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Ophthalmology > Microbiology > Flashcards

Microbiology Flashcards

1
Q

when is bacterial conjunctivitis a worry?

A

in neonates

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2
Q

causative organisms of neonate bacterial conjunctivitis

A

staph aureus
neisseria gonorrhoea
chlamydia trachomatis

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3
Q

causative organisms in other age groups outside neonates of bacterial conjunctivitis

A

staph aureus
strep pneumonia
H. influenza (especially children)

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4
Q

presentation of bacterial conjunctivitis

A

morning crust (yellow discharge)
difficulty opening eye
rapid onset
gritty eye (BUZZWORD)

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5
Q

diagnosis of bacterial conjunctivitis

A

swab

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6
Q

management of bacterial conjunctivitis

A

topical antibiotic e.g. chloramphenicol qds
fusidic acid for staph aureus
gentamicin for gram -ve

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7
Q

what does chloramphenicol treat?

A

most bacteria except pseudomonas aeruginosa

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8
Q

two ways of delivering chloramphenicol?

A

drops (need to be stored in the fridge)

ointment (difficult to see through)

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9
Q

when should you avoid chloramphenicol?

A

history of aplastic anaemia

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10
Q

action of chloramphenicol

A

inhibits peptidyl transferase enzymes (stops bacterial protein being made)

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11
Q

what is chloramphenicol bactericidal to?

A

strep

haemophilus

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12
Q

what is chloramphenicol bacteriostatic to?

A

staph

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13
Q

side effects of chloramphenicol

A

allergy
irreversible aplastic anaemia
grey baby syndrome (neonatal liver cannot cope)

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14
Q

what gram negatives is gentamicin used against in bacterial conjunctivitis?

A

coliforms

pseudomonas

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15
Q

what can neisseria gonorrhoeae additionally present with in bacterial conjunctivitis?

A

lid swelling
globe tenderness
conjunctival chemosis

this can lead to corneal ulceration and perforation (URGENT referral)

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16
Q

causes of viral conjunctivitis

A

adenovirus (pink eye)
herpes simplex
herpes zoster

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17
Q

presentation of viral conjunctivitis

A 
sudden onset and rapidly progressive
can be bilateral due to contagious and spreading to other eye
watery
pain
pre-auricular nodes
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18
Q

what hygiene should be exercised in viral conjunctivitis?

A

strict hand hygiene
no sharing of towels

this is because it is highly contagious

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19
Q

diagnosis of viral conjunctivitis

A

swab

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20
Q

presentation of adenoviral conjunctivitis

A

red and inflamed eye
watery discharge (bacterial is stickier)
often history of URTI

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21
Q

management of adenoviral conjunctivitis

A

antibiotics only used if risk of secondary infection

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22
Q

presentation of herpes simplex conjunctivitis

A

vesicles on conjunctiva and eyelids

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23
Q

describe herpes zoster conjunctivitis

A

reactivation of V1, V2 and/or V3 (herpes zoster ophthalmicus)

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24
Q

management of herpes zoster conjunctivitis

A

acyclovir to minimise risk of post-hepatic neuralgia

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25
Q

management of viral conjunctivitis

A

topical lubricant e.g. hypromellose (aim for preservative free as if the patient is using this 4-6 times a day then there is risk of irritation)
acyclovir for herpes zoster

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26
Q

presentation of chlamydial conjunctivitis

A 
chronic history
low grade red eye
follicles on inner eyelid (grains of rice)
discharge
pre-auricular lymphadenopathy
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27
Q

when to consider chlamydial conjunctivis

A

unresponsive to treatment

bilateral in young adults (contact tracing required)

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28
Q

management of chlamydial conjunctivitis

A

topical oxytetracycline as risk of subtarsal scarring (+ oral azithromycin if genital infection)

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29
Q

what to think in follicular conjunctivitis?

A

chlamydial conjunctivitis

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30
Q

presentation of allergic conjunctivitis

A

itch
watery
bilateral

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31
Q

management of allergic conjunctivitis

A

allergen avoidance
topical antihistamines
once stabilised use mast cell stabilisers e.g. sodium cromoglycate

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32
Q

define episcleritis

A

inflammation of the thin vascular sheet between the conjunctiva and sclera

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33
Q

who is episcleritis common in?

A

patients with collagen-vascular disease such as RA, sarcoidosis and IBD

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34
Q

management of episcleritis

A

NSAIDs

topical lubricants

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35
Q

define acute anterior uveitis (iridocyclitis)

A

inflammation of the iris and ciliary body

36
Q

presentation of acute anterior uveitis (iridocyclitis)

A

sudden onset of pain (can radiate to brow and exacerbated by focusing on a near object)
red eye and hyperaemia at limbus
photophobia (BUZZWORD)
smaller pupil, ptosis due to local tissue swelling
blurred vision
if significant inflammation then a hypopyon can form

37
Q

what to do if it is a first presentation of acute anterior uveitis (iridocyclitis)

A

refer

38
Q

what is acute anterior uveitis (iridocyclitis) linked to?

A

HLA-B27 (if multiple presentations do AI screen)

39
Q

management of acute anterior uveitis (iridocyclitis)

A

mydriatics (cycloplegia e.g. cyclopentolate hydrochloride)= dilates pupil reducing risk of it getting stuck to the eye
steroids e.g. dexamethasone to reduce inflammation

40
Q

define blepharitis

A

inflammation of eyelids, usually a chronic condition affecting both eyes

41
Q

presentation of blepharitis

A

redness around eyelid margins

patients complain of gritty eyes

42
Q

why should bacterial keratitis be referred?

A

it eats the eyeball and can cause perforation

43
Q

define keratitis

A

infection of the cornea

44
Q

presentation of bacterial keratitis

A

loss of clear appearance

hypopyon

45
Q

what is bacterial keratitis associated with?

A

other corneal pathology

wearing contacts lenses (swimming or sleeping)

46
Q

diagnosis of bacterial keratitis

A

corneal scrap for microscopy

47
Q

management of bacterial keratitis

A

hourly drops (including at night so may need to admit)

48
Q

examples of drops used in bacterial keratitis

A
  • 4-quinolone (oflaxacin)= gram -ve including coliforms, pseudomonas and H. influenza
  • gentamicin and cefuroxime= gram +ve and -ve
49
Q

what can UVB exposure cause?

A

keratitis

50
Q

causes of viral keratitis

A

herpes (HSV)

adenovirus

51
Q

what does hepatic keratitis present with?

A

dendritic ulcer (branching)

52
Q

diagnosis of hepatic keratitis?

A

fluorescence to show missing epithelium where virus is

53
Q

presentation of hepatic keratitis

A

pain

recurrence can lead to reduced corneal sensation (vision)

54
Q

management of hepatic keratitis

A

must use steroids with acyclovir/ ganciclovir as can cause corneal melt and perforation
can use topical anaesthetic for examination but do not repeat as toxic

55
Q

presentation of adenoviral keratitis

A

bilateral
follows URTI
contagious
can affect vision

56
Q

management of adenoviral keratitis

A

topical antibiotics only to prevent secondary infection

steroids to tame immune reaction

57
Q

fungal keratitis causes

A

acanthamoeba (pseudomonas aeruginosa)

moraxella

58
Q

what is fungal keratitis associated with?

A

wearing contacts
younger patients
chronic history
those who work outside

59
Q

presentation of fungal keratitis

A

extreme pain

more defined hypopyon

60
Q

diagnosis of fungal keratitis

A

culture of contact lens and microscopy

61
Q

management of fungal keratitis

A

urgent referral

topical anti-fungal e.g. natamycin

62
Q

define orbital cellulitis

A

pus in the orbit

63
Q

what can orbital cellulitis lead to?

A

can lead to compartment syndrome and proptosis

64
Q

presentation of orbital cellulitis

A

pain, especially on eye movements as muscle are close to inflammation
paranasal sinusitis (ethmoid)
pyrexia
history of URTI
well demarcated erythema around the orbit

65
Q

diagnosis of orbital cellulitis

A

CT to show orbital abscesses

66
Q

secondary causes of orbital cellulitis

A 
infected chalazion (cyst on eyelid due to blocked duct)
dacryocystitis
67
Q

two types of orbital cellulitis

A

pre-septal (compresses optic nerve)

orbital (does not compress optic nerve)

68
Q

causative organisms in orbital cellulitis

A

large spectrum of microorganisms so manage with broad spectrum antibiotics

69
Q

management of orbital cellulitis

A

broad spectrum antibiotics

abscess may require drainage

70
Q

define endophthalmitis

A

infection of the inside of the eye

71
Q

cause of endophthalmitis

A

almost always post surgery (return 2-3 days after with pain)

endogenous (septicaemia)

72
Q

presentation of endophthalmitis

A

pain
decreasing vision (lost in 48 hours and irreversible)
very red eye

73
Q

causative organisms of endophthalmitis

A

commensals e.g. staph epidermidis

74
Q

diagnosis of endophthalmitis

A

aqueous/vitreous for culture

75
Q

management of endophthalmitis

A

antibiotic injections into vitreous under LA (amikain/ceftazidime/ vancomycin)
topical antibiotics
systemic antibiotics

76
Q

define chorioretinitis

A

inflammation of the choroid and retina

77
Q

cause of chorioretinitis in AIDS

A

CMV

78
Q

cause of chorioretinitis in immunosuppressed

A

HSV (or when run down/tired)

79
Q

two parasitic causes of chorioretinitis

A 
toxoplasmosis
toxocara canis (worms)
80
Q

where does toxoplasmosis come from?

A

cats
raw meat
mother to foetus (IgG)

81
Q

presentation of toxoplasmosis

A

flu-like illness
cyst forming
macula scarred

reactivation in later life can affect vision

82
Q

what do you get toxocara canis from?

A

cats

dogs

83
Q

describe toxocara canis

A

unable to replicate so remains as larvae

reactivate and produce granulomas

84
Q

diagnosis of parasitic choriretinitis

A

serology

85
Q

define dacrocystitis

A

stagnation of the drainage of the lacrimal duct

86
Q

what does dacrocystitis lead to?

A

occlusion of the sac causing swelling due to excess fluid and a secondary infection

87
Q

management of dacrocystitis

A

penicillin

Ophthalmology (28 decks)

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