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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
Herpes Simplex Virus: Latency is characterised by what?
Restricted transcriptional profile with the latency-associated transcripts
26
Herpes Simplex Virus: Transported to epithelial cells from ganglia how?
Anterograde Axonal Transport
27
Herpes Simplex Virus: Cold Sores - Pathophysiology
Reactivation of HSV-1 from nerves causes active infection
28
Herpes Simplex Virus: Cold Sores - Management
Aciclovir
29
Herpes Simplex Virus: Cold Sores - Aciclovir does not prevent what?
Latency
30
Herpes Simplex Virus: Precipitating factors for HSV-1 (4)
Immunodeficiency Stress Exposure to sunlight Fever
31
Herpes Simplex Virus: Cold Sores - Oral herpetic lesions are often caused by what?
HSV-1
32
Herpes Simplex Virus: Cold Sores - What would suggest HSV is not the causative organism?
Recurrent intra-oral lesions
33
Herpes Simplex Virus: Cold Sores - What precedes the appearance of painful lesions?
Prodomal symptoms 24 hours before - Pain, Burning, Tingling and Pruritus 6-53 hours before the appearance of the first vesicles
34
Herpes Simplex Virus: Cold Sores - Recurrences typically present where?
Vermillon border
35
Herpetic Whitlow: Often misdiagnosed as what?
Bacterial infection
36
Herpetic Whitlow: Occupational hazard of what?
Dentistry and anaesthetics
37
Herpetic Whitlow
HSV infection of the finger due to innoculation of the virus through a break in the skin
38
Herpetic Whitlow: Time period if left untreated
2-3 weeks
39
Herpes Simplex Virus: Herpes Simplex Encephalitis - Clinical Presentation (5)
Rapid onset of: - Fever - Headache - Seizures - Focal neurological signs - Impaired consciousness
40
Herpes Simplex Virus: Diagnosis - Procedure used
Swab of lesion in the viral transport medium and detection via PCR
41
Herpes Simplex Virus: Diagnosis - What is the diagnostic cell?
Multinucleated giant cell - epithelial cell containing numerous nuclei with nuclear moulding and viral inclusions (causes a glass appearance)
42
Herpes Simplex Virus: Diagnosis - Tzanck Smear
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
43
Herpangina
Benign clinical syndrome characterised by fever and painful papulo-vesiculo-ulcerative oral enanthem
44
Herpangina: Causative organism
Coxsackie viruses - most commonly A serotypes
45
Herpangina: Clinical Presentation
Abrupt fever with hyperaemia and yellow/grey-white papulovesicular papules that undergo vesiculation in 24 hours
46
Herpangina: Diagnostic test
Clinical or PCR test of the swab in viral transport medium
47
Hand, Foot and Mouth Disease
Clinical syndrome characterised by oral enanthem and macular/maculopapular/vesicular rash of the hands and feet
48
Hand, Foot and Mouth Disease: Causative organism
Coxsackie Virus - A serotypes common
49
Hand, Foot and Mouth Disease: Diagnosis
Clinical or by PCR test of the swab in a viral transport medium
50
Primary Syphilis: Causative Organism
Treponema pallidum
51
Primary Syphilis: Clinical presentation
Painless indurated ulcer on the genitals, mouth or pharynx
52
Apthous Ulcers
Recurring painful ulcers of the mouth that are round or ovoid and have inflammatory halos
53
Apthous Ulcers: Confined to what area?
Mouth
54
Apthous Ulcers: Duration
Each ulcer lasts 3 weeks
55
Apthous Ulcers: Most common cause of mouth ulcers
Recurrent apthous stomatitis - canker sores
56
Apthous Ulcers: Risk Factors (5)
Genetic predisposition Trauma Stress Smoking cessation Hormonal imbalance
57
Apthous Ulcers: Ulcers of Systemic Disease - Behcets Disease (3)
Recurrent oral ulcers Genital ulcers Uveitis
58
Sore throat clinical presentation
Pain at the back of the throat
59
Acute pharyngitis
Inflammation of the oropharynx behind the soft palate
60
Tonsillitis
Inflammation of the tonsils
61
If a sore throat and lethargy persist for 2 weeks what should be suspected?
Mononucleosis
62
Sore Throat: Centor Score
Gives one point for: - Tonsillar exudate - Tender anterior cervical lymph nodes - History of fever - Absence of cough
63
Bacterial Sore Throat: Most common cause
Streptococcus pyogenes
64
Bacterial Sore Throat: Management
Penicillin
65
Bacterial Sore Throat: Streptococcus Pyogenes - Late Complications (2)
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
Bacterial Sore Throat: Group A Beta Haemolytic Streptococcus - How is this assessed?
CENTOR Score
67
Bacterial Sore Throat: Group A Beta Haemolytic Streptococcus - Management for FeverPAIN 0/1OR Centor 0/1/2
Do not offer an antibiotic
68
Bacterial Sore Throat: Group A Beta Haemolytic Streptococcus - Management for FeverPAIN 2/3
Consider no antibiotic or an antibiotic backup prescription - use if no improvement within 3-5 days
69
Bacterial Sore Throat: Group A Beta Haemolytic Streptococcus - Management for FeverPAIN 4/5 OR Centor Score of 3/4
Immediate antibiotic required
70
DMARD
Disease-Modifying Anti-Rheumatic Drugs
71
DMARDs and Sore Throat: Management
FBC Withhold the DMARD whilst awaiting the result
72
DMARDs and Sore Throat: Management if person has leucopenia or deteriorates
Provide symptomatic relief and antibiotics
73
Tonsillitis: Management - Unable to swallow
Benzylpenicillin IV
74
Tonsillitis: Management - Unable to swallow with a penicillin allergy
Clarithromycin IV
75
Tonsillitis: Management - Able to swallow
Penicillin for 5 days
76
Tonsillitis: Management - Able to swallow with a penicillin allergy
Clarithromycin
77
Diphtheria
Infectious disease caused by gram positive bacillus Corynebacterium diphtheriae
78
Diphtheria: Hallmark
Tough pharyngeal membrane
79
Diphtheria: Respiratory types is typically called by what?
Toxin-producing strains of C. diphtheriae
80
Diphtheria: Length of time
Symptoms begin 2-5 days after infection
81
Diphtheria: Can cause what to happen to the heart?
Myocarditis due to toxin damage
82
Diphtheria: Most common presentation (4)
Sore throat Malaise Cervical lymphadenopathy Low grade fever
83
Diphtheria: Earliest pharyngeal finding
Mild erythema that can progress to gray and white exudate
84
Diphtheria: In untreated patients when is the infectious period?
Begins at symptom onset and lasts two weeks
85
Diphtheria: In treated patients what is the time frame?
Infectious period lasts less than four days
86
Diphtheria: Neurological Toxicity - Local Neuropathies (2)
Paralysis of the soft palate Paralysis of the pharyngeal wall
87
Diphtheria: Neurological Toxicity - Cranial Neuropathies (4)
Oculomotor and Ciliary > Facial or Laryngeal paralysis
88
Diphtheria: Neurological Toxicity - What may present on the posterior pharynx?
Pseudomembrane - may obstruct the airway
89
Diphtheria: The exotoxin is toxic to what two structures?
Heart Nervous System
90
Diphtheria: Management
Anti-toxin Penicillin or Erythromycin
91
Diphtheria: Vaccine type
Cell-free purified toxin from C. diphtheriae (toxoid vaccine)
92
Infectious Mononucleosis: Clinical Presentation (6)
Fever Enlarged lymph noes Sore throat Pharyngitis Tonsillitis Malaise and Lethargy
93
Infectious Mononucleosis: Haematological signs
Leucocytosis Atypical lymphocytes on film
94
Infectious Mononucleosis: Causative organism
Epstein-Barr Virus
95
Infectious Mononucleosis: Establishes a persistent infection where?
In the epithelial cells - mainly of the pharynx
96
Infectious Mononucleosis: Two Phases of Primary Infection
Primary infection in early childhood rarely results in infectious mononucleosis Primary infection in those >10 years old results in infectious mononucleosis
97
Infectious Mononucleosis: Why does it establish a life long infection?
Establishes latency with periodic reactivation with oral shedding of EBV
98
Infectious Mononucleosis: When are corticosteroids considered?
Upper Respiratory Tract Obstruction Haemolytic Anaemia
99
Oral Thrush: Causative organism
Candida albicans
100
Oral Thrush: Clinical presentation
White patches on red and raw mucous membranes of the throat and mouth
101
Oral Thrush: Aetiologies (4)
Post-antibiotic therapy Immunosuppression Smoking Inhaled steroids
102
Oral Thrush: Management options (2)
Nystatin Fluconazole
103
Acute Otitis Media: Management - First line (+ if penicillin allergy)
Amoxicillin (Clarithromycin)
104
Recurrent Otitis Media: Definition
>3 episodes in 6 months or >5 episodes in 12 months
105
Recurrent Otitis Media: Management - What is considered in paediatric cases?
Amoxicillin
106
Otitis Externa: Bacterial Causes (3)
Staphylococcus aureus Proteus species Pseudomonas aeruginosa
107
Otitis Externa: Fungal Causes (2)
Aspergillus niger Candida albicans
108
Otitis Externa: Management - Swabs and antibiotics reserved for what?
Unresponsive or severe cases
109
Otitis Externa: Management - Mild cases
Acetic Acid for 7 days - increase management if no improvement after 3 days
110
Otitis Externa: Management - Moderate cases
Otomize or Sofradex
111
Otitis Externa: Management - Antibiotic options (2)
Gentamicin Ciprofloxacin (with Dexamethasone)
112
Otitis Externa: Management - For fungal infection
Clotrimazole solution
113
Otitis Externa: Management - Oral or IV antibiotics considered when?
If there is cellulitis or disease extends out of the ear canal
114
Malignant Otitis
Extension of otitis externa into the bone surrounding the ear canal - the mastoid and temporal bones
115
Malignant Otitis: Clinical Presentation
Pain and headache
116
Malignant Otitis: Signs (3)
Granulation tissue at the bone-cartilage junction of the ear canal Exposed bone in the ear canal Facial nerve palsy
117
Acute Sinusitis: 1st line management in severe cases
Phenoxymethylpenicillin
118
Acute Sinusitis: 2nd line management in severe cases
Doxycycline
119
Acute Sinusitis: When can doxycycline not be used?
In children

Otolaryngology (4 decks)

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