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Y. Post Seg 2 > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

About how many people in US have HIV/AIDS and what percentage of people are unaware?

A

1.1 million; 20%

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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

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3
Q

STDs on Ocular-Genital Axis (7)

A
  1. Syphilis
  2. Chlamydia
  3. Gonorrhea
  4. Herpes
  5. HIV
  6. Hepatitis B
  7. Pediculosis
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4
Q

Highest risk category for HIV

A

MSM

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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

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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

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7
Q

CD4 Cell Count: what does it indicate?

A

Status of patient’s immune system

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8
Q

Treatment for HIV

A

Reverse transcriptase inhibitors and protease inhibitors
Aka “Highly Active Antiretroviral Therapy” (HAART)

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9
Q

Prophylactic Treatment for HIV

A

Truvada: combo of Emtriva and Viread

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10
Q

3 Methods of HIV transmission

A
  1. Sexual contact
  2. Transfer of infected blood (e.g. drug use)
  3. Vertical transmission (in utero, during delivery, breast milk)
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11
Q

HIV: What are ways to prevent transmission from mother to child?

A
  1. No breastfeeding
  2. C section
  3. AZT (Zidovudine)
    — untreated with AZT (25% transmission)
    — treated with AZT (8%)
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12
Q

Ocular involvement in ___% of HIV patients

A

75%

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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

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14
Q

Most common malignancies associated with HIV

A

Kaposi Sarcoma
Lymphoma

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15
Q

Most common bacterial infection associated with HIV

A
  1. Mycobacterium Tuberculosis
  2. Strep Pneumoniae
  3. Salmonella
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16
Q

Most common viral infections associated with HIV (5)

A
  1. CMV
  2. JC pap virus
  3. Epstein Barr virus
  4. Herpes Simplex 1 & 2
  5. HHV 8
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17
Q

Most common fungal infections associated with HIV

A
  1. Candida
  2. Cryptococcus
  3. Histoplasmosis
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18
Q

Most common parasitic infections associated with HIV

A

Pneumocystis jiroveci (formally carinii, toxo gondii)

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19
Q

Diagnostic Tests for HIV

A
  1. ELISA — initial screen
  2. Western Blot — confirm
  3. Genotype
  4. Tropism Array
  5. PCR — viral load
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20
Q

How often should you see a pt with a CD4 count of >250 cells/mm3?

A

Every year

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21
Q

How often should you see a pt with a CD4 count of 150 cells/mm3?

A

Every 6 months

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22
Q

How often should you see a pt with a CD4 count of 50-150 cells/mm3?

A

Every 3 months

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23
Q

How often should you see a pt with a CD4 count of < 50 cells/mm3?

A

Every month!

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24
Q

Symptoms associated with HIV Retinopathy

A

Typically asymptomatic

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25
Q

Most common finding of HIV retinopathy

A

Cotton Wool Spots

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26
Q

TRUE/FALSE: Roth Spots do not progress

A

TRUE

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27
Q

TRUE/FALSE: the more severe the HIV, the more severe the HIV retinopathy

A

FALSE; does not correlate

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28
Q

Cytomegalovirus belongs to the ____ family

A

Herpes

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29
Q

Cytomegalovirus: Fulminant Form

A

Necrotic and hemorrhagic fundus
(severe and sudden)

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30
Q

Cytomegalovirus: Indolent Form

A

Granular retinitis w/ less edema and hemorrhage
*(chronic, slow-progressing)

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31
Q

When is RD most likely to occur in a CMV pt?

A

CD4 count < 50 µl

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32
Q

Describe Immune Recovery Uveitis + Sx + Tx

A

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

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33
Q

ARN & PORN represent a spectrum of ____ ____ ____ (3 words) herpetic retinopathies

A

Rapidly progressing necrotizing

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34
Q

How do you differentiate between CMV and ARN?

A

Blood testing

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35
Q

Which spreads more rapidly: ARN or CMV?

A

ARN

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36
Q

T/F: ARN only affect immunocompromized pts

A

FALSE; can alsooccur in healthy pts

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37
Q

What layer(s) of the retina are affected by ARN?

A

All ‘em (full thickness retinal necrosis)

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38
Q

T/F: A clinical finding of ARN is cells in the vitreous

A

TRUE

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39
Q

How often does RD occur with ARN?

A

Most of the time (75%)

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40
Q

Viruses associated with ARN (4)

A
  1. Varicella-zoster
  2. Herpes Simplex
  3. CMV
  4. Toxoplasmosis
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41
Q

T/F: ARN is associated with A-AION

A

FALSE; ARN is associated with/ AION, but the non-arteritic (NA-AION) variety

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42
Q

TX for ARN

A

IV acyclovir or intravitreal ganciclovir

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43
Q

The main difference between/w ARN and PORN?

A

PORN occurs in advanced HIV patients

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44
Q

Virus(es) associated w/ PORN

A

Usually Varicella Zoster

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45
Q

T/F: A clinical finding of PORN is cells in the vitreous

A

FALSE

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46
Q

What retinopathy is associated with a “cracked mud” appearance?

A

PORN

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47
Q

Which layer(s) are affected in PORN?

A

Outer layers

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48
Q

T/F: Kaposi Sarcoma is malignant

A

TRUE

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49
Q
A

Molluscum Contagiosum

50
Q

Molluscum Contagiosum is associated with which virus

A

DNA pox virus

51
Q

Describe the recurrence rate of Molluscum Contagiosum

52
Q

Most common human retinal infection ⭐️

A

Toxoplasmosis

53
Q

What is a retinochoroiditis (eg Toxoplasmosis)?

A

Affects retina first then the choroid

54
Q

What is congenital toxoplasmosis?

A

Transplacental transmission from mother to fetus

55
Q

When (during pregnancy) is acquired infection most damaging to a fetus?

A

First two trimesters

56
Q

What is the most common manifestation of congenital toxoplasmosis?

A

Retinochoroiditis

57
Q

T/F: Macular involvement is highly common in congenital toxoplasmosis

58
Q

When would you see “headlight in a fog” appearance?

A

Active toxoplasmosis retinochoroiditis

59
Q

What is the typical macular lesion for congenital toxoplasmosis?

A

Punched out scar (visible sclera), surrounded by pigment (orrrr just small pigment clumps in retina)

60
Q

T/F: “headlights in a fog” appearance is often characteristic of congenital toxoplasmosis

A

FALSE; reactivation of ocular toxoplasmosis

61
Q

Most common protozoan eye infection

A

Toxoplasmosis

62
Q

Most common protozoan eye infection

A

Toxoplasmosis

63
Q

Pathogen associated with Toxoplasmosis

A

Toxoplasma gondii

64
Q

What is important to remember r/o with a Dx of Toxoplasmosis?

A
  1. HIV
  2. CNS Toxoplasmosis
65
Q

Testing for Toxo

A

ELISA
For IgG or IgM anti-Toxoplasma antibodies

66
Q

Pathogen associated with Toxocariasis

A

Nematode (roundworms) or larvae of Toxocara canis

67
Q

What causes chorioretinal scarring in toxocariasis?

A

Subretinal granuloma

68
Q

Pathogen associated with Ocular Histoplasmosis Syndrome

A

Histoplasma (fungal)

69
Q

Triad for Histoplasmosis

A
  1. Peripapillary atrophy
  2. Maculopathy
  3. Histo spots
70
Q

Histoplasmosis usually occurs (Uni/Bi)-lateral

A

Unilateral
but can occur bilateral

71
Q

Where (in the US) is Histoplasmosis most prominent?

A

Ohio/Mississippi River Valley

72
Q

Majority of TB manifestations are associated with which organ?

A

LUNGS (mostly pulmonary manifestations and transmitted via aerosolized droplets)

73
Q

Ways to test for TB

A

PPD skin test or chest x-ray

74
Q

T/F: only a patient with pre-existing systemic TB can have ocular TB

75
Q

TB most commonly presents as ___ with in the eye

A

Posterior Uveitis

76
Q

Longstanding TB can result in what type of choroiditis?

A

Serpiginous

77
Q

TX for TB

A
  1. Rifampin
  2. Isoniazid
  3. Pyrazinamide
  4. Ethambutol

X 2 months

78
Q

What is an easily examined sign of Candida?

A

Oral thrush

79
Q

TX for Candida or Crytococcal?

A

Amphotericin B + Fluconazole

80
Q

What ocular sign is seen in Cryptococcal ?

A

Meningitis —> ON edema

81
Q

Most common systemic opportunistic infection

A

Pneumocystis carinii

82
Q

TX for Pneumocystitis carinii

A

Trimethoprim and sulfamethoxizole

83
Q

“Salt and pepper” appearance

84
Q

Most common ocular finding in Syphillis?

85
Q

T/F: syphilis is associated with an itchy rash

A

FALSE; non-itchy rash

86
Q

Pathogen associated with Syphillis

A

Treponema palladium

87
Q

T/F: Syphillis is highly treatable

88
Q

Which is a common feature in Syphillis: episcleritis or scleritis?

89
Q

T/F: Syphillis can be transmitted by kissing

90
Q

Stages of Ssytemic Syphillis

A

Primary — Chancre lesion
Secondary — Sore throat, non-itchy rash, fever
Latent Stage
Tertiary — Benign/severe stages, CV and CNS problems

91
Q

Tests for active Syphillis infection

92
Q

Tests for current or previous Syphillis infection

A

FTA-ABS, MHA-TP

93
Q

TX for Syphillis

A

IV or IM penicillin G
Or Oral Tetracycline/Doxycycline or Azithromycin

94
Q

Argyll-Robertson Pupil

A
  1. Miosis in darkness (2.5 mm)
  2. No direct response
  3. Brisk near response
  4. Preserved vision
  5. Dilates poorly
95
Q

Causes of Argyll-Robertson (4)

A
  1. MS
  2. Syphillis
  3. Lyme
  4. Sarcoidosis
96
Q

Main pathogen associated with Neuroretinitis

A

Bartonella (Cat scratch)

97
Q

T/F: Vitreous cells will be present in Neuroretinitis

98
Q

T/F: APD is likely to be present in Neuroretinitis

99
Q

Retinal findings w/ Neuroretinitis

A
  1. Serous RD
  2. Mac star of hard exudates
  3. ON swelling
  4. Multi focal retinitis
100
Q

Causes of Neuroretinitis (5)

A
  1. Cat Scratch Disease
  2. Lyme
  3. Syphilis
  4. TB
  5. Toxoplasmosis
101
Q

VF defect in Neuroretinitis

A

Central or cecocentral scotoma

102
Q

Endophthalmitis occurs after (3)

A
  1. Penetrating trauma
  2. Recent intraocular surgery
  3. Intravitreal injection

Anything in the eye

103
Q

Why is endophthalmitis the “most feared post op complication”?

A

Poor visual prognosis

104
Q

Most cases of POE are caused by what pathogen?

A

Coagulase-negative Staphylococcus
(Staphylococcus Epidermidis)

105
Q

Endophthalmitis

A

inflammation secondary to intraocular infection

106
Q

Toxic Anterior Segment Syndrome (TASS)

A

Masquerade syndrome
Acute, sterile AC inflammatory reaction 12-48 hrs post-op

Highly responsive to steroids

107
Q

What operation has highest risk of POE?

A

Secondary IOL placement

108
Q

Endogenous Endophthalmitis

A

Spread via blood
Usually associated with/ DM, liver disease, etc.. (systemic)

109
Q

What conditions increase risk factors for POE?

A
  1. Clear corneal incisions
  2. Temporal placement of incisions
  3. Use of topical anesthetic
  4. Poor wound cleaning
110
Q

Hallmark of endophthalmitis

A

Vitreous inflammatory cells

111
Q

T/F: POE is associated with pain

112
Q

Most POE pathogens: gram (+) or (-)

113
Q

Which is higher risk for POE: ICCE or ECCE?

A

ICCE
Due to vitreous communication

114
Q

An incision where decreased risk of POE?

A

Limbal, scleral (as opposed to clear cornea)

115
Q

Acute POE usually shows up ____ days post op

116
Q

Chronic POE usually shows up ____ weeks post op

117
Q

T/F: Hypopyon is indicative of POE

118
Q

T/F: IV antibiotics are best for tx of POE

A

FALSE; EVS said it didnt help

119
Q

Initial TX of choice for POE

A

Intravitreal AB

120
Q

The most significant independent risk factor for poor visual outcome in POE

A

VA of LP or worse at initial presentation

Y. Post Seg 2 (13 decks)

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