Kentucky Special
What bacteria causes syphilis? Bonus 100: what shape is this bacteria?
Treponema Pallidum; spriochete
What bacteria causes Lyme disease?
Bonus 100: what tick carries the disease?
Borrelia burgdorferi
Bonus: Ixodes scapularis
What kind of inflammation is found in ocular TB? granulomatous or nongranulomatous?
Bonus 100: What do they call the deposits on the endothelium?
granulomatous
Bonus: mutton fat KP
List at lease one host for leptospirosis
livestock, horses, dogs, rodents
what is the host animal for bartonella and what age demographic of patients are most likely to acquire this disease?
Cats; kids under 10
How do you treat primary/secondary/early latent syphilis? How about neurosyphilis?
Bonus +200: What is the name of the hypersensitivity reaction reaction to treponemal antigens after initiating treatment?
Intramuscular penicillin
IV penicillin
Bonus: Jarisch-Herxheimer
Most common ocular manifestation of stage 1 lyme disease?
follicular conjunctivitis
How can people have false positive TB skin tests?
patients infected with aty pi cal mycobacteria, immunized with BCG vaccine, and treated with intraluminal BCG injections for bladder carcinom
What do you see on staining of nocardia species?
gram-positive rod with partially acid- fast beaded branching filaments
Give name and describe most common posterior findings of bartonella
Leber stellate neuroretinitis:unilateral optic disc swelling and macular star formation
What is the most common sign of late, untreated congenital syphilis? Bonus 200: what is the name and the components of the triad involved with congenital syphilis?
Interstitial keratitis
Bonus: Hutchinson triad- interstitisal keratitis, CN8 deafness, Hutchinson teeth
Preferred IV treatment for lyme disease
Ceftriaxone; Alternatives are cefotaxime and penicillin G
List the 4 drugs in RIPE
livestock, horses, dogs, and rodents, which excrete the organism in their urine
2 months with all 4, followed by 4-7 months with 2 drugs
Treatment of ocular nocardia
trimethoprim/sulfamethoxazole
Give the name and describe the type of conjunctivitis associated with bartonella
Parinaud oculoglandular conjunctivitis: granulomatous conjunctivitis with regional lymphadenopathy
List the findings in primary, secondary and tertiary syphilis
Primary: painless chancre
Secondary: lymphadenopathy, maculopapular rash on palms/soles, uveitis in 10%, latent period 1-10 yrs
Tertiary: gumma (can be on iris and choroid), cardiovascular syphilis, neurosyphilis (ocular involvement implies neurosyphilis)
Gold standard for diagnosis of lyme disease
ELISA testing for IgM and IgG, followed by Western immunoblot testing
DAILY DOUBLE!!!
Where did Dr. Clevenger complete her residency and fellowship?
List two non-ocular findings in whipple disease
migratory arthritis, diarrhea, steatorrhea, and malabsorption, pitting edema, weight loss, cardiomyopathy, seizuress, dementia, coma
What medication is most commonly used to treat bartonella?
doxycycline; rifampin and azithromycin can also be used
List three posterior segment findings in acquired syphilis
vitritis, chorioretinitis, focamultifocal retinitis, necrotizing retinochoroiditis, retinal vasculitis, exudative retinal detachment, isolated papillitis, and neuroretinitis
Most common: small, grayish yellow, and located in the postequatorial fundus
List 5 ocular findings of lyme disease
anterior/intermediate/posterior/panuveitis; papillitis; neuroretinitis; choroiditis; retinal vasculitis; exudative RD; peripheral multifocal choroiditis; cranial nerve palsy, optic neuritis; horner syndrome; keratitis
What is the FA finding of disseminated choroiditis from tuberculosis?
active choroidal lesions display early hypohyperfluorescence with late leakage, and cicatricial lesions show early blocked fluorescence with late staining
Gold standard diagnosis of whipple disease
duodenal biopsy that demonstrates a PAS positive bacillus in macrophages within intestinal villi
List 5 differentials for neuroretinitis
Bartonellosis, Syphilis, Lyme, Tuberculosis, Diffuse unilateral subacute neuroretinitis (DUSN), Toxoplasmosis, Toxocariasis, Leptospirosis, Salmonella, Chickenpox (varicella), Mumps, Herpes simplex, Ehrlichiosis, Rocky Mountain spotted fever, Sarcoidosis Acute systemic hypertension, Diabetes, IIH, AION, Leukemic infiltration of the optic nerve