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109 Cards in this Set
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- Back
herpes simplex virus overview
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ds DNA virus; 2 forms HSV-1 and HSV-2; most common cause of corneal opacification
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when does herpes simplex virus primary infection occur
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between 6 months and 5 years old
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percentage of adults who have and how many manifest herpes simplex virus
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80% have antibodies, but only 20-25% manifest disease
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what happens after first infection of herpes infection
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first exposure/infection infects peripheral end organ (ex. eyelid) then the virus travels to ganglia where it may become latent (trigeminal and crevical)
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relapses of herpes simplex virus in immunocompromised people
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relapses from activation of latent virus are common with immunocompromised (steroids, UV exposure, stress, fatigue, irradiation, fever, etc.); relapses occur in 25-50% of patients
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does basal cell carcinoma metastasize
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not usually, however it may be highly invasive to surrounding tissues
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treatment for basal cell carcinoma
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photodocument and excise
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what are the two forms of nevus
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dermal (most common) and junctional (at the dermal/epithelial junction)
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dermal nevi
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a dermal nevi can be flat or raised and rarely progresses to malignancy
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junctional nevi
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are usually flat and may progress to malignant melanoma
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what is the visual differentiation between dermal and junctional nevi
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this is difficult so refer out any suspicious lesions. Borders of both types of nevi are distinct and pigmentation varies from lesion to lesion.
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will an nevi grow
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nevi may grow with advancing age in the absence of malignancy
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etiology of malignant melanoma
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arise from pre-existing nevi or de nevo
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what does malignant melanoma de novo mean
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anew; when you first see it is already malignant
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are de novo malignant melanoma common
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no de novo malignant melanoma are not common but most are deadly.
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s/s of malignant melanoma
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pigmentation variability within the lesion should cause suspicion of malignancy
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who gets kaposi's sarcoma usually
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Aids patients; at least 1/3 of aids patients
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s/s of kaposi's sarcoma
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pink to dark purple nodules or plaques
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treatment for kaposi's sarcoma
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surgery, radiation, or chemotherapy
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what are the rules of thumb for malignancies
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ABCD EE F G H
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A
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Asymmetry
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B
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Border irregularity
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C
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Color irregularity
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D
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Diameter greater than 6mm
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E
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Elevation
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E
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Exterior (note texture, hydration, etc. of tissue compared to surrounding tissue)
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F
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Function (loss of function is suspicious)
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F
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Feeder vessesl
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G
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gut feeling (refer out)
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H
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Height (same as elevation)
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Viral infections that cause conjunctivitis
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simple adenoviral conjunctivitis; Epidemic Keratoconjunctivitis; pharyngoconjunctival Fever; Acute Hemorrhagic Follicular Conjunctivitis; Molluscum contagiosum
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causes of follicular conjunctivitis
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Newcastle disease; Moraxella; Parinaud's Oculoglandular Conjunctivitis; Axenfeld's Conjunctivitis; Measles Mumps Rubella; Chronic folliculosis
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etiology of simple adenoviral conjuctivitis
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any number of serotypes of adenovirus;
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is adenoviral conjunctivitis severe
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it has a spectrum of severity
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adenoviral conjunctivitis is also known as
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pink eye
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s/s of adenoviral conjunctivitis
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follicles in lower lid fornix; serous discharge; conjunctival chemosis; an acute onset of a pink eye(day or two); usually starts unilaterally and then rapidly becomes bilateral; swelling and erythema of eyelids; PAN may be present; often history of URTI
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treatment for adenoviral conjunctivitis
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this condition is self limiting usually so the treatment is usually supportive
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what is the supportive treatment for adenoviral conjunctivitis
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artifical tears, cool compresses, vasoconstrictors. Topical NSAIDS (voltaren) can be prescribed is patient complains of significant discomfort or pain
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is adenoviral conjunctivitis contagious
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yes it is highly contagious so encourage the patient to observe good hygiene to limit disease spread
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whatis good hygiene for a patient with adenoviral conjunctivitis
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wash hads thoroughly and frequently, do not share toweling or bedding with anyone else; use disposable paper towels to dry your face and hands; avoid touching your eyes; do not re-use kleenex or handkerchiefs; If you use eye makeup discard it and buy new cosmetics after infection is cleared up; if you wear contact lenses discontinue wearing them until the infection clears up
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Epidemic KeratoConjunctivitis etiology
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adenoviral 8,19,37 and others
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what is the difference between epidemic keratoconjunctivitis and adenoviral conjunctivitis
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epidemic keratoconjunctivitis is a more serous variation of simiple adenoviral conjunctivitis. It is HIGHLY CONTAGIOUS
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what is the rule of eight
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epidemic keratoconjunctivitis follows the rule of 8; day 1-7 is incubation period; day 8 is when the patient first shows symptoms, day 16 is when the cornea develops infiltrates and patient is supposedly no longer contagious
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why is epidemic keratoconjunctivitis named epidemic
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because the disease tends to occur in large groups of patients at the same time. It may be spread from OD offices.
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How long are the patients infected
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2 weeks from inoculation
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what is a major sign of EKC epidemic keratoconjunctivitis
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SEI's subepithelial infiltrates; the appearance of these is associated with the passing of the infectious period; most SEI's disappear within 3-4 months
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s/s epidemic keratoconjunctivitis
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aute onset; usually one eye then both affected; pt is quite uncomfortable; follicles; petechial hemorrhages; chemosis; edema of caruncle; PAN; may have pseudomembranes (in moederate to severe cases); corneal involvement is usually a diffuse PEK that by day 16 form elevated epithelial lesions that still stain, often causing a FBS. SEI's then form which may reduce VA, sometimes dramatically.
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treatment for epidemic keratoconjunctivitis
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supportive treatment
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what is supportive treatment for epidemic keratoconjunctivitis
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artificial tears, cool compress, vasoconstriction with prophylactic antibiotic drop (because the cornea has disrupted areas); the pt should not return to work or school until the infectious process is over
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what is the prophylactic antibiotic drop for epidemic keratoconjunctivitis
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polytrim QID
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should you use steroids for epidemic keratoconjunctivitis
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It is discouraged because steroids are effective in intially eliminating the SEI's but they tend to rebound as soon as the steroid is discontinued
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why would a dr. use stseroids
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for highly symptomatic patients (pts who have pseudomembranes or whoes vision is reduced from the SEI's
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If you use steroids how should you stop the pt from taking them
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taper. The taper process may take 4 months or even longer
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what is pharyngoconjunctival fever also known as
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swimming poolconjunctivitis
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s/s of pharyngoconjunctival fever
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adenoviral infection presenting with conjunctival findings similar to simple adenoviral infection accompanied by fever, pharyngitis (sore throat)
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what is the inicubation time for pharyngoconjunctival fever
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1-2 days
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is pharyngeal unilateral or bilateral
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pharyngealconjunctivitis fever begins unilaterally and the fellow eye is usually involved in 2-5 days
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is the cornea involved with pharyngealconjunctivitis fever
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corneal involvement when present tends to be mild and transient
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treatment for pharyngealconjunctivitis
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self-limiting, supportive therapy is usually all that is necessary
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causitive organisms of Acute Hemorrhagic Follicular Conjunctivitis
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enterovirus, coxsackievirus
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s/s of acute hemorragic follicular conjunctivitis
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follicular conjunctivitis with prominent subconjunctival hemorrhages (eye looks bloody)
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what is the incubatiion time for acute hemorragic follicular conjunctivitis
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18-24 hours
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is acute hemorragic follicular conjunctivitis unilateral or bilateral
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bilateral onset
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how long do the symptoms of acute hemorragic follicular conjunctivitis persist
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3-5 days
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involvemtent of acute follicular hemorragic conjunctivitis
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no corneal involvement, no systemic symptoms
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is acute hemorragic follicular conjunctivitis contagious
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yes it is highly contagious
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can there be bacterial causes of acute hemorragic follicular conjunctivitis
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yes bacterial causes of acute hemorragic follicular conjunctivitis are possible but in these cases you would see mucopurulent discharge and papillary vs. follicular response
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site of mollluscum contagiosum
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eyelid margin and a secondary follicular conjunctivitis may be present
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etiology of molluscum contagiosum
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an immune reaction to the poxvirus particles which are shed into the eye
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treatment of the molluscum contagiosum
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If the lid lesion is excised the follicular reaction will resolve without further treatment. Treat the pts symptoms supportively during resolution with artificial tears, cool compresses and vasocontrictors as necessary
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who are the most susceptible to molluscum contagiosum
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immunocompromised patients so be sure to look for other manifestations arising from a compromised immune system (HIV and AIDS)
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other causes of follicular conjunctivitis
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newcastle disease; moraxella;parinaud's oculoglandular conjunctivitis; axenfeld's conjunctivitis; measels, mumps rubella, chronic folliculosis
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etiology of newcastle disease
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from paramyxovirus group
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who gets newcastle disease
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poultry workers
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newcastle disease treatment
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supportive
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what is a bacterial cause of follicular conjunctivitis
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moraxella
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who gets moraxella follicular conjunctivitis
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young girls sharing eye makeup
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moraxella follicular conjunctivitis treatment
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topical erythromycin or tetracycline; ZINCFRIN (OTC topical decongestant which contains zinc) may be enough to eradicate
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parinaud's oculoglandular conjunctivitis s/s
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abrupt unilateral onset associated with ipsilateral lymphadenopathy, fever, and conjunctival ulcerations and granulomas with conjunctivitis
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which systemic diseases are parinaud's oculoglandular conjunctivitis associated with
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cat scratch disease, tularemia, TB, syphilis
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parinaud's oculoglandular conjunctivitis treatment
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do a systemic workup treating underlying disease as necessary; apply hot compresses to tender lymph nodes.; use gentamicin, bacitracin ung q2h to cover conjunctiva ; analgesics PRN
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Axenfeld's conjunctivitis s/s
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mild usually asymptomatic upper large palpebral follicles
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treatment for axenfeld's conjunctivitis
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no treatment necessary ; usually chronic
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Measles, mumps, rubella conjunctivitis
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these 3 conditions may be accompanied by a mild follicular conjunctivitis which appears similar to simple adenoviral infection
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treatment for measles, mumps, rubella conjunctivitis
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supportive
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who gets chronic folliculosis
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common in pre-adolescent children
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s/s of chronic folliculosis
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mardked inferior conjunctival follicular response which is asymptomatic
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etiology of chronic folliculosis
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chronic viral infection? Or lymphoid hyperplasia?
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treatment for chronic folliculosis
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no treatment usually resolves as child reaches adolescence
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NaFl and kerato-conjunctivitis
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all of the above viral conjunctivitis conditions may be accompanied by corneal staining as seen with NaFl. If this is the case it is generally referred to as kerato-conjunctivitis.
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potential risk of kerato-conjunctivitis
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bacterial infection
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treatment for kerato-conjunctivitis
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treat the cornea prophylactically in at risk cases with a broad spectrum antibiotic (polytrim) drop QID or an antibiotic ointment if the condition is unilateral or in infants
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betadine solution
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off label way to treat viral eye disease
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