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Cornea & Lens and Cataract > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

Name 4 bacteria that can overcome intact epithelium?

A
  1. N. gonorrhoae 2. N. meningitidis 3. Corynebacterium diphtheriae 4. Shigella spp
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2
Q

List the Septated fungi. Do they grow fast or slow and on what broth?

A

Fusarium, Asperfillus, Curvularia. Slow growing. Sabourauds agar.

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3
Q

List the non septated fungi?

A

Mucor, Rhizopus, Absidia

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4
Q

What are 3 signs of acute HSV ocular infection?

A
  1. Cutaneous or EYELID MARGIN vesicles or ulcers on the bulbar conjunctiva
  2. Dendrites
  3. Conj membrance or pseudomembranes.
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5
Q

What % of patients have U/L HSV?

A

97%

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6
Q

Primary ocular HSV infection typically manifests as what?

A

Unilateral Blepharoconjunctivits

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7
Q

What are 2 signs to distinguish acute HSV from adenovirus?

A
  1. Cutaneous or eyelid margin vesicles or ulcers on the BULBAR conj
  2. Dendritic epithelial keratitis
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8
Q

Primary ocular HSV is what type of condition?

A

Self-limited and antiviral therapy speeds resolution.

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9
Q

Primary ocular HSV develop most commonly where?

A

Epithelial keratitis (stromal keratitis and uveitis are UNCOMMON)

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10
Q

Recurrent HSV affects which ocular tissue?

A

Eyelid, conjunctiva, cornea, iris, TRABECULAR MESHWORK, retina.

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11
Q

What are the MOST COMMON presentations of clinically recognizable recurrent ocular HSV?

A
  1. Blepharoconjuncitivis 2. Epithelial keratitis 3. Stromal keratitis 4. Iridocyclitis
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12
Q

What is a common way that geographic epithelial ulcers form?

A

Topical steroid use causes areas of dendritis keratitis coalesce.

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13
Q

Each episode of what type of keratitis increases the risk of future episodes of HSV?

A

Stromal keratitis

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14
Q

What are the 2 types of stromal keratitis?

A
  1. Nonnecrotizing (intersitial or disciform)

2. Necrotizing

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15
Q

How do you differentiate Disciform keratitis from uveitis with secondary corneal endothelial decompensation?

A

The disc-shaped stromal edema and KPs are OUT OF PROPORTION to the degree of AC reaction.

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16
Q

What is common with necrotizing stromal keratitis?

A

Corneal stromal vascularization.

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17
Q

Do topical steriods treat stromal keratitis?

A

Yes. They significantly decrease stromal inflammation and shorten duration of keratitis.

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18
Q

Is oral acyclovir in addition to treatment with trifluridine and steroids helpful in treating stromal keratitis?

A

NO. Treatment of nonnecrotizing stromal keratitis with oral acyclovir was not beneficial.

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19
Q

Does oral acyclovir prevent patients with epithelial keratiis from devloping stromal keratitis and iritis?

A

NO

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20
Q

Does acyclovir prophylaxis minimize HSV recurrences?

A

Recurrent ocular disease was less (approx 50%) in group on oral prophylaxis, esp those with recurrent stromal keratitis.

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21
Q

What is the antiviral dose for Trifluride and acyclovir for stromal keratitis?

A

Trifluridine qid or oral acyclovir 400mg bid

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22
Q

What is the treatment dose of oral acyclovir in the treatment of HSV iridocyclitis?

A

400 mg 5 times a day

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23
Q

Neurotrophic ulcers do not stain with what?

A

Rose bengal

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24
Q

In primary HZV infection was ocular manifestation are there?

A
  1. eyelid vesicles 2. FOLLICULAR conjuncitivits
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25
Q

What type of iris atrophy do u get in HSV vs VZV?

A

Patchy vs SECTORAL

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26
Q

What type of corneal hypoesthesia do u get with HSV vs VZV?

A

Sectoral or diffuse vs MAY BE SEVERE

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27
Q

What type of corneal infiltrates are said to be characteristic of zoster stromal keratits?

A

NUMMULAR

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28
Q

What is the dosage of acyclovir for HZO?

A

800 mg 5 times a day for 7-10 days best if started within 72 hours

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29
Q

What can be given early on to decrease duration of postherpetic neuralgia?

A

Amitriptyline

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30
Q

Epstein-Barr virus is the most common cause of what?

A

Acute dacryoadenitis

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31
Q

A chronic follicular conjunctivitis should make u think of what?

A

Molluscum contagiosum.

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32
Q

Acute hemorrhagic conjunctivitis caused by 3 bugs?

A
  1. Enterovirus 2. Coxsackievirus 3. adenovirus
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33
Q

Chronic staph blepharoconjunctvitis has what type of chronic reaction?

A

Papillary reaction

34
Q

Moraxella angular blepharoconjunctivitis affect which area?

A

skin in the lateral canthal angle

35
Q

What is the most common cause of bacterial conjunctivitis in neonates?

A

Chlamydia trachomatis

36
Q

What are 5 ways to differentiate newborn vs adult chlamydial conjunctivitis?

A
  1. No follicular response in newborns
  2. Mucopurlent d/c is greater in newborns
  3. Membranes can develop on the TARSAL conj in newborns
  4. Intracytoplasmic inclusions are seen in greater percentage of newborns
  5. Newborns more likely to respond to topical meds
37
Q

How do you treat neonatal chalmydial conj?

A

Systemic erythromycin

38
Q

What serotypes are responsible for adult and neonatal inclusion conjunctivitis?

A

D-K

39
Q

Involution and necrosis of follicles that result in limbal depression in Trachoma are called?

A

Herbert’s pits

40
Q

What is the typical course of adult chlamydial conjunctivitis?

A

Onset of conjunctivitis is 1-2 weeks after ocular inoculation. Often patients complain of mild symptoms for weeks to months. Left untreated, often resolves spontaneously in 6-18 months.

41
Q

Post LASIK infections are from?

A

Atypical mycobacteria - M. fortuitum and M chelonei

42
Q

Deep stromal infiltrate may occur in the presence of intact epithelium in which type of keratitis?

A

FUNGAL

43
Q

Which kerititis has dry white stromal infiltrate with feathery edges?

A

FUNGAL

44
Q

How do you treat Aspergillus and yeast?

A

Ampho B

45
Q

How do you treat Fusarium?

A

Natamycin 5%

46
Q

Radial perineurtis and focal, nodular, or diffuse sclertis are seen in what type of keratitis?

A

Acanthamoeba

47
Q

Characterisitc trails from motile trophozoites are seen with?

A

Acanthameba

48
Q

A noncontigous or multifocal pattern of granular epitheliopathy are seen with which type of keratitis?

A

Acanthamoeba (HSV has the contiguous, dendritic pattern)

49
Q

What is the initial therapy for acanthoamoba keratitis?

A

PHMB

50
Q

All arms of the HEDS study had which medication?

A

Viroptic drops

51
Q

Disciform keratitis is secondary to what?

A

To an endothelitis- the overlying stroma and epithelium have edema in a circular fashion.

52
Q

How is Thyygeson’s treated?

A

topical cyclosporine bid is preferred over fluorometholone 0.1%

53
Q

What is the treatment regimen for stromal keratitis in HEDS?

A

Pred q2 and trifluride qid (no benefit to oral acyclovir)

54
Q

Lowenstin-Jensen agar is best for what?

A

Mycobacteria

55
Q

Thayer-Martin agar is best for what?

A

Neissera

56
Q

Sabouraud’s agar is best for what?

A

fungus

57
Q

Mooren’s ulcer is “classically” a/w which dz?

A

Helmenthic infection, parasites worms

58
Q

In gonocococus conjunctivitis, if a PCN allergy exists, how do you treat?

A

IM Spectromycin or 5-7 days of oral Avelox

59
Q

What is a common clinical presentation of primary HSV?

A

Enlarged pre-auricular nodes

60
Q

What is the most common presentation of Reactive (Reiter’s) Arthritis?

A

PAPILLARY conjunctivitis

61
Q

EKC gets what type of membranes?

A

TRUE and pseudomembranes

62
Q

What are specific characteristics of inclusion conjunctivitis?

A
  1. Affect LOWER paplebral conj
  2. Follicules are slightly larger than seen in EKC
  3. Subepithlial infiltrates are less and more peripheral than EKC
63
Q

Peduclated HSV is associated with which type?

A

6 , 16

64
Q

Sessile HSV is a/w what types?

A

16,18

65
Q

Neurotrophic ulcers are most commonly found where in the cornea?

A

Inferonasal

66
Q

Reiter’s is a/w with what systemic infection?

A

Chlamydia trachoma

67
Q

What is the leading cause of U/L interstitial keraitis?

A

HSV

68
Q

What is the earliest presentation of acanthomeba kerititis?

A

Punctate Epithelial keritits - then it goes deeper into the stroma

69
Q

Satellite lesions in corneal infiltrates makes you think of what?

A

Fungal keratitis

70
Q

Adult chlamydial keratitis represents how?

A
  1. No membranes
  2. Follicular conj in inferior conj/fornix
  3. Epithelial corneal infiltrates more promienent in upper cornea
71
Q

Basophilic intracytoplasmic inclusion bodies makes you think of?

A

Chlaymdia trachomatis

72
Q

GMS, Calcoflour white, Acradine orange and non nutrient agar with e coli overlay is the agar for what?

A

acanthomeba

73
Q

Which bug causes infected SB post RD?

A

Proteus

74
Q

Herbert’s pits vs Horner trantus dots?

A
  1. Trachoma

2. Vernal conj

75
Q

Give ddx of follicular conj? (Vessels to the side)

A
  1. LYMPHOMA
  2. Chlamydia
  3. MORAxELLA - chronic
  4. *Paurinauds ocularglandular conj
  5. Molluscum
  6. Drugs
76
Q

Give ddx of papillary conj (central vascular core)?

A
  1. Gonococcus
  2. Allergic
  3. Atopy
  4. Vernall
77
Q

What is 4 ddx of ring infiltrate?

A
  1. Acanthomeba - pain
  2. Pseudomonas
  3. Hsv
  4. anesthetic abuse
78
Q

What causes pigmented corneal ulcers?

A

Fungi (caused by chronic steroid and abx use)

79
Q

Soupy, melting, elevated ulcer?

A

Pseudomonas or gram negative

80
Q

Name 2 filamentous fungi and how do you treat it?

A
  1. Fusarium
  2. Aspergillus

Natamycin 5%

81
Q

What is the name for a central disc of stomal keritits with underlying kp?

A

Disciform keratitis (hsv - non-necrotising stromal keratitis ); Wesley ring

Cornea & Lens and Cataract (11 decks)

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