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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
What type of iris atrophy do u get in HSV vs VZV?
Patchy vs SECTORAL
26
What type of corneal hypoesthesia do u get with HSV vs VZV?
Sectoral or diffuse vs MAY BE SEVERE
27
What type of corneal infiltrates are said to be characteristic of zoster stromal keratits?
NUMMULAR
28
What is the dosage of acyclovir for HZO?
800 mg 5 times a day for 7-10 days best if started within 72 hours
29
What can be given early on to decrease duration of postherpetic neuralgia?
Amitriptyline
30
Epstein-Barr virus is the most common cause of what?
Acute dacryoadenitis
31
A chronic follicular conjunctivitis should make u think of what?
Molluscum contagiosum.
32
Acute hemorrhagic conjunctivitis caused by 3 bugs?
1. Enterovirus 2. Coxsackievirus 3. adenovirus
33
Chronic staph blepharoconjunctvitis has what type of chronic reaction?
Papillary reaction
34
Moraxella angular blepharoconjunctivitis affect which area?
skin in the lateral canthal angle
35
What is the most common cause of bacterial conjunctivitis in neonates?
Chlamydia trachomatis
36
What are 5 ways to differentiate newborn vs adult chlamydial conjunctivitis?
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
How do you treat neonatal chalmydial conj?
Systemic erythromycin
38
What serotypes are responsible for adult and neonatal inclusion conjunctivitis?
D-K
39
Involution and necrosis of follicles that result in limbal depression in Trachoma are called?
Herbert's pits
40
What is the typical course of adult chlamydial conjunctivitis?
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
Post LASIK infections are from?
Atypical mycobacteria - M. fortuitum and M chelonei
42
Deep stromal infiltrate may occur in the presence of intact epithelium in which type of keratitis?
FUNGAL
43
Which kerititis has dry white stromal infiltrate with feathery edges?
FUNGAL
44
How do you treat Aspergillus and yeast?
Ampho B
45
How do you treat Fusarium?
Natamycin 5%
46
Radial perineurtis and focal, nodular, or diffuse sclertis are seen in what type of keratitis?
Acanthamoeba
47
Characterisitc trails from motile trophozoites are seen with?
Acanthameba
48
A noncontigous or multifocal pattern of granular epitheliopathy are seen with which type of keratitis?
Acanthamoeba (HSV has the contiguous, dendritic pattern)
49
What is the initial therapy for acanthoamoba keratitis?
PHMB
50
All arms of the HEDS study had which medication?
Viroptic drops
51
Disciform keratitis is secondary to what?
To an endothelitis- the overlying stroma and epithelium have edema in a circular fashion.
52
How is Thyygeson's treated?
topical cyclosporine bid is preferred over fluorometholone 0.1%
53
What is the treatment regimen for stromal keratitis in HEDS?
Pred q2 and trifluride qid (no benefit to oral acyclovir)
54
Lowenstin-Jensen agar is best for what?
Mycobacteria
55
Thayer-Martin agar is best for what?
Neissera
56
Sabouraud's agar is best for what?
fungus
57
Mooren's ulcer is "classically" a/w which dz?
Helmenthic infection, parasites worms
58
In gonocococus conjunctivitis, if a PCN allergy exists, how do you treat?
IM Spectromycin or 5-7 days of oral Avelox
59
What is a common clinical presentation of primary HSV?
Enlarged pre-auricular nodes
60
What is the most common presentation of Reactive (Reiter's) Arthritis?
PAPILLARY conjunctivitis
61
EKC gets what type of membranes?
TRUE and pseudomembranes
62
What are specific characteristics of inclusion conjunctivitis?
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
Peduclated HSV is associated with which type?
6 , 16
64
Sessile HSV is a/w what types?
16,18
65
Neurotrophic ulcers are most commonly found where in the cornea?
Inferonasal
66
Reiter's is a/w with what systemic infection?
Chlamydia trachoma
67
What is the leading cause of U/L interstitial keraitis?
HSV
68
What is the earliest presentation of acanthomeba kerititis?
Punctate Epithelial keritits - then it goes deeper into the stroma
69
Satellite lesions in corneal infiltrates makes you think of what?
Fungal keratitis
70
Adult chlamydial keratitis represents how?
1. No membranes 2. Follicular conj in inferior conj/fornix 3. Epithelial corneal infiltrates more promienent in upper cornea
71
Basophilic intracytoplasmic inclusion bodies makes you think of?
Chlaymdia trachomatis
72
GMS, Calcoflour white, Acradine orange and non nutrient agar with e coli overlay is the agar for what?
acanthomeba
73
Which bug causes infected SB post RD?
Proteus
74
Herbert's pits vs Horner trantus dots?
1. Trachoma | 2. Vernal conj
75
Give ddx of follicular conj? (Vessels to the side)
1. LYMPHOMA 2. Chlamydia 3. MORAxELLA - chronic 4. ***Paurinauds ocularglandular conj** 5. Molluscum 6. Drugs
76
Give ddx of papillary conj (central vascular core)?
1. Gonococcus 2. Allergic 3. Atopy 4. Vernall
77
What is 4 ddx of ring infiltrate?
1. Acanthomeba - pain 2. Pseudomonas 3. Hsv 4. anesthetic abuse
78
What causes pigmented corneal ulcers?
Fungi (caused by chronic steroid and abx use)
79
Soupy, melting, elevated ulcer?
Pseudomonas or gram negative
80
Name 2 filamentous fungi and how do you treat it?
1. Fusarium 2. Aspergillus Natamycin 5%
81
What is the name for a central disc of stomal keritits with underlying kp?
Disciform keratitis (hsv - non-necrotising stromal keratitis ); Wesley ring

Cornea & Lens and Cataract (11 decks)

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