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ENT - Fearghal > Microbiology > Flashcards

Microbiology Flashcards

1
Q

What is required for diagnosis of a sore throat?

A

A well taken throat swab

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2
Q

2/3rds of sore throats are bacterial and need ABx - true/false

A

False - 2/3rd are viral and DO NOT need ABx

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3
Q

What is the most common bacteria to infect the throat?

A

streptococcus pyogenes (group A streps)

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4
Q

Clinically streptococcal throat will present as ______

A

Acute follicular tonsillitis

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5
Q

Strep throat should be treated with _____ but NOT ______

A

Penicillin but not amoxicillin

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6
Q

What ABx can be used if there is an allergy?

A

Clarithromycin

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7
Q

Strep pyogenes is a gram positive/negative coccus which forms chains/clusters and undergoes what type of haemolysis?

A

Gram positive
Chains
B (complete) haemolysis

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8
Q

name three acute complications of strep throat

A

Quinsy
Sinusitis/otitis media
Scarlet fever

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9
Q

What causes scarlet fever?

A

Strains of group A strep which produce a erythrogenic toxin

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10
Q

What is a Quinsy?

A

An abscess near the tonsils and below the palate

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11
Q

Which infection control procedures are used in a Quinsy?

A

Standard protection + Gloves and apron and consider if droplet precaution is necessary

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12
Q

Name the two most common later complications of streptococcal throat

A

Rheumatic fever - fever/arthritis/pancarditis (3weeks post infection)
Glomerulonephritis (1-3weeks post infection) giving haematuria.

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13
Q

What is thought to cause the two later complications of streptococcal throat?

A

Cross reacting antibodies damaging the heart tissues and the glomerulus

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14
Q

name the infecting organism in diphtheria.

A

Cornybacterium diphtheriae

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15
Q

State the clinical presentation of diphtheria

A

Severe sore throat

Grey white membrane across the pharynx

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16
Q

What does cornybacterium diphtheriae produce?

A

A cardiotoxic and neurotoxic endotoxin.

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17
Q

What is the grey white membrane across the pharynx? Why is it clinically important?

A

it is a pseudomembrane

Pseudomembrane if not diagnosed rapidly can grow across and block the airway and cause suffocation.

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18
Q

Diphtheria is not common in the UK - Why? Where is it common?

A

Vaccination programmes

Russia for example

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19
Q

How is diphtheria vaccine produced?

A

it is a cell free, purified toxin from a strain of C. diphtheriae

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20
Q

Treatment for diphtheria is amoxicillin and supportive treatment - true/false

A

False - antitoxin and supportive treatment along with penicillin or erythromycin if pen allergic

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21
Q

What organism causes oral thrush?

A

Candida albicans

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22
Q

Describe the clinical appearance of oral thrush

A

White patches on red raw mucous membranes in the throat and mouth.

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23
Q

What is the treatment for candida infection?

A

Nystatin suspension delivered topically

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24
Q

Acute otitis media is a middle ear infection which occurs from entry of a pathogen through the ________

A

eustachian tube

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25
Q

AOM is more common in infants and adults than in young children - true/false

A

False it is most common in infants and children and not very common in adults

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26
Q

how will AOM usually present?

A

It will present with ear ache

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27
Q

What is required for diagnosis of AOM?

A

Swab of pus if eardrum perforates; completely clinical if it doesn’t

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28
Q

What percentage of AOM will resolve without treatment and over what period of time?

A

80% over 4 days

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29
Q

Acute sinusitis is most commonly seen in patients with ______

A

URTI

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30
Q

Severe pain, tenderness over the maxillary or frontal sinuses and horrible, purulent nasal discharge is indicative of what?

A

Secondary bacterial infection of acute sinusitis

31
Q

often no samples can be taken in acute sinusitis - true/false

A

True

32
Q

Abx should be avoided in acute sinusitis as 80% will resolve themselves in 14days - true/false

A

True

33
Q

When indicated, what ABx should be used for acute sinusitis?

A

Penicillin V first line

Doxycycline - second line in adults but NEVER in kids

34
Q

What are the three most common bacterial causes of otitis externa?

A
  • Staph aureus
  • proteus spp.
  • pseudomonas aeruginosa
35
Q

Fungal causes of otitis external include:

A
  • aspergillus niger

- candida albicans

36
Q

management of otitis externa includes:

A
  • Topical aural toilet
  • swabbing if that doesn’t fix it
  • treat based on swab results e.g. clotrimazole for fungal cause or antibiotic suitable for bacteria isolated
37
Q

What age group does infectious mononucleosis affect?

A

Young adults mostly

38
Q

How does mono present?

A

Fever, enlarged nodes, sore throat, pharyngitis, tonsillitis, malaise and lethargy

39
Q

What is the classic triad of mono and what percentage of cases are all three present in?

A
  • fever
  • Pharyngitis
  • lymphadenopathy
  • 70% of cases
40
Q

What other signs and symptoms can be present in mono? What is the incidence of a few of them?

A
  • jaundice; 5%
  • Rash; 5%
  • hepato-splenomegaly; unknown
  • palatal petechiae
41
Q

No patient with suspected mononucleosis should be prescribed which ABx and why?

A
  • NEVER amoxicillin or ampicillin

- will always give a rash in 100% of patients; often mistaken for pen. allergy

42
Q

What may haematology show for patients with mononucleosis?

A

leucocytosis and abnormal lymphocytes on blood film

43
Q

Infectious mononucleosis is caused by bacteria - true/false

A

False - Epstein Barr Virus

44
Q

Infectious mononucleosis is protracted and self-limiting - true/false

A

True

45
Q

Name the complications of infectious mononucleosis

A
  • Anaemia
  • thrombocytopenia
  • splenic rupture
  • upper airway obstruction
  • increased lifetime risk of lymphoma
46
Q

EBV is a member of which family?

A

Herpes

47
Q

EBV forms a persistent infection in which cells, especially in which part of the URT?

A

Epithelial cells especially in the pharynx

48
Q

What are the two phases of primary infection with EBV?

A

Primary infection before 10 - rarely causes mono

Primary infection after 10 - often causes mono

49
Q

What is treatment for mono?

A

Supportive - bed rest and paracetamol
Avoid sport for at least one month but if they insist on returning within one month, abdo ultrasound to look for splenomegaly.
Antivirals are NOT clinically effective. Corticosteroids may be effective in complex cases

50
Q

What testing should be done for infectious mononucleosis?

A

EBV IgM and heterophile antibody testing
Blood count and film
LFTs

51
Q

What are other causes of similar illnesses?

A
  • cytomegalovirus
  • toxoplasmosis
  • primary HIV infection causing seroconversion illness.
52
Q

When is type I HSV normally acquired and what does it normally cause?

A

it is normally acquired in childhood and causes oral ulcerations.

53
Q

What percentage of adults in the UK have been infective with primary HSV type I?

A

70%

54
Q

How is HSV type I passed on?

A

Saliva contact

55
Q

What causes primary gingivostomatitis?

A

Primary HSV1 infection

In pre-school children.

56
Q

How does primary gingivostomatitis present?

A

Systemic upset
1-2 mm vesicular lesions on the lips, buccal mucosa and hard palate, ulceration. Fever and lymphadenopathy. Can last 3 weeks

57
Q

How is primary gingivostomatitis treated?

A

Aciclovir

58
Q

HSV 1 becomes inactive but never really goes away - it remains in the sensory nerve cells and can reactivate to reinfect mucosal surfaces - true/false

A

True

59
Q

What is the cause of a cold sore?

A

Reactivation of HSV1 from the nerves causes active infection including suppression.

60
Q

Are all HSV1 reactivations symptomatic?

A

No

61
Q

Does acyclovir prevent HSV1 latency?

A

No

62
Q

How is HSV infection confirmed in the lab?

A
  • swab of lesion in viral transport medium

- DNA detected by PCR

63
Q

How many people will get herpes simplex encephalitis per annum?

A

1/1million

64
Q

What does herpes simplex encephalitis cause?

A

Temporal lobe necrosis

65
Q

How does herpes simplex encephalitis present? What are the mortality rates for herpes simplex encephalitis?

A

Fever, malaise and possibly new onset gran mal seizures. Very wide mortality range - 10-90%.

66
Q

What group of viruses does enterovirus belong to?

A

Coxsackie viruses

67
Q

What is the cause of herpangina?

A

You would think its HSV but its actually coxsackie viruses like enterovirus.

68
Q

What patient’s is herpangina likely to affect?

A

preschool children

69
Q

What are the symptoms of herpangina?

A

vesicles/ulcers on the hard palate

70
Q

How is herpangina diagnosed?

A

Clinical diagnosis or PCR of swab in viral transport medium.

71
Q

What causes hand foot and mouth disease?

A

Coxsackie viruses.

72
Q

Family outbreaks of hand, foot and mouth are common - true/false

A

True

73
Q

how is hand foot and mouth diagnoses?

A

Clinical diagnosis or PCR of swab in viral transport medium.

ENT - Fearghal (9 decks)

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