ENT microbiology Flashcards by Jasmine Aikman

if have sore throat and stridor = absolute indication for __

avoid ___

hospital admission

dont examine throat

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pain at back of mouth can be __/__ usually caused by viral (or bacterial) infection

pharyngitis and tonsillitis

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complications of a tonsillitis/pharyngitis =

otitis media (most common)
quinsy
parapharyngeal abscess
mastoiditis

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viral + bacterial causes of tonsillitis/pharyngitis

cold/flu usually
strep
HIV
gonococcal pharyngitis
diphtheria

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if >=2wk sore throat and 15-25yo suspect

mono

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treatment of pharyngitis/tonsillitis =

paracetamol/ibuprofen
warm salty water
if bacterial = phenoxymethylpenicillin

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a high centor score increases the likelihood of __ being the causative organism of tonsillitis

srtep pyogenes

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late complications of strep throat =

rheumatic fever (3wks after sore throat)
glomerulonephritis (1-3wk post sore throat)

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severe sore throat with pseusomembrane across pharynx =
exotoxin is __+__ toxic
increasing incidence in ___

diphtheria
neuro and cardiotoxic
Russia

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treatment of diptheria

antitoxin

supportive penicillin/ erythromycin

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thrush organism -

appearance =

candida albicans

white patches on red raw mucous membranes

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treatment of thrush

nystatin

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acute otitis media usually occurs in __+__ due to a ___ spreading through the ___ to the middle ear

infants and kids
URTI
eustachian tube

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cause of otitis media is usually __

with a secondary ___ infection - org.s =

viral

bacterial - H influ, Strep. pneumoniae, strep pyogenes

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can only swab pus in acute otitis media if __

eardrum is perforated

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treatment for acute otitis media =

80% resolve themselves in 4 days

Abx = amoxicillin (erythromycin if allergy)

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discomfort over frontal/maxillary sinus in patients with a viral URTI =

acute sinusitis

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severe pain and tenderness in acute sinusitis suggests __

2ndry bacterial infection

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treatment for acute sinusitis

only Abx if >10 days and severe/deteriorating
1st line = penicillin V
2nd = doxycyline (NOT IN KIDS)

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s+s of otitis externa =

red and swollen skin of ear canal
maybe itchy
may become sore and painful
may have discharge/increased wax
hearing may be affected

malignant otitis externa = extends to __+__ and possibly __+__

mastoid and temporal bone

skull and meninges

s+s of malignant otitis externa

pain
headache v severe
granulation tissue at bone-cartilage junction
exposed bone in ear canal
CNVII palsy

investigations for malignant otitis externa =

PV, CRP, image, biopsy, culture

usual organism of malignant otitis externa

pseudomonas aeruginosa

risk factors for malignant otitis externa =

diabetes | head and neck radiotherapy

causative organisms of otitis externa =

``` aspergillus niger candida albicans S. aureus proteus spp Pseudomonas aeruginosa (more likely to cause malignant OE) ```

treatment for otitis externa -

``` topical aural toilet if severe/resistant = culture => gentamicin 0.3% drops or topical clotrimazole (= canasten - for aspergillus niger) ```

triad seen in infective mononucleosis

fever pharyngitis lymphadenopathy

signs and symptoms of infective mononucleosis

``` hepatitis/jaundice rash leucocytosis atypical lymphocytes (large and irregular) splenomegaly palatal petechiae ```

duration of fever pharyngitis and lymphadenopathy in mono

fever and pharyngitis = 2-4 wks | lymphadenopathy = 4wks

complications of mono =

anaemia (AI and related to steroids) thrombocytopaenia upper airway obstruction increased lymphoma risk

causative agent of mono | establishes itself in __ cells

EBV | epithelial

treatment for mono =

bed rest no sport for 6 wks paracetamol steroids if haem anaemia/ upper airway obstruction

lab confirmation of mono =

EBV IgM heterophile antibody - Paul-Bunnell and monospot tests FBC and film LFTs

similar illnesses to mono

CMV (no heterophile Ig and fewer atypical lymphocytes) toxoplasmosis primary HIV -seroconversion illness, also have diarrhoea

HSV__ is acquired in kids and causes oral lesions | infection is through ___

1 | salivary contact

primary gingivostomatitis is caused by ___ and affects ___ s+s = Rx = time to recovery =

``` HSV pre-schoolers systemic upset lips buccal mucosa and hard palate 1-2mm vesicles, ulcers fever local lymphadenopathy aciclovir around 3wks ```

latency of HSV1 is in ___ and reactivation leads to __

CN V | cold sores

herpetic whitlow =

tip of finger infection with HSV

confirmation of presence of HSV is by

PCR

herpangina is caused by ___ manifests as __ usually affects ___ Ix =

coxsackie (enterovirus) vesicle/ulcers on soft palate pre-schoolers PCR

Hand foot and mouth is caused by ___

coxsackie (enterovirus)

appearance of aphthous ulcers =

recurring and painful | round/ovoid and inflammatory halo

recurrent oral ulcers caused by systemic disease =

``` Behcets coeliac IBD Reiters drugs pemphigus pemphigoid ```

painless indurated ulcer =

primary syphilis - chancre

why PO amoxicillin over penicillin in acute OM

better oral absorption (also covers more organisms)

in hospital this test is done to confirm mono as it is the most specific

clotted blood for IgM

systemic antifungal =

IV ampotericin

___ given for strep throat not amoxicillin because ___

penicillin | not worried about H. influenza so don't need the broader spectrum