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Part 1 > Conj disease > Flashcards

Conj disease Flashcards

1
Q

What is a conjunctival cyst?

A

= inclusion/retention cyst
- fluid filled sac

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2
Q

potential symptoms of conjunctival cyst?

A

irritation

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3
Q

What are concretions?

A

mucous secretions + epithelial cells + calcium

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4
Q

another name for conj concretions?

A

ocular lithiasis

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5
Q

When do you treat conj concretions?

A

if bothersome or stain, can remove

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6
Q

What is a conj nevus?

A

proliferation of melanocytes

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7
Q

when does a conj nevus develop?

A

puberty/ early adulthood

by 20s

can increase in size during puberty

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8
Q

what are characteristics for a conj nevus?
What is diagnostic for conj nevus?

A

unilateral, usually only one
mobile
30% non-pigmented

INCLUSION CYST inside

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9
Q

what is the most common location for a conj cyst?

A

juxtalimbal > plica/caruncle

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10
Q

what are melanosomes?

A

organelle in melanocytes
- contains melanin

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11
Q

what type of cancer can conj nevus cause?

A

melanoma

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12
Q

What is primary acquired melanosis?

A

unilateral (usually flat) acquired pigment with indistinct margins

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13
Q

What is PAM a precursor to?

A

Malignant melanoma - 30% of patients (biopsy)

NOTE: usually benign

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14
Q

what are signs that PAM is melanoma?

A

nodular
increased vascularity
increased growth

*** does not have to be pigmented

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15
Q

Who gets conj melanomas?

A

50 year old white people
- hx of PAM (75%)
- nevus (30%)

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16
Q

What is the most important prognostic indicator for malignancy in a conj melanoma?

A

thickness

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17
Q

What is the most common site for metastasis for a conj melanoma?

A

liver

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18
Q

What is the most common conjunctival neoplasia in the US?

A

CIN - conjunctival intraepithelial Neoplasia

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19
Q

what are other names for CIN?

A

Bowen’s disease
conjunctival squamous dysplasia

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20
Q

What is CIN?

A

unilateral, pre-malignant condition that can progress to squamous cell carcinoma

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21
Q

what is the risk of CIN progressing to a cancerous lesion?

A

low - because the basement membrane is usually intact.

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22
Q

what are risk factors for developing cancer from CIN?

A

UV-B light
smoking
exposure to petroleum derivatives
fair skin
xanthoderma pigmentosa
HIV
HPV

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23
Q

How do you distinguish benign vs malignant/pre-malignant lesions?

A

toluidine blue 0.05%

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24
Q

What is Conjunctival squamous cell carcinoma? who gets it? located? cause? diagnositc?

A

rare, slow - growing malignant tumor.

white old males

limbus, can involve adjacent cornea
seen at limbus

CIN, UV radiation, HPV

usually has a feeder vessel

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25
Q

what is pyogenic granuloma

A

pedunculate, benign, red, vascular lesion of the conj

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26
Q

what causes pyogenic granuloma

A

trauma
sx
chalazion

CHRONIC IRRITATION

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27
Q

what is Conjunctival ganuloma?

A

inflamed area in the con storm secondary to a foreign body, surgery trauma, infection or systemic condition (sarcoid)

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28
Q

what infection can cause a conj granuloma?

A

Parinaud’s oculoglandular syndrome

29
Q

How do you treat conjunctival granuloma?

A

steroids

30
Q

Types of bacterial conjunctivitis?

A
  1. simple bacterial conjunctivitis
  2. gonococcal conjunctivitis
31
Q

What gets simple bacterial conjunctivitis?

A

kids

32
Q

Common causes of simple bacterial conjunctivitis
- kids
- adults
- worldwide

A

kids: H influenzae (gram -)
adults: S epi and S aureus
worldwide - S. aureus (b/c of high association with blepharitis)

33
Q

Signs and symptoms of simple bacterial conjunctivitis

A
  1. acute onset (starts one eye then moves to the other)***contagious
    - know the hour it began
  • eyelids stuck together in morning
    (discharge - first serous then mucopurulent)
  • papillae
34
Q

what conditions cause papillae?

A

pABillae + friction

  • allergic, bacterial
35
Q

Treatment for simple bacterial conjunctivitis?

A

polytrim
- usually resolve un 10-14 days without treatment

36
Q

How do you differentiate staph from other bacterias ?

A

staph A++
- catalase +
- coagulase +

37
Q

What is chocolate agar used for?

A

N: nestle : N. gonorrhea - gram (-) diplococci

H: Hershey: H. influenzae - gram (-)

38
Q

what bacterial can invade the epithelium?

A

CNHL

C- Corneum bacteria
N- N.gonorrhea
H-H. influenze
L - Listeria

39
Q

who gets gonococcal conjunctivitis?

A

young adults - STD
- have multiple sexual partners

infants (as travel through the birth canal)

40
Q

what is another name for chocolate agar?

A

Thayer-martin afar

41
Q

Signs and symptoms of gonococcal conjunctivitis?

A

” gonorrhea -> diarrhea” - severe purulent discharge (wipe and back)
- sudden onset - minute it began
-hyperacute - (starts one eye, then spreads)
- swollen pre-auricular nodes
- conj chemosis, pseudomembrane , 4+ papillae, tender/swollen lids

in severe cases corneal ulcers

42
Q

What are systemic signs to ask for/ look for if suspect gonococcal conjunctivitis?

A

purulent urethral discharge (seen in men> females)

look for associated chlamydial infection *** always do testing for both If suspect one.

43
Q

How do you treat gonococcal conjunctivitis?

A

gram (-) Antibiotic
- ie. use Ceftriaxone (3rd gen) > cephalexin (first gen)

44
Q

what bacterial infection causes conjunctivitis + pseudomembrane + pre-auricular lymphadenopathy?

A

gonorrhea
** note also usually seen in viral infections

45
Q

What are the most common viral conjunctivitis?

A

Adenoviral

molluscum

HSV/ HZV

46
Q

Who gets adenovirus conjunctivitis?

A

adults > kids (ie. 40 year old with pink eye + follicles)
- who have a hx of illness (upper respiratory trace infections or nasal mucosal infections)
- those who have been around someone with an illness (ie. transmission happens from direct contact)

***respiratory/ocular secretion contact, contaminated towels, bedsheets, pillowcases

47
Q

How long is the adenoviral conjunctivitis contagious for?

A

12-14 days

48
Q

What are the 3 adenoviral syndromes? serotypes? which is the most common? which is the most serious?

A
  1. Acute nonspecific (serotypes 1-11,19) *** most common
  2. EKC = epidemic keratoconjunctivits (serotypes 3-5, 7) *** most serious
  3. pharyngoconjunctival fever (PCF) (serotypes 8,19, 37)
49
Q

what do all adenovirus syndromes present with?

A
  1. follicles
  2. pseudomembrane
  3. diffuse hyperemia
  4. hx of systemic viral infection (can be 3 weeks ago)

*** Note: pre-auricular nodes and pseudomembrane only seen in EKC

50
Q

Acute non-specific conjunctivitis signs and symptoms, who?

A

pink eye + follicles + serous tearing

** usually in adults

51
Q

what conditions cause follicles?

A

CHAT
C- chlamidiya (inclusion conjunctivitis, trachoma)
H - HSV/HSZ
A - adenoviral
T - toxic (molluscum, allergic, eye drops)

52
Q

pharyngoconjunctival fever signs and symptoms, who?

A

kids (swimming pool conjunctivitis)
*** highly contagious, but rare (remember kids usually get bacterial conjunctivitis)

triad: follicles + mild fever + pharyngitis (mild sore throat)

3F’s (fever, follicles, phayangitis)

53
Q

EKC phases

A
  • symptoms start 8 days after exposure

Phase 1 - week 1&2 : SPK/ superficial keratitis

phase 2 - week 3- SEI (sub- epithelial infiltrates) *** means condition is no longer active ie. contagious

RULE OF 8 - serotype 8 causes, symptoms start after 8 days, SEI after 8 days of onset of symptoms

54
Q

EKC signs/ symptoms

A
  1. follicles
  2. palpable pre-auricular nodes ** pathognomonic
  3. pseudomembrane (contains active virus - need to peel)
  4. severe pain -> due to superficial keratitis (diffuse)
  5. starts in 1 eye and then spreads to the other eye.
  6. rapid onset red eye + bearings
55
Q

Molluscum - who gets it?

A

Rare - seen in communities with poor hygiene

  • usually kids, young adults
56
Q

pathophys of molluscum? how is it spread?

A

skin condition (located on lid/lid margin) caused by DNA pox virus

spread by direct contact

57
Q

what do you worry about with molluscum?

A

if you see multiple nodules -> consider HIV or other autoimmune conditions
- do western bloct/ Elisa
- CD 4 count <200

if see 1 - not a big deal

58
Q

signs and symptoms of molluscum?

A

usually asymptomatic, but may have mild mucous discharge

rupture -> chronic follicle conjuncitivits + superficial panes

59
Q

HSV presentation

A

usually see unilateral follicular conjunctivitis + serous discharge

60
Q

What are the 4 types of allergic disorders affecting the conjunctiva?

A
  1. allergic conjunctivitis
  2. VKC
  3. AKC
  4. GPC
61
Q

What are the 2 categories of allergic conjunctivitis? what are the triggers? what hypersensitivity rxn?

A
  1. seasonal (airborne pathogens -pollen - trigger)
  2. perennial ( household allergens - dust, dander )

*** both are type 1 hypersensitivity rxn ** IgE = Allergy

62
Q

signs/symptoms of allergic conjunctivitis?

A

itching, conj chemosis, papillae,
watery discharge

63
Q

Who gets VKC? how long does it last?

A

males < 10 yo in hot dry climates, in patients with atopic systemic conditions (eczema, asthma, rhinitis, fam hx of atopy)

2-10 years before resolving by puberty

64
Q

signs and symptoms of VKC

A

symptomatic usually during warm months, but can occur all year round

itching, photophobia, thick mucous discharge, bilateral cobblestone papillae Superior lid margin

trantas dots at the limbus

worried about forming shield ulcer
(starts with PEK-> erosion -> plaque + localized ulcer = shield ulcer)

65
Q

Who gets AKC?

A

Teens to 40s w/ hx of atopic conditions

ie. atopic dermatitis

66
Q

what is atopic dermatitis? hallmark signs? complications?

A

chronic eczema that starts at birth
- rash and itching - hallmark signs
- lead to cataract formation by age 30 and keratoconus, AKC (skin infection that gets into eyes)

67
Q

what type of hypersensivity rxn is AKC?

A

type 1 and type 4

68
Q
A

Part 1 (4 decks)

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