WITH ADJACENT PIGMENTENTED RETINAL CHOROIDAL SCARRING

toxoplasmosis gondii (cat litter)
-spontaneous miscarriage
-blindness
-enchephalitis

32
Q

what is the treatment for toxoplasmosis

A

oral pyrimethamine
sulfadiazine
corticosteroids

33
Q

what are some ocular manifestations of patients with HIV/AIDS

A

retinochoroiditis toxoplasma
endophthalmitis
HIV reproduces in CD4+ t cells
can tell what they might be susceptible by their cell count

250/uL- toxoplasmosis
100/uL- CMV

34
Q

what is cytomegalovirus retinitis CMV
what is treatment

A

cotton wool on retina
antiviral ganciclovir

35
Q

what is endophthalmitis
treatment

A

develops after intra-ocular operation
trauma with inoculation of foreign body
complication of systemic infection

intra-ocular and systemic antibiotics
virectomy

36
Q

what is otitis externa

A

epithelium of the ear can be affected by comon skin conditions
eg. eczema, psoriasis
pain
ear ache
itch
discharge
swimmers ear- gets moist for bacteria to grow in
cottage cheese discharge, can be blood stained
conduction deafness

ear drops

37
Q

what is innate immune system for upper resp. tract

A

hair follicles
ciliated cells

38
Q

what are common microorganisms for otitis externa

A

pseudomonas aeeruginosa
staph aure.

less common
candida albicans
aspergillus niger

39
Q

what is otitis media
what are pathogen

A

middle ear
most common in infants and small children- flatter eustachian tubes
50% viral in origin
mainly RSV
also s. pneu, and h. inflenzae

young:
red ears, fever, crying, poor feeding, restlessness, hearing difficulties, delayed learning development

glue ear- fluid in middle ear
bulging ear drum and dilated vessels
chronic suppurative otitis media

40
Q

what is mastoiditis

A

a severe complication of otitis media
spread of infection from middle ear to mastoid air cells via the mastoid antrum
mastoid process inflammation

redness
tenderness
pain behind the ear
pushed forward pinna
fever
fatigue

if unwell
IV antibiotics

41
Q

what is sinusitis

A

pathogen invasion of the air spaces associated with URT
mucosal swelling prevents muco-ciliary clearance of infection
exacerbated by local accumulation of inflammatory bacterial products

nasal blockage
discharge with facial pain/pressure/loss of smell

self limiting
increase in symptoms after day 5 of urt infection -double sickening

42
Q

what are causative agents of comomon cold and symptoms

A

40%rhino
30% coronaviruses
coxsackie virus a
echovirus
parainfluenza virus

tired, pyrexia, malaise, sore nose, pharynx. nasal discharge, sneezing

43
Q

what is pharyngitis
when should you worry

A

Pharyngitis is often is associated with
pharyngeal exudate and cervical
lymphadenopathy
* Sore throat, reduced oral/fluid intake,
fatigue, lethargy, fever, Headache,
nausea, vomiting.
* Management: Self-limiting for most,
antibiotics need to be considered for
some.

worry if taking DMARDS, carbimazole, HIV, chemo

44
Q

what causes pharyngitis

A

Viruses
* Cytomegalovirus (CMV)
* Epstein-Barr virus (EBV)
* Herpes simplex virus type I (HSV-1)
* Rhinovirus
* Coronavirus
* Adenovirus
* Bacteria
* Streptococcus pyogenes
* Haemophilus influenzae
* Corynebacterium diphtheriae

45
Q

discuss CMV

A

Cytomegalovirus (CMV)
* Transmission in body secretions and organ transplants
* Usually asymptomatic or mild in healthy adults
* CMV causes cold-like symptoms, such as a
sore throat, fever, fatigue and swollen glands.
* Symptoms last for only a few short weeks and is
not worrying for healthy children or adults.
* Virus can reactivate and cause disease when cellmediated immunity is compromised
* Treatment with ganciclovir, foscarnet, cidofovir

46
Q

what is tonsilitis

A

Inflammation of the tonsils
– typically palatine. Can be viral or bacterial.
Therefore
– may or may not need antibiotics.
* Symptoms: Dysphagia, odynophagia, cervical lymphadenopathy, fever * 90% of cases will resolve in 7 days without treatment

47
Q

what is fever pain scoring

A
  • A score of 0-1 is associated with 13-18%
    isolation of streptococcus (close to
    background carriage rates).
  • No antibiotics recommended.
  • A score of 2 is associated with 30-35%
    isolation of streptococcus.
  • Delayed antibiotic may be
    appropriate.
  • A score of 3 is associated with 39-48%
    isolation of streptococcus.
  • Delayed antibiotic may be
    appropriate.
  • A score of 4 or more is associated with 62-
    65% isolation of streptococcus.
  • Consider antibiotics if symptoms
    are severe or a short delayed
    prescribing strategy may be
    appropriate (48 hours).
48
Q

what are some complications of streptococcus pyogenes

A

complications * Scarlet Fever * Caused by
erythrogenic toxin
from S. pyogenes
* Peritonsillar abscess
(“quinsy”)
* Otitis media / sinusitis * Rheumatic heart
disease
* Glomerulonephritis

acute Group A streptococcal (GAS): * 5 to 15 years old * more common in the winter * High Fever PAIN or CENTOR score * A scarlatiniform rash may be
present, especially in children. * Significant complications if not
treated
Treatment: * Able to swallow Benzylpenicillin IV * Unable to swallow Penicillin V * Paracetamol, Ibuprofen, IV Fluids

49
Q

what is quinsy

A
  • Collection of pus between the tonsillar capsule and superior
    constrictor muscle.
  • Complication of untreated bacterial pharyngitis / tonsillitis
  • Symptoms: Fever, pain, trismus, general malaise
  • Signs: Hot-potato voice, unilateral swelling, deviation of uvula
  • Management: Same day hospital admission to ENT.
  • Needle aspiration / drainage, IV antibiotics (Penicillin based) and IV
    Steroids, analgesia and IV Fluids until oral route available.
  • Complications: Retropharyngeal or deep neck space infection in
    fascial planes of the neck,

HOT POTATO VOICE

50
Q

what is glandular fever

A

Replicates in B lymphocytes
* Clinical features:
* Fever
* Headache
* Malaise
* Sore throat
* Anorexia
* Palatal petechiae
* Cervical lymphadenopathy
* Splenomegaly
* Mild hepatitis
Diagnosis: EBV Serology, FBC and LFTs
EBV IgM – Acute 4-6 weeks
EBV IgG – Lifelong (Indicative of past infection)

51
Q

what is the mumps virus

A

parotitis

Clinical features:
* Fever, Malaise, Headache
* Anorexia, Trismus, joint pain
* Severe pain and swelling of
parotid gland(s)
* Treatment is supportive /
symptomatic
* 88% resistance with full
vaccination

52
Q

what is acute epiglottitis

A

HAEMOPHILUS INFLUENZA

  • Present in nasopharynx of 75% healthy people
  • 88% reduction in cases since vaccine in 1992
  • Clinical features:
  • High fever / Bacteraemia
  • Massive oedema of the epiglottis - tripod position
  • Severe airflow obstruction – Stridor, Dysponoea
    Most often seen in young children 2 to 6 years of age
    MEDICAL EMERGENCY needing 999 ambulance to hospital
    for intubation and IV antibiotics. Do Not examine a child with
    suspected epiglottitis without an anaesthetist.
53
Q

what is diagnosis and treatment for diptheria

A

diagnosis: * Made on clinical grounds as therapy is
usually urgently required
* Treatment: * Prompt anti
-toxin therapy administered
intramuscularly
* Concurrent antibiotics (penicillin or
erythromycin)
* Strict isolation and contact tracing

Medicine (54 decks)

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