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MB2: Ophthalmology > Microbiology > Flashcards

Microbiology Flashcards

1
Q

chemical properties of the eye to prevent infection

A

lysozyme to destroy bacterial cell walls
lipids and IgA to prevent attachment
interleukins to allow immune regulation

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2
Q

physical features of the blink reflex to prevent infection

A

tears flush dirt and bacteria from eye

mucus layer on top of cornea as anti-adhesive

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3
Q

what function does the langerhans cell have in immune regulation within the eye and where is it present

A

principle APC for external eye
corneo-scleral limbus and in peripheral cornea
absent from central cornea

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4
Q

what is the only part of the eye with lymphatic drainage

A

conjunctiva

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5
Q

describe immune properties of the conjunctiva for fighting infection

A

dendritic cells, langerhans
travel to MALT if required
mast cells, macrophages and langerhans are all present in MALT

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6
Q

describe immune properties of the sclera and cornea for fighting infection

A

no lymphatics or MALT
lack of APC
langerhans is present in the peripheral cornea
downregulated environment

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7
Q

describe the immune properties of the lacrimal gland and drainage system

A

plasma cells secreting IgA and CD8+T cells in small groups
resting lymphoid cells rare
diffuse MALT in the drainage system

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8
Q

describe immune privilege and sites that may have it

A 
placenta and foetus 
eye 
brain 
testes 
can tolerate introduction of antigens without eliciting inflammatory immune response
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9
Q

what properties allow the eye to have immune privilege

A

blood tissue barrier
lack of lymphoid drainage
immune suppressive molecules

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10
Q

what is symptathetic ophthalmia

A

rare and bilateral uveitis due to trauma/surgery to one eye
AA reaction to ocular antigens due to event
immune response at elevated rate with CD4/CD8 T cells
these are activated by antigens and respond to the antigens in both eyes

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11
Q

sympathetic ophthalmia - injured eye is the exciting/sympathising eye and the other is the exciting/sympathising eye

A

injured is exciting

other is sympathising

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12
Q

how can you tell the exciting and sympathising eye apart in sympathetic ophthalmia

A

the history alone

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13
Q

what is ocular cicatrical pemphigoid

A

blistering autoimmune conjunctavitis leading to scarring
can lead to adhesions of conjunctiva and sclera leading to ectropia
manage with high dose steroids

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14
Q

example of type 3 sensitivity to eye

A

autoimmune corneal melt

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15
Q

example of a type 4 hypersensitivity to eye

A

corneal graft rejection

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16
Q

what causes corneal graft rejection

A

vascularisation of host cornea reaching donor tissue and leading to immune response

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17
Q

factors of immune privilege that prevent corneal graft rejection

A

reduced MCH I/II
lack of blood and lymph supply to cornea
central cornea deficient in langerhans cells
immunosuppressive molecules and inhibition of immune mediators

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18
Q

side effects of steroid therapy on the eye?

A

steroid induced glaucoma

cataracts

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19
Q

bacteria in neonatal bacterial conjunctavitis?

A

MUST refer
n gonorrhoeae
staph aureus
chlamydia

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20
Q

bacteria in child/adult bacterial conjunctavitis

A

h influenzae in children
staph aureus
strep pneumoniae

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21
Q

management of bacterial conjunctavitis?

A

swab

topical abx - chloramphenicol drop/ointment 4 daily

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22
Q

side effects/contraindication chloramphenicol?

A

allergy, aplastic anaemia

worsening symptoms may mean allergy

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23
Q

microbes in viral conjunctavitis

A

adenovirus - following URTI
herpes simplex
herpes zoster

24
Q

presentation of viral conjunctivitis

A

red eye, profuse watering

hutchisons sign in shingles

25
Q

presentation of bacterial keratitis

A

whitening of cornea

hypopyon

26
Q

who is more likely to get bacterial keratitis

A

people with other eye pathologies or contact lens wearers

27
Q

management of bacterial keratitis

A 
admit 
hourly eye drops 
daily review 
local anaesthetic, removal, swab 
can lead to cornea rupture
28
Q

how may viral keratitis be managed

A

ganiclovir

do not treat with steroids as may lead to corneal melt

29
Q

presentation of herpes viral keratitis

A

little vesicles round eye and maxilla
painful
dendritic appearance on stain

30
Q

presentation of adenovirus viral keratitis

A

dimples, reduced vision
painful
bilateral
may follow URTI or conjunctivitis

31
Q

in who is fungal keratitis more common and how is it treated

A

ocular surface disease, those who work outside
defined corneal lesions
anti-fungals

32
Q

what is acanthomoeba

A

parasite specific to contact lens wearers
usually due to rinsing contacts under tap water
ring like deposit on cornea
culture contact lenses

33
Q

presentation of preseptal cellulitis and management

A

shiny, red tight around eyelid

fluclox usually settles, may be needed systemic

34
Q

presentation of orbital cellulitis

A

pain, esp on eye movement
proptosis
involvement with paranasal sinuses
pyrexia

35
Q

treatment of orbital cellulitis

A

broad spec systemic abx
drainage of abscesses
CT scanning

36
Q

organisms in orbital cellulitis

A

staph/strep
coliforms
h influenzae
anaerobes

37
Q

diagnosis of orbital cellulitis

A

CT urgent
visual function
redness of entire orbital wall
hx

38
Q

what is endopthalmitis and what causes it

A

devastating infection in inside of eye
sight threatening
post surgical/endogenous

39
Q

presentation of endopthalmitis

A

highly painful and red eye with decreasing vision

40
Q

management of endopthalmitis

A

intra-vitreal abx directly
sample then take abx
topical bx
systemic abx dont do much

41
Q

management of CMV chorioretinitis and what causes it

A

HIV/AIDS

intra-vitreal antiviral drugs

42
Q

what viruses can lead to acute retinal necrosis

A

HSV/HZV

43
Q

presentation of toxoplasma chorioretinitis, where is it caught

A

mild flu like illness

congenital or acquired from contaminated soil, undercooked meat

44
Q

how may toxoplasma/toxocara cause retinal issues

A

may lead to retinal scarring and may be incidental

can reactivate

45
Q

how is toxoplasma causing sight threatening damage managed

A

systemic clidamycin/azithromycin with steroids

46
Q

cause of candida chorioretinitis

A

endocarditis, indwelling catheters, central lines

47
Q

what are swabs suited for in eye infection

A

bacteria
viruses
chamydia

48
Q

what are corneal scrapes suited for in eye infection

A

fungi

49
Q

what are aqueous/vitreous cultures indicated for

A

endopthalmitis

50
Q

what is serology in eye infection indicated for

A

toxoplasma/toxocara

51
Q

what is microscopy and culture indicated for in eye infection

A

acanthomoeba

52
Q

management of chlamydial conjunctavitis

A

topical oxytetracycline

53
Q

how does chloramphenicol work and side effects

A

inhibits bacterial peptidyl transferase

irreversible aplastic anaemia, grey baby syndrome, allergy

54
Q

how do quinolones work, what are they and what do they treat

A

inhibit gyrase
gentamicin, cefuroxime
treat most gram -ves, coliforms and pseudomonas

55
Q

what are the issues from storing eye drop bottles with preservatives

A

can contaminate to culture pseudomonas

56
Q

indication for ganiclovir and how does it work

A

inhibits viral DNA synthesis

dendritic ulcers of cornea

MB2: Ophthalmology (8 decks)

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