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Otolaryngology > Microbiology > Flashcards

Microbiology Flashcards

1
Q

Herpes Simplex Virus: Structure

A

Enveloped double stranded DNA alpha herpes virus

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2
Q

Herpes Simplex Virus: Two type

A

HSV-1
HSV-2

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3
Q

Herpes Simplex Virus: HSV-1 associated with what?

A

Orofacial disease

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4
Q

Herpes Simplex Virus: HSV-2 associated with what?

A

Genital disease

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5
Q

Herpes Simplex Virus: HSV-1 - Acquired when?

A

In childhood

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6
Q

Herpes Simplex Virus: HSV-1 - Causes what?

A

Oral lesions

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7
Q

Herpes Simplex Virus: HSV-1 - Transmission

A

Infected oral secretions during close contact
Oral-genital or Genital-Genital
Contamination of skin abrasions with infected oral secretions

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8
Q

Herpes Simplex Virus: HSV-1 - Can cause what oral disease?

A

Primary Gingivostomatitis

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9
Q

Herpes Simplex Virus: Primary Gingivostomatitis - Most common in what population group?

A

Pre-school children

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10
Q

Herpes Simplex Virus: Primary Gingivostomatitis - Impacts what regions? (3)

A

Lips
Buccal mucosa
Hard palate

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11
Q

Herpes Simplex Virus: Primary Gingivostomatitis - Presentation

A

Vesicles and Ulcers present

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12
Q

Herpes Simplex Virus: Primary Gingivostomatitis - Clinical Presentation of Primary Infection

A

2-12 days for clinical illness - multiple painful oral lesions with local lymphadenopathy

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13
Q

Herpes Simplex Virus: Primary Gingivostomatitis - Systemic Clinical Presentation

A

Fever
Malaise
Headache

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14
Q

Herpes Simplex Virus: Primary Gingivostomatitis - Length of presentation without therapy

A

12 days

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15
Q

Herpes Simplex Virus: Primary Gingivostomatitis - Management

A

Aciclovir

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16
Q

Herpes Simplex Virus: Inactive form remains where?

A

Sensory nerve cells

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17
Q

Herpes Simplex Virus: Can reactivate to do what?

A

Reinfect mucosal surfaces

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18
Q

Herpes Simplex Virus: Viral replication occurs where?

A

Epidermis
Dermis

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19
Q

Herpes Simplex Virus: Can infect what structures?

A

Sensory and autonomic nerve endings - CN V - Mandibular, Maxillary and Ophthalmic Branches and the Meningeal branch and the Trigeminal ganglion

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20
Q

Herpes Simplex Virus: Virus travels from nerve endings to where?

A

Sensory ganglia - establishes a latent reservoir that cannot be eliminated by the immune system

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21
Q

Herpes Simplex Virus: Virus persists in a latent state where?

A

Trigeminal ganglia to reactivate intermittently

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22
Q

Herpes Simplex Virus: Virus attaches to epithelial cells through what?

A

HSV-1 surface glycoproteins and cellular HSV receptors e.g. Nectin-1

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23
Q

Herpes Simplex Virus: How is it transported into sensory ganglia?

A

Retrograde transport

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24
Q

Herpes Simplex Virus: HSV-1 establishes life-long latent infection where?

A

Trigeminal or sacral ganglia

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25
Q

Herpes Simplex Virus: Latency is characterised by what?

A

Restricted transcriptional profile with the latency-associated transcripts

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26
Q

Herpes Simplex Virus: Transported to epithelial cells from ganglia how?

A

Anterograde Axonal Transport

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27
Q

Herpes Simplex Virus: Cold Sores - Pathophysiology

A

Reactivation of HSV-1 from nerves causes active infection

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28
Q

Herpes Simplex Virus: Cold Sores - Management

A

Aciclovir

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29
Q

Herpes Simplex Virus: Cold Sores - Aciclovir does not prevent what?

A

Latency

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30
Q

Herpes Simplex Virus: Precipitating factors for HSV-1 (4)

A

Immunodeficiency
Stress
Exposure to sunlight
Fever

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31
Q

Herpes Simplex Virus: Cold Sores - Oral herpetic lesions are often caused by what?

A

HSV-1

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32
Q

Herpes Simplex Virus: Cold Sores - What would suggest HSV is not the causative organism?

A

Recurrent intra-oral lesions

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33
Q

Herpes Simplex Virus: Cold Sores - What precedes the appearance of painful lesions?

A

Prodomal symptoms 24 hours before - Pain, Burning, Tingling and Pruritus 6-53 hours before the appearance of the first vesicles

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34
Q

Herpes Simplex Virus: Cold Sores - Recurrences typically present where?

A

Vermillon border

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35
Q

Herpetic Whitlow: Often misdiagnosed as what?

A

Bacterial infection

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36
Q

Herpetic Whitlow: Occupational hazard of what?

A

Dentistry and anaesthetics

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37
Q

Herpetic Whitlow

A

HSV infection of the finger due to innoculation of the virus through a break in the skin

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38
Q

Herpetic Whitlow: Time period if left untreated

A

2-3 weeks

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39
Q

Herpes Simplex Virus: Herpes Simplex Encephalitis - Clinical Presentation (5)

A

Rapid onset of:
- Fever
- Headache
- Seizures
- Focal neurological signs
- Impaired consciousness

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40
Q

Herpes Simplex Virus: Diagnosis - Procedure used

A

Swab of lesion in the viral transport medium and detection via PCR

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41
Q

Herpes Simplex Virus: Diagnosis - What is the diagnostic cell?

A

Multinucleated giant cell - epithelial cell containing numerous nuclei with nuclear moulding and viral inclusions (causes a glass appearance)

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42
Q

Herpes Simplex Virus: Diagnosis - Tzanck Smear

A

Smear material from the base of a vesicle onto a slide and stain it with Wright’s stain - positive smear demonstrates multi-nucleate cells

Limited utility due to poor sensitivity and specificity

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43
Q

Herpangina

A

Benign clinical syndrome characterised by fever and painful papulo-vesiculo-ulcerative oral enanthem

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44
Q

Herpangina: Causative organism

A

Coxsackie viruses - most commonly A serotypes

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45
Q

Herpangina: Clinical Presentation

A

Abrupt fever with hyperaemia and yellow/grey-white papulovesicular papules that undergo vesiculation in 24 hours

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46
Q

Herpangina: Diagnostic test

A

Clinical or PCR test of the swab in viral transport medium

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47
Q

Hand, Foot and Mouth Disease

A

Clinical syndrome characterised by oral enanthem and macular/maculopapular/vesicular rash of the hands and feet

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48
Q

Hand, Foot and Mouth Disease: Causative organism

A

Coxsackie Virus - A serotypes common

49
Q

Hand, Foot and Mouth Disease: Diagnosis

A

Clinical or by PCR test of the swab in a viral transport medium

50
Q

Primary Syphilis: Causative Organism

A

Treponema pallidum

51
Q

Primary Syphilis: Clinical presentation

A

Painless indurated ulcer on the genitals, mouth or pharynx

52
Q

Apthous Ulcers

A

Recurring painful ulcers of the mouth that are round or ovoid and have inflammatory halos

53
Q

Apthous Ulcers: Confined to what area?

54
Q

Apthous Ulcers: Duration

A

Each ulcer lasts 3 weeks

55
Q

Apthous Ulcers: Most common cause of mouth ulcers

A

Recurrent apthous stomatitis - canker sores

56
Q

Apthous Ulcers: Risk Factors (5)

A

Genetic predisposition
Trauma
Stress
Smoking cessation
Hormonal imbalance

57
Q

Apthous Ulcers: Ulcers of Systemic Disease - Behcets Disease (3)

A

Recurrent oral ulcers
Genital ulcers
Uveitis

58
Q

Sore throat clinical presentation

A

Pain at the back of the throat

59
Q

Acute pharyngitis

A

Inflammation of the oropharynx behind the soft palate

60
Q

Tonsillitis

A

Inflammation of the tonsils

61
Q

If a sore throat and lethargy persist for 2 weeks what should be suspected?

A

Mononucleosis

62
Q

Sore Throat: Centor Score

A

Gives one point for:
- Tonsillar exudate
- Tender anterior cervical lymph nodes
- History of fever
- Absence of cough

63
Q

Bacterial Sore Throat: Most common cause

A

Streptococcus pyogenes

64
Q

Bacterial Sore Throat: Management

A

Penicillin

65
Q

Bacterial Sore Throat: Streptococcus Pyogenes - Late Complications (2)

A

Rheumatic Fever - 3 weeks post-sore throat
with fever, arthritis and pancarditis
Glomerulonephritis - 1-3 weeks post-sore throat with haemturia, albuminuria and oedema

66
Q

Bacterial Sore Throat: Group A Beta Haemolytic Streptococcus - How is this assessed?

A

CENTOR Score

67
Q

Bacterial Sore Throat: Group A Beta Haemolytic Streptococcus - Management for FeverPAIN 0/1OR Centor 0/1/2

A

Do not offer an antibiotic

68
Q

Bacterial Sore Throat: Group A Beta Haemolytic Streptococcus - Management for FeverPAIN 2/3

A

Consider no antibiotic or an antibiotic backup prescription - use if no improvement within 3-5 days

69
Q

Bacterial Sore Throat: Group A Beta Haemolytic Streptococcus - Management for FeverPAIN 4/5 OR Centor Score of 3/4

A

Immediate antibiotic required

70
Q

DMARD

A

Disease-Modifying Anti-Rheumatic Drugs

71
Q

DMARDs and Sore Throat: Management

A

FBC
Withhold the DMARD whilst awaiting the result

72
Q

DMARDs and Sore Throat: Management if person has leucopenia or deteriorates

A

Provide symptomatic relief and antibiotics

73
Q

Tonsillitis: Management - Unable to swallow

A

Benzylpenicillin IV

74
Q

Tonsillitis: Management - Unable to swallow with a penicillin allergy

A

Clarithromycin IV

75
Q

Tonsillitis: Management - Able to swallow

A

Penicillin for 5 days

76
Q

Tonsillitis: Management - Able to swallow with a penicillin allergy

A

Clarithromycin

77
Q

Diphtheria

A

Infectious disease caused by gram positive bacillus Corynebacterium diphtheriae

78
Q

Diphtheria: Hallmark

A

Tough pharyngeal membrane

79
Q

Diphtheria: Respiratory types is typically called by what?

A

Toxin-producing strains of C. diphtheriae

80
Q

Diphtheria: Length of time

A

Symptoms begin 2-5 days after infection

81
Q

Diphtheria: Can cause what to happen to the heart?

A

Myocarditis due to toxin damage

82
Q

Diphtheria: Most common presentation (4)

A

Sore throat
Malaise
Cervical lymphadenopathy
Low grade fever

83
Q

Diphtheria: Earliest pharyngeal finding

A

Mild erythema that can progress to gray and white exudate

84
Q

Diphtheria: In untreated patients when is the infectious period?

A

Begins at symptom onset and lasts two weeks

85
Q

Diphtheria: In treated patients what is the time frame?

A

Infectious period lasts less than four days

86
Q

Diphtheria: Neurological Toxicity - Local Neuropathies (2)

A

Paralysis of the soft palate
Paralysis of the pharyngeal wall

87
Q

Diphtheria: Neurological Toxicity - Cranial Neuropathies (4)

A

Oculomotor and Ciliary > Facial or Laryngeal paralysis

88
Q

Diphtheria: Neurological Toxicity - What may present on the posterior pharynx?

A

Pseudomembrane - may obstruct the airway

89
Q

Diphtheria: The exotoxin is toxic to what two structures?

A

Heart
Nervous System

90
Q

Diphtheria: Management

A

Anti-toxin
Penicillin or Erythromycin

91
Q

Diphtheria: Vaccine type

A

Cell-free purified toxin from C. diphtheriae (toxoid vaccine)

92
Q

Infectious Mononucleosis: Clinical Presentation (6)

A

Fever
Enlarged lymph noes
Sore throat
Pharyngitis
Tonsillitis
Malaise and Lethargy

93
Q

Infectious Mononucleosis: Haematological signs

A

Leucocytosis
Atypical lymphocytes on film

94
Q

Infectious Mononucleosis: Causative organism

A

Epstein-Barr Virus

95
Q

Infectious Mononucleosis: Establishes a persistent infection where?

A

In the epithelial cells - mainly of the pharynx

96
Q

Infectious Mononucleosis: Two Phases of Primary Infection

A

Primary infection in early childhood rarely results in infectious mononucleosis
Primary infection in those >10 years old results in infectious mononucleosis

97
Q

Infectious Mononucleosis: Why does it establish a life long infection?

A

Establishes latency with periodic reactivation with oral shedding of EBV

98
Q

Infectious Mononucleosis: When are corticosteroids considered?

A

Upper Respiratory Tract Obstruction
Haemolytic Anaemia

99
Q

Oral Thrush: Causative organism

A

Candida albicans

100
Q

Oral Thrush: Clinical presentation

A

White patches on red and raw mucous membranes of the throat and mouth

101
Q

Oral Thrush: Aetiologies (4)

A

Post-antibiotic therapy
Immunosuppression
Smoking
Inhaled steroids

102
Q

Oral Thrush: Management options (2)

A

Nystatin
Fluconazole

103
Q

Acute Otitis Media: Management - First line (+ if penicillin allergy)

A

Amoxicillin (Clarithromycin)

104
Q

Recurrent Otitis Media: Definition

A

> 3 episodes in 6 months or >5 episodes in 12 months

105
Q

Recurrent Otitis Media: Management - What is considered in paediatric cases?

A

Amoxicillin

106
Q

Otitis Externa: Bacterial Causes (3)

A

Staphylococcus aureus
Proteus species
Pseudomonas aeruginosa

107
Q

Otitis Externa: Fungal Causes (2)

A

Aspergillus niger
Candida albicans

108
Q

Otitis Externa: Management - Swabs and antibiotics reserved for what?

A

Unresponsive or severe cases

109
Q

Otitis Externa: Management - Mild cases

A

Acetic Acid for 7 days - increase management if no improvement after 3 days

110
Q

Otitis Externa: Management - Moderate cases

A

Otomize or Sofradex

111
Q

Otitis Externa: Management - Antibiotic options (2)

A

Gentamicin
Ciprofloxacin (with Dexamethasone)

112
Q

Otitis Externa: Management - For fungal infection

A

Clotrimazole solution

113
Q

Otitis Externa: Management - Oral or IV antibiotics considered when?

A

If there is cellulitis or disease extends out of the ear canal

114
Q

Malignant Otitis

A

Extension of otitis externa into the bone surrounding the ear canal - the mastoid and temporal bones

115
Q

Malignant Otitis: Clinical Presentation

A

Pain and headache

116
Q

Malignant Otitis: Signs (3)

A

Granulation tissue at the bone-cartilage junction of the ear canal
Exposed bone in the ear canal
Facial nerve palsy

117
Q

Acute Sinusitis: 1st line management in severe cases

A

Phenoxymethylpenicillin

118
Q

Acute Sinusitis: 2nd line management in severe cases

A

Doxycycline

119
Q

Acute Sinusitis: When can doxycycline not be used?

A

In children

Otolaryngology (4 decks)

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