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Ophthalmology SB > Microbiology + Immunology > Flashcards

Microbiology + Immunology Flashcards

(66 cards)

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1
Q

what infections can happen in the eye

A

Conjunctivitis
Cornea= keratitis
Entire globe= endophthalmitis
Cellulitis (skin around the eyes)

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2
Q

bacteria that causes neonates bacterial conjunctivitis

A

Staph aureus
Neisseria gonorrhoeae
Chlamydia trachomatis

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3
Q

what must happen in cases of neonate bacterial conjunctivitis

A

all cases must be referred to ophthalmology

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4
Q

bacteria that causes other ages bacterial conjunctivitis

A

Staph aureus
Strep pneumoniae
Haemophilus influenzae (especially in children)

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5
Q

Tx for bacterial conjunctivitis

A

Swab

Topical Chloramephenical

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6
Q

when should Chloramephenical not be used

A

history of aplastic anaemia or allergy

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7
Q

what are signs that the patient is allergic to Chloramephenical

A

worsening symptoms

skin becomes red and itchy

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8
Q

what are causes of viral conjunctivitis

A

Adenovirus
Herpes simplex
Herpes zoster

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9
Q

what is suggestive of chlamydial conjunctivitis

A

Often chronic history
Unresponsive to treatments
Suspect in bilateral conjunctivitis in young adults
May or may not have symptoms of urethritis, vaginitis

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10
Q

what is seen in chlamydial conjunctivitis

A 
follicles under upper eye lid 
intense erythema
subtarsal scarring (caused by follicles bursting)
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11
Q

what is seen in bacterial keratitis

A

hypopyon - leukocytic exudate, seen in the anterior chamber

appears as white mark in red eye

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12
Q

Mx of bacterial keratitis

A

Scrap hypopyon
Admission + Hourly drops
Associated w/ contact lens wearers

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13
Q

what viruses can cause keratitis

A

Herpes

Adenovirus

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14
Q

what is an indication of a herpetic keratitis

A

dendritic ulcer

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15
Q

Sx of herpetic keratitis

A

Very painful
Can be recurrent
recurrences eventually result in reduced corneal sensation

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16
Q

what is NOT given in the treatment of herpetic keratitis and why

A

Steroids

Can cause Corneal melt

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17
Q

what is seen in adenoviral keratitis

A

subepithelial infiltrates

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18
Q

features of adenoviral keratitis

A

Bilateral
Usually follows an URTI
Contagious
May affect vision

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19
Q

Mx of adenoviral keratitis

A

Can give topical AB to prevent secondary infection

Can give steroids to speed up recovery if becomes chronic

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20
Q

what are fungal causes of keratitis

A

Acanthamoeba

Pseudomonas aeruginosa

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21
Q

what can lead to fungal keratitis

A

contact lenses

trauma Hx of trauma from vegetation

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22
Q

features of orbital cellulitis

A 
Painful – especially on eye movements
Proptosis
Often associated with paranasal sinusitis
Pyrexial
Sight threatening
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23
Q

IX for orbital cellulitis

A

CT scan

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24
Q

what causes orbital cellulitis

A

spread via paranasal sinus infection

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25
what organisms are seen in orbital cellulitis
``` Staphylococci Streptococci Coliforms Haemophilus influenzae anaerobes ```
26
Tx of orbital cellulitis
Broad spectrum AB | Surgery
27
what is Endophthalmitis
infection is in the whole eye
28
what causes Endophthalmitis
post-surgical infection trauma endogenous (low grade sepsis/endocarditis)
29
Sx of Endophthalmitis
Painful +++, with decreasing vision Very red eye Sight threatening - lose vision very quickly
30
what organisms cause endophthalmitis
Staph epidermidis most commonly
31
Tx for endophthalmitis
Intravitreal amikacin and vancomycin and topical antibiotics
32
what is choridoretinitis
inflammation of the choroid of the uvea
33
what can cause choridoretinitis
CMV in AIDS Toxoplasma gondii Toxocara canis (worm)
34
what is toxoplasmosis
Protozoan infection - toxoplasmosis gondii Mild flu like illness Get from cats and dogs
35
what happens in immunocompetent patients with toxoplasmosis
it enters latent phase with cysts forming Can reactivate Requires systemic treatment if sight threatening
36
what is toxocara
Parasitic nemotode (roundworm) Affects cats or dogs Unable to replicate in humans Remains an immature form of the worm (larvae)
37
features of toxocara
self limiting as they cannot replicate | However, can form granulomas which can cause irreversible visual loss
38
when is 'Swabs for Culture' used to diagnose an eye infection
bacterial, chlamydial, viral | Corneal scrapes in bacterial keratitis
39
what Ix is done in cases of endophthalmitis
Aqueous/vitreous for culture
40
what is done in cases of acanthamoeba
Microscopy/culture
41
what is done in cases of toxoplasma and toxocara
Serology
42
what are Chloramphenicol side effects
Allergy Irreversible aplastic anaemia Grey baby syndrome
43
what is dacryocystitis
infection of the lacrimal sac, secondary to obstruction of the nasolacrimal duct at the junction of lacrimal sac
44
Tx for viral conditions
Aciclovir - used for dendritic ulcers of the cornea
45
Tx for Bacterial conjunctivitis
chloramphenicol - (treats most bacteria except Pseudomonas aeruginosa) fusidic acid - (treats Staph. aureus) gentamicin- (treats most Gram negative bacteria including Pseudomonas aeruginosa)
46
Tx for chlamydial conjunctivitis
topical oxytetracycline
47
Tx for bacterial keratitis
A 4-quinolone (Ofloxacin) OR Gentamicin and cefuroxime
48
what is part of the immediate, innate immune response
Complement proteins Mast cells Macrophages
49
features of innate immune system
Rapid, general response (mins-hours) Targets groups of pathogens - Responds to only a limited number of microbial structures No memory
50
features of adaptive immune system
Gradual response (>days) Targets specific pathogens - Can responds to a huge array of different microbial structures Memory
51
what chemicals are contained in tears for immune protection
Lysozyme - works against gram –ve, fungi Lactoferrin and transferrin - works against gram +ve Complement Tear lipids - antibacterial to cell membranes Secretory IgA- prevents attachment
52
what cells are contained in tears for immune protection and what are there function
Neutrophils - attracted by chemotaxis - Scavengers-release free radicals, enzymes Macrophages - Phagocytosis of damaged cells - Help to trigger adaptive immune system Conjunctival mast cells - Vasoactive mediators
53
what is immune privilege
parts of the body that able to tolerate the introduction of antigens without eliciting an inflammatory immune response
54
why does the eye need immune privilege
eye is very small | immune response can cause damage
55
what is the only part of the eye with lymphatic drainage
conjunctiva
56
what cells act as APC in the conjunctiva
dendritic cells
57
features of cornea and sclera
Avascularity No lymphphatics/lymphoid tissue Downregulated immune environment Relative lack of antigen presenting cells
58
what is the role of cornea and sclera
tough collagen coat
59
role of vitreous, choroid and retina in immune system
Blood-ocular barrier Relative lack of APCs Downregulated immune environment
60
what are the hypersensitivity classifications
Type I: Immediate hypersensitivity Type II: Direct cell killing Type III: Immune complex mediated Type IV: Delayed type hypersensitivity
61
what happens in type I hypersensitivity reaction
- mast cells Express receptors for Fc region of IgE antibody on their surface - On encounter with allergen, B cells produce antigen-specific IgE antibody - allergen is cleared - Residual IgE antibodies bind to circulating mast cells via Fc receptors. - re-encounter with allergen - Allergen binds to IgE - coated mast cells & disrupts cell membrane - 
Release of vasoactive mediators – histamine, tryptase, also increased cytokines and leukotriene transcription
62
what happens in Type II hypersensitivity
Cells killed either by: Macrophages/natural killer cells Complement (membrane attack complex)
63
what is an example of type II hypersensitivity in the eye
Ocular cicatricial pemphigoid
64
what is an example of type III hypersensitivity in the eye
Autoimmune corneal melting
65
what happens in type IV hypersensitivity
T helper cells activated by intracellular pathogens Clonal expansion When re-exposed, macrophages attracted
66
example of type IV hypersensitivity in the eye
corneal graft rejection

Ophthalmology SB (7 decks)

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