Bacterial infections

Question 1

Actinomycosis

Answer 1

Chronic, suppurative granulomatous disease
Filamentous anaerobic gram positive bacilli
human commensal flora
M:F

Question 2

predisposing factors for actinomycosis

Answer 2

poor oral hygiene
trauma
poorly controlled diabetes mellitus
immunosuppressed
alcoholism
malnutrition

Question 3

clinical presentation actinomycosis

Answer 3

cervicofacial
submandibular region
slow growing painless, indurated swelling
abscesses with sinus discharge to oral mucosa/skin
discharge contains visible granules
pain and trismus in advanced stages

Question 4

diagnosis actinomycosis

Answer 4

imaging
aspiration and culture
histopathology

Question 5

management of actinomycosis

Answer 5

removal of dental focus
antimicrobials
surgical debridement

Question 6

Cat scratch disease

Answer 6

regional lymphadenopathy and fever resulting from the scratch of an infected cat
bartonella henselae - gram negative bacilli
M>F
33yrs

Question 7

clinical presentation CSD

Answer 7

benign self limiting disease
papule/pastule at site inoculation
regional lymphadenopathy
surrounding tissue changes
suppuration

Question 8

Diagnosis CSD

Answer 8

History of cat bite
exclusion of other causes
PCR positivity for bartonella dna
ELISA positive for B henselae
tissue biopsy

Question 9

management of CSD

Answer 9

avoidance
antimicrobial therapy

Question 10

Impetigo

Answer 10

contagious superficial bacterial skin infection
3-5 yrs
staph aureus. strep pyogenes
trauma creates a portal of entry
face and perioral region

Question 11

Non-bullous impetigo

Answer 11

common
erythematous macule, papule
rupture
honey coloured yellow crust on skin
lesions expand and coalesce
pruritis, pain, lymphadenopathy

Question 12

Bullous impetigo

Answer 12

new born and infants
vesicles/bullae
s.aureus
blister formation
rupture and shed to produce an erythematous moist base that oozes serum
systemic symptoms

Question 13

diagnosis of impetigo

Answer 13

gram stain and culture of pus
histopathology

Question 14

management of impetigo

Answer 14

spontaneous resolution
antimicrobial agents

Question 15

Lyme disease

Answer 15

Bacterial infection
B. Burgdorferi
Endemic

Question 16

Lyme disease symptoms

Answer 16

3 stages
1. spreading annular rash 14-30 days following bite
2. cardiac/neurological/musculoskeletal abnormalities
3. chronic skin, CNS, joint abnormalities

Question 17

erythema migrans

Answer 17

rash pathognomonic of lyme disease
red rash, increases in size
central clearing
days to months

Question 18

erythema migrans diagnosis and management

Answer 18

clinica diagnosis
antibody test
jarisch-herxheimer reaction

Question 19

Syphilis

Answer 19

STI
T. Pallidum
Transmission - sexual contact/vertical/indirect routes e.g., blood transfusion

Question 20

Primary syphilis

Answer 20

Chancre
Site of inoculation
Solitary lesion
Lymphadenopathy
Healing within 8 weeks

Question 21

Secondary syphilis

Answer 21

2-12 weeks after first contact
2 months after healing of primary syphilis
due to haematogenous dissemination
constitutional or mucocutaneous manifestations

Question 22

constitutional symptoms of 2 syphilis

Answer 22

fever
headache
weight loss
malaise
aches and pains

Question 23

mucocutaneous symptoms of 2 syphilis

Answer 23

skin rash
symmetrical pink/red macules, papules, pustules
heals within weeks
33% have mucous patches
50% generalised lymphadenopathy
condyloma latum
ocular involvement
joint involvement
glomerulonephritis
neurological involvement

Question 24

latent syphilis

Answer 24

positive serological testing
no sign of disease

Question 25

tertiary syphilis

Answer 25

rare
2-3 years after primary infection
gummata
- multiple sites
- induratd, nodular or ulcerated lesion
- may produce tissue destruction

Question 26

tertiary syphilis clinical presentation

Answer 26

hard palate
small pale raised area, ulcerated area of necrosis
bone exposure
perforated into nasal canal
painless

osteomyelitis
glossitis
leukoplakia

Question 27

tertiary syphilis complications

Answer 27

cardiovascular syphilis
- aneurysms of the ascending aorta
- left ventricular hypertrophy
- congestive heart failure

neurosyphilis
- tabes dorsalis
- psychosis
- dementia

Question 28

Argyll Robertson Pupils

Answer 28

Neurosyphilis
Bilateral, asymmetrical small irregular pupils
constricts with accommodation

Question 29

Congenital syphilis

Answer 29

T. Pallidum can cross placental barrier
mother in primary or secondary stage of infection
second or third trimester

Question 30

congenital syphilis manifestations

Answer 30

Early
Periostitis
Diffuse maculopapular rash
Rhinitis

Late
dental anomalies
sensorineural hearing loss
interstitial keratitis of the cornea

Question 31

congenital syphilis oral presentations

Answer 31

mulberry molars
hutchinson’s incisors
open bite

Question 32

congenital syphilis management

Answer 32

benzyl penicillin
erythromycin
tetracycline

Question 33

Tuberculosis

Answer 33

Chronic communicable infectious disease
mycobacterium tuberculosis
transmitted via droplet spread
lung
extrapulmonary infections

Question 34

Tuberculosis predisposing factors

Answer 34

over crowding
poor oral health and hygiene
poverty
drug abuse
immunosuppression

local factors
- poor OH
- local trauma/irritation

Question 35

tuberculosis oral manifestations

Answer 35

uncommon
young adults
tongue
painful ulcers
lymphadenopathy

Question 36

tuberculosis management

Answer 36

quadruple therapy.