7: Microbiology

Question 1

A sore throat with stridor or respiratory distress is an indication for what?

Answer 1

Admission

Question 2

Why shouldn’t you examine an inflamed throat?

Answer 2

Could make inflammation (i.e epiglottitis) worse and constrict throat

Question 3

What throat infections cause pain at the back of the mouth?

Answer 3

Acute pharyngitis

Tonsilitis

Question 4

What tends to cause throat infections?

Answer 4

Viruses

Bacteria

Question 5

In which groups do acute throat infections usually occur?

Answer 5

Younger people (< 25 years)

Question 6

Acute throat infections are often complicated by which diseases?

Answer 6

Otitis media

Quinsy

Parapharyngeal abscess

Mastoiditis

Question 7

What is the course of most acute throat infections?

Answer 7

Resolve within 1 week - self-limiting

Question 8

Should acute throat infections be swabbed?

Answer 8

Not routinely

Question 9

What should you suspect if a sore throat and lethargy last more than 2 weeks in a young person?

Answer 9

Glandular fever

(infectious mononucleosis)

Question 10

If someone has a persistent sore throat and a neck mass, what should you suspect?

Answer 10

Pharyngeal cancer

Question 11

Which score is used to predict which acute throat infection patients would actually benefit from antibiotics?

Answer 11

Centor clinical prediction score

Question 12

The vast majority of sore throats (do / do not) require antibiotics.

Why?

Answer 12

do not

viral

Question 13

What are the most common bacterial causes of sore throat?

Answer 13

GAS

Strep. pyogenes

gram +ve chains

Question 14

How would a Strep. pyogenes throat infection be treated?

Answer 14

Penicillin

Question 15

What are rare complications of GAS throat infections causing:

a) fever, arthritis
b) acute renal failure?

Answer 15

a) Rheumatic fever

b) Glomerulonephritis

Question 16

Which organism produces a grey white membrane across the throat which is an exotoxin?

What is the disease called?

Answer 16

Corynebacterium diptheriae

Diptheria

Question 17

What is the classical feature of diptheria?

Answer 17

Pseudomembrane

Question 18

Is diptheria common in the UK?

Answer 18

No

Question 19

What sort of vaccine is given for diptheria?

Answer 19

Inactivated vaccine

Question 20

How is diptheria treated?

Answer 20

Supportive therapy

Diptheria antitoxin

Penicillin

Question 21

What causes oral thrush?

Answer 21

Candida

Question 22

What does oral thrush look like?

Answer 22

White patches on inflamed membranes in throat and mouth

Question 23

How is oral thrush treated?

Answer 23

Nystatin (anti-fungal)

Question 24

What is acute otitis media?

What is the main symptom?

Answer 24

Middle ear infection

Earache

Question 25

What commonly causes otitis media?

Answer 25

**Most are VIRAL** **Bacterial** - *Strep. pneumoniae, H. influenzae, Strep. pyogenes*

Question 26

In which situation only can you obtain a swab of pus in otitis media?

Answer 26

**Perforation of tympanic membrane** which is obviously really bad

Question 27

How is **otitis media** treated?

Answer 27

**Supportive** (viral) **Bacterial:** amoxicillin \> erythromycin

Question 28

What is **acute sinusitis**?

Answer 28

**Mild discomfort over sinuses often seen in URTI**

Question 29

When is **acute sinusitis** treated?

Answer 29

**Secondary bacterial infection** Severe pain

Question 30

How is **secondary bacterial sinusitis** treated?

Answer 30

**Penicillin IV** **Doxycyline** BUT NOT IN CHILDREN

Question 31

What is **otitis externa**?

Answer 31

**Inflammation of external acoustic meatus** (ear canal)

Question 32

What are the symptoms of **otitis externa**?

Answer 32

**Inflammation of ear canal** **Pain** **Itch** **Discharge** **Loss of hearing**

Question 33

What is **malignant otitis externa**?

Answer 33

**Otitis externa** which has turned into an **osteomyelitis** of mastoid and temporal bones

Question 34

Which bacteria usually causes **malignant otitis externa**?

Answer 34

***Pseudomonas aeurginosa***

Question 35

Which cranial nerve can be damaged by **malignant otitis externa**?

Answer 35

**CN VII** Facial nerve palsy

Question 36

What bacteria cause otitis externa?

Answer 36

***Staph. aureus*** ***Pseudomonas***

Question 37

People who ___ a lot can get **otitis externa**.

Answer 37

**swim**

Question 38

What is **infectious mononucleosis**? Who gets it?

Answer 38

**Glandular fever** Young adults

Question 39

What are the symptoms of infectious mononucleosis?

Answer 39

**Fever** **Enlarged lymph nodes** **Sore throat** (throat infection, pharyngitis, tonsilits) **Malaise, lethargy** (lacking energy)

Question 40

What sign on histology is pathognomic of glandular fever?

Answer 40

**Atypical T lymphocytes:** massive blue stipled cytoplasm smaller nucleus than normal (should take up the whole cell)

Question 41

What is the course of glandular fever?

Answer 41

**3**+ **week duration but self-limiting**

Question 42

What are haematological complications of glandular fever?

Answer 42

**Haemolytic anaemia** **Thromocytopenia** production of autoantibodies against RBCs and platelets **Splenic rupture**

Question 43

What can enlarged tonsils cause in severe glandular fever?

Answer 43

**Upper airway obstruction**

Question 44

People who have had glandular fever are at increased risk of which blood cancer?

Answer 44

**Lymphoma**

Question 45

Which **virus** causes glandular fever?

Answer 45

**Epstein Barr virus** (EBV)

Question 46

What happens to patients a) in early childhood b) \> 10 years old who are exposed to EBV?

Answer 46

**a) Rarely mono** **b) Often mono**

Question 47

How is glandular fever treated?

Answer 47

**Bed rest** **Avoid sport** **Paracetamol**

Question 48

Are antivirals given for glandular fever?

Answer 48

**No, not effective**

Question 49

What drug can be given for **complications** of glandular fever?

Answer 49

**Steroids**

Question 50

What investigations confirm **EBV** infection in glandular fever?

Answer 50

**EBV IgM** (early infection) **Specific antibody tests** (e.g monospot) **Blood films** (for increased numbers of lymphocytes) **LFTs** (for jaundice)

Question 51

What should be checked in **pregnant women** with **glandular fever**?

Answer 51

**Causal organism** (because CMV, toxoplasma can cause birth defects)

Question 52

If someone has glandular fever and tests negative for EBV, what important virus should they be tested for?

Answer 52

**HIV**

Question 53

Which type of **HSV** causes mouth ulcers?

Answer 53

**HSV Type 1**

Question 54

What disseminated skin infection are people with HSV1 susceptible to?

Answer 54

**Eczema herpeticum**

Question 55

How does HSV1 infection present on a) primary infection b) reactivation?

Answer 55

**a) Gingivostomatitis** **b) Cold sores**

Question 56

What are people given if they suffer from recurrent mouth ulcers due to HSV1 infection?

Answer 56

**Aciclovir**

Question 57

Genital herpes is caused by both HSV1 and \_\_\_.

Answer 57

**HSV2**

Question 58

What is **herpetic whitlow**? Who tended to get them?

Answer 58

**Cold sores on fingers due to contact with HSV1 mouth ulcers** Dentists

Question 59

How is **HSV** infection confirmed in the lab?

Answer 59

**Viral PCR**

Question 60

What is the name for viral infection causing vesicles and ulcers on the **back of the throat**? What organisms cause it?

Answer 60

**Herpangina** **Coxsackie virus**

Question 61

What viral infection causes lesions on the hands, feet and mouth? What causes it?

Answer 61

**Hand, foot and mouth disease** **Coxsackie virus**

Question 62

What are **apthous ulcers**?

Answer 62

**Mouth ulcers which aren't associated with infection** i.e they're inflammatory

Question 63

What organism causes **syphilis**?

Answer 63

***Treponema pallidum***

Question 64

What is the painless ulcer caused by primary syphilis infection?

Answer 64

**Chancre**