Infectious Disease Flashcards
(120 cards)
1
Q
About how many people in US have HIV/AIDS and what percentage of people are unaware?
A
1.1 million; 20%
2
Q
What are the two clinically important retroviruses? And what is the difference between them?
A
Human Immunodeficiency Virus - kills T-cells
Human T-cell Lymphotropic Virus 1 - proliferation of T-cells
3
Q
STDs on Ocular-Genital Axis (7)
A
- Syphilis
- Chlamydia
- Gonorrhea
- Herpes
- HIV
- Hepatitis B
- Pediculosis
4
Q
Highest risk category for HIV
A
MSM
5
Q
Diagnostic Criteria for HIV
A
Any of the following:
1. CD4+ T-lymphocytes < 200 µl
2. CD4+ T-lymphocytes < 14% of total lymphocytes
3. (+) any of the specific group of opportunistic infections or neoplasms
6
Q
Viral Load: definition and what does it indicate?
A
Measure of amount of HIV RNA in blood
Indicates likelihood of progressive to AIDS and mortality
7
Q
CD4 Cell Count: what does it indicate?
A
Status of patient’s immune system
8
Q
Treatment for HIV
A
Reverse transcriptase inhibitors and protease inhibitors
Aka “Highly Active Antiretroviral Therapy” (HAART)
9
Q
Prophylactic Treatment for HIV
A
Truvada: combo of Emtriva and Viread
10
Q
3 Methods of HIV transmission
A
- Sexual contact
- Transfer of infected blood (e.g. drug use)
- Vertical transmission (in utero, during delivery, breast milk)
11
Q
HIV: What are ways to prevent transmission from mother to child?
A
- No breastfeeding
- C section
- AZT (Zidovudine)
— untreated with AZT (25% transmission)
— treated with AZT (8%)
12
Q
Ocular involvement in ___% of HIV patients
A
75%
13
Q
Describe course of AIDS
A
Initial Stage: flu-like (4-12 wks after infection)
Chronic Stage: Latent period, ~10 yrs, minor immune dysfunction
Final (Crisis) Stage: Virus replicating within lymph nodes — symptomatic + opportunistic infections/neoplasms
14
Q
Most common malignancies associated with HIV
A
Kaposi Sarcoma
Lymphoma
15
Q
Most common bacterial infection associated with HIV
A
- Mycobacterium Tuberculosis
- Strep Pneumoniae
- Salmonella
16
Q
Most common viral infections associated with HIV (5)
A
- CMV
- JC pap virus
- Epstein Barr virus
- Herpes Simplex 1 & 2
- HHV 8
17
Q
Most common fungal infections associated with HIV
A
- Candida
- Cryptococcus
- Histoplasmosis
18
Q
Most common parasitic infections associated with HIV
A
Pneumocystis jiroveci (formally carinii, toxo gondii)
19
Q
Diagnostic Tests for HIV
A
- ELISA — initial screen
- Western Blot — confirm
- Genotype
- Tropism Array
- PCR — viral load
20
Q
How often should you see a pt with a CD4 count of >250 cells/mm3?
A
Every year
21
Q
How often should you see a pt with a CD4 count of 150 cells/mm3?
A
Every 6 months
22
Q
How often should you see a pt with a CD4 count of 50-150 cells/mm3?
A
Every 3 months
23
Q
How often should you see a pt with a CD4 count of < 50 cells/mm3?
A
Every month!
24
Q
Symptoms associated with HIV Retinopathy
A
Typically asymptomatic
25
Most common finding of HIV retinopathy
Cotton Wool Spots
26
TRUE/FALSE: Roth Spots do *not* progress
TRUE
27
TRUE/FALSE: the more severe the HIV, the more severe the HIV retinopathy
FALSE; does not correlate
28
Cytomegalovirus belongs to the ____ family
Herpes
29
Cytomegalovirus: Fulminant Form
Necrotic and hemorrhagic fundus
*(severe and sudden)*
30
Cytomegalovirus: Indolent Form
Granular retinitis w/ less edema and hemorrhage
*(chronic, slow-progressing)
31
When is RD most likely to occur in a CMV pt?
CD4 count < 50 µl
32
Describe Immune Recovery Uveitis + Sx + Tx
Inactive CMV retinitis pt no longer on CMV therapy develops
1. Ant Uveitis — significant
2. Vitreous cells — low grade
3. Diffuse CME
4. CAT
5. ERM
Tx: periocular steroid injection
REMEMBER: C DAVE
33
ARN & PORN represent a spectrum of ____ ____ ____ (3 words) herpetic retinopathies
Rapidly progressing necrotizing
34
How do you differentiate between CMV and ARN?
Blood testing
35
Which spreads more rapidly: ARN or CMV?
ARN
36
T/F: ARN only affect immunocompromized pts
FALSE; *can also*occur in healthy pts
37
What layer(s) of the retina are affected by ARN?
All ‘em (full thickness retinal necrosis)
38
T/F: A clinical finding of ARN is cells in the vitreous
TRUE
39
How often does RD occur with ARN?
Most of the time (75%)
40
Viruses associated with ARN (4)
1. Varicella-zoster
2. Herpes Simplex
3. CMV
4. Toxoplasmosis
41
T/F: ARN is associated with A-AION
FALSE; ARN is associated with/ AION, but the non-arteritic (NA-AION) variety
42
TX for ARN
IV **acyclovir** or intravitreal **ganciclovir**
43
The *main* difference between/w ARN and PORN?
PORN occurs in advanced HIV patients
44
Virus(es) associated w/ PORN
Usually Varicella Zoster
45
T/F: A clinical finding of PORN is cells in the vitreous
FALSE
46
What retinopathy is associated with a “cracked mud” appearance?
PORN
47
Which layer(s) are affected in PORN?
Outer layers
48
T/F: Kaposi Sarcoma is *malignant*
TRUE
49
Molluscum Contagiosum
50
Molluscum Contagiosum is associated with which virus
DNA pox virus
51
Describe the recurrence rate of Molluscum Contagiosum
High rate
52
Most common human retinal infection ⭐️
Toxoplasmosis
53
What is a retinochoroiditis (eg Toxoplasmosis)?
Affects retina first then the choroid
54
What is congenital toxoplasmosis?
Transplacental transmission from mother to fetus
55
When (during pregnancy) is acquired infection most damaging to a fetus?
First two trimesters
56
What is the most common manifestation of congenital toxoplasmosis?
Retinochoroiditis
57
T/F: Macular involvement is *highly* common in congenital toxoplasmosis
TRUE
58
When would you see “headlight in a fog” appearance?
Active toxoplasmosis retinochoroiditis
59
What is the typical macular lesion for congenital toxoplasmosis?
Punched out scar (visible sclera), surrounded by pigment (orrrr just small pigment clumps in retina)
60
T/F: “headlights in a fog” appearance is often characteristic of congenital toxoplasmosis
FALSE; reactivation of ocular toxoplasmosis
61
Most common protozoan eye infection
Toxoplasmosis
62
Most common protozoan eye infection
Toxoplasmosis
63
Pathogen associated with Toxoplasmosis
Toxoplasma gondii
64
What is important to remember r/o with a Dx of Toxoplasmosis?
1. HIV
2. CNS Toxoplasmosis
65
Testing for Toxo
**ELISA**
For IgG or IgM anti-Toxoplasma antibodies
66
Pathogen associated with Toxocariasis
Nematode (roundworms) or larvae of Toxocara canis
67
What causes chorioretinal scarring in toxocariasis?
Subretinal granuloma
68
Pathogen associated with Ocular Histoplasmosis Syndrome
Histoplasma (fungal)
69
Triad for Histoplasmosis
1. Peripapillary atrophy
2. Maculopathy
3. Histo spots
70
Histoplasmosis usually occurs (Uni/Bi)-lateral
Unilateral
*but can occur bilateral*
71
Where (in the US) is Histoplasmosis most prominent?
Ohio/Mississippi River Valley
72
Majority of TB manifestations are associated with which organ?
LUNGS (mostly pulmonary manifestations and transmitted via aerosolized droplets)
73
Ways to test for TB
PPD skin test or chest x-ray
74
T/F: only a patient with pre-existing systemic TB can have ocular TB
FALSE
75
TB most commonly presents as ___ with in the eye
Posterior Uveitis
76
Longstanding TB can result in what type of choroiditis?
Serpiginous
77
TX for TB
1. Rifampin
2. Isoniazid
3. Pyrazinamide
4. Ethambutol
X 2 months
78
What is an easily examined sign of Candida?
Oral thrush
79
TX for Candida or Crytococcal?
Amphotericin B + Fluconazole
80
What ocular sign is seen in Cryptococcal ?
Meningitis —> ON edema
81
Most common systemic opportunistic infection
Pneumocystis carinii
82
TX for Pneumocystitis carinii
Trimethoprim and sulfamethoxizole
83
“Salt and pepper” appearance
Syphilis
84
Most common ocular finding in Syphillis?
Uveitis
85
T/F: syphilis is associated with an itchy rash
FALSE; **non-itchy rash**
86
Pathogen associated with Syphillis
Treponema palladium
87
T/F: Syphillis is highly treatable
TRUE
88
Which is a common feature in Syphillis: episcleritis or scleritis?
BOTH
89
T/F: Syphillis can be transmitted by kissing
TRUE
90
Stages of Ssytemic Syphillis
Primary — Chancre lesion
Secondary — Sore throat, non-itchy rash, fever
Latent Stage
Tertiary — Benign/severe stages, CV and CNS problems
91
Tests for *active* Syphillis infection
VDRL, RPR
92
Tests for *current or previous* Syphillis infection
FTA-ABS, MHA-TP
93
TX for Syphillis
IV or IM penicillin G
Or Oral Tetracycline/Doxycycline or Azithromycin
94
Argyll-Robertson Pupil
1. Miosis in darkness (2.5 mm)
2. No direct response
3. Brisk near response
4. Preserved vision
5. Dilates poorly
95
Causes of Argyll-Robertson (4)
1. MS
2. Syphillis
3. Lyme
4. Sarcoidosis
96
Main pathogen associated with Neuroretinitis
Bartonella (Cat scratch)
97
T/F: Vitreous cells will be present in Neuroretinitis
TRUE
98
T/F: APD is likely to be present in Neuroretinitis
TRUE
99
Retinal findings w/ Neuroretinitis
1. Serous RD
2. Mac star of hard exudates
3. ON swelling
4. Multi focal retinitis
100
Causes of Neuroretinitis (5)
1. Cat Scratch Disease
2. Lyme
3. Syphilis
4. TB
5. Toxoplasmosis
101
VF defect in Neuroretinitis
Central or cecocentral scotoma
102
Endophthalmitis occurs after (3)
1. Penetrating trauma
2. Recent intraocular surgery
3. Intravitreal injection
Anything *in* the eye
103
Why is endophthalmitis the “most feared post op complication”?
Poor visual prognosis
104
Most cases of POE are caused by what pathogen?
Coagulase-negative Staphylococcus
(Staphylococcus Epidermidis)
105
Endophthalmitis
inflammation secondary to intraocular infection
106
Toxic Anterior Segment Syndrome (TASS)
Masquerade syndrome
Acute, *sterile* AC inflammatory reaction 12-48 hrs post-op
Highly responsive to steroids
107
What operation has highest risk of POE?
Secondary IOL placement
108
Endogenous Endophthalmitis
Spread via blood
Usually associated with/ DM, liver disease, etc.. (systemic)
109
What conditions increase risk factors for POE?
1. Clear corneal incisions
2. Temporal placement of incisions
3. Use of topical anesthetic
4. Poor wound cleaning
110
Hallmark of endophthalmitis
Vitreous inflammatory cells
111
T/F: POE is associated with *pain*
TRUE
112
Most POE pathogens: gram (+) or (-)
Gram (+)
113
Which is higher risk for POE: ICCE or ECCE?
ICCE
Due to vitreous communication
114
An incision where decreased risk of POE?
Limbal, scleral (as opposed to clear cornea)
115
Acute POE usually shows up ____ days post op
2-5
116
Chronic POE usually shows up ____ weeks post op
> 6 weeks
117
T/F: Hypopyon is indicative of POE
TRUE
118
T/F: IV antibiotics are best for tx of POE
FALSE; EVS said it didnt help
119
Initial TX of choice for POE
Intravitreal AB
120
The most significant independent risk factor for poor visual outcome in POE
VA of LP or worse at initial presentation
