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ENT > Microbiology > Flashcards

Microbiology Flashcards

1
Q

Some common causes of a sore throat?

A

Common cold
Influenza
Streptococcal infection

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2
Q

In a person aged 15-25 with sore throat persisting >2 weeks, what should you suspect?

A

Infective mononucleosis

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3
Q

Why do the majority of sore throats not need antibiotics?

A

Over 2/3 of sore throats are viral

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4
Q

What is the most common cause of bacterial sore throat?

Treatment?

A

Streptococcus pyogenes
aka Group A streptococcus
aka Group A beta haemolytic strep
Penicillin

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5
Q

How does Strep pyogenes show on gram stain + haemolysis?

What do you need to keep in mind with this organism?

A

Gram positive cocci in chains
Complete - beta haemolysis
Extra contact precautions need to be taken into account

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6
Q

Give two late complications of streptococcal sore throat

A 
Rheumatic fever 
- 3 weeks after sore throat
- Fever, arthritis pancarditis 
Glomerulonephritis 
- 1-3 weeks after sore throat 
- Haematuria, albuminuria, oedema
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7
Q

Severe sore throat with a grey white membrane across the pharynx = ?
Which organism and what does it produce?

A

Diphtheria
Corynebacterium diphtheriae
Produces a potent endotoxin which is cardiotoxic and neurotoxic

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8
Q

What type of vaccine is that for diphtheria?

A

Toxoid

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9
Q

What is the treatment for diphtheria?

A

Antitoxin

Penicillin/erythromycin

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10
Q

White patches on red, raw mucous membranes in throat/mouth = ?
Organism?
Cause?
Treatment?

A

Candida/thrush
Candida albicans
Cause - endogenous
Nystatin

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11
Q 
What is acute otitis media?
How does it present?
What should you remember about the microbiology?
Diagnosis?
Treatment?
A

An upper respiratory infection involving the middle ear by extension of infection up the eustachian tube.
Ear ache
Usually viral with secondary bacterial infection
Swab of pus if eardrum perforates – otherwise samples can’t be obtained
80% resolve in 4 days without antibiotics
First line – amoxicillin
Second line – erythromycin

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12
Q

What is acute sinusitis?
What might indicate secondary infection?
Treatment?

A

Mild discomfort over frontal or maxillary sinuses due to congestion often seen in patients with upper respiratory viral infections.
However, severe pain and tenderness with purulent nasal discharge indicates secondary bacterial infection.
Av. length illness 2.5 weeks. Reserve antibiotics for severe/deteriorating cases of >10 days duration.
1ST LINE penicillin V
2ND LINE doxycycline – NOT IN CHILDREN!!!

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13
Q

What is otitis externa?

A

Inflammation of the outer ear canal

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14
Q
  • Redness and swelling of the skin of the ear canal
  • It may be itchy (especially in the early stages)
  • Can become sore and painful
  • There may be a discharge, or increased amounts of ear wax
  • If the canal becomes blocked by swelling or secretions, hearing can be affected
    What is it?
A

Otitis externa

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15
Q

Management of otitis externa?

A

Management
- Topical aural toilet
- Swab to microbiology and prescription of antimicrobial reserved for unresponsive or severe cases
Treat depending on culture results
- Topical clotrimazole (trade name canesten) for Aspergillus niger,
- Gentamicin 0.3% drops

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16
Q

What is malignant otitis?

Most common causative organism?

A

Malignant otitis externa is an extension of otitis externa into the bone surrounding the ear canal (i.e. the mastoid and temporal bones). Malignant otitis, without treatment, is a fatal condition. Osteomyelitis will progressively involve the skull and meninges.
Pseudomonas aeruginosa

17
Q

What are some symptoms and signs of malignant otitis?

A

Symptoms: Pain and headache, more severe than clinical signs would suggest.
Signs: Granulation tissue at bone–cartilage junction of ear canal; exposed bone in the ear canal. Facial nerve palsy (drooping face on the side of the lesion).

18
Q

Name two risk factors for malignant otitis

A

Diabetes

Radiotherapy to head and neck

19
Q
  • Fever
  • Enlarged lymph nodes
  • Sore throat, pharyngitis, tonsillitis
  • Malaise, lethargy
    Diagnosis?
A

Infective mononucleosis

20
Q

What is the classic triad of infective mononucleosis?

A

Fever
Pharyngitis
Lymphadenopathy

21
Q

What are some other symptoms and signs of infective mononucleosis?

A 
Jaundice/hepatitis
Rash
Haematology - Leucocytosis (lymphocytosis), presence of atypical lymphocytes in blood film
Splenomegaly
Palatal petechiae
22
Q

What are some possible complications of infected mononucleosis?

A
  • Anaemia, thrombocytopenia
  • Splenic rupture
  • Upper airway obstruction
    Increased risk of lymphoma, especially in immunosuppressed
23
Q

Organism responsible for infective mononucleosis?

What are the two phases of primary infection?

A

Epstein-Barr virus

  • Primary infection in early childhood rarely results in infectious mononucleosis
  • Primary infection in those >10 years often causes infectious mononucleosis
24
Q

Treatment for infective mononucleosis?

A 
Bed rest
Paracetamol
Avoid sport
Antivirals not clinically effective
Corticosteroids may have a role in some complicated cases
25
Q

Describe the two types of herpes simplex virus

A
  • Types 1 and 2
  • Type 1 acquired in childhood
  • HSV1 is cause of oral lesions
  • 70% UK adults have been infected
  • Infection through saliva contact
    Genital herpes: obviously a disease of adults and 50% is caused by HSV1, 50% by HSV2. HSV2 tends to cause more reactivations. HSV2 very rarely seen in oral lesions.
26
Q
  • Systemic upset
  • Lips, buccal mucosa, hard palate
  • Vesicles 1-2mm, ulcers
  • Fever, local lymphadenopathy
  • May take up to 3 weeks to recover
    What is it?
    Treatment?
A

Primary gingivostomatitis

Aciclovir

27
Q

Treatment of cold sore?

A

Aciclovir

28
Q

What is herpetic whitlow?

Who is at risk?

A

Herpes simplex abscess at the end of the finger

Doctors and densists

29
Q

How can you confirm a diagnosis of HSV?

A

Swab of lesion in virus transport medium - detection of viral DNA by PCR

30
Q

Main symptom of herpangia?
Organism?
Diagnosis?

A

Vesicles/ulcers on soft palate
Coxsackie viruses (not HSV) - enterovirus
Diagnosis clinically or by PCR test of swab in viral transport medium

31
Q

Organism causing hand, foot and mouth disease?

A

Coxsackie virus

32
Q

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

A

Apthous ulcers

33
Q

Give five possible causes of recurrent oral ulcers associated with systemic disease

A 
Behcet's disease
Gluten-sensitive enteropathy or IBD
Reiter's disease
Drug reactions
Skin diseases - lichen planus, pemphigus,or pemphigoid
34
Q

Give some features of Behcet’s disease
Which systems are involved?
Where in the world do you get it?

A 
Recurrent oral ulcers
Genital ulcers
Uveitis. 
It can also involve visceral organs such as the gastrointestinal tract, pulmonary, musculoskeletal, cardiovascular and neurological systems
Commonest in Middle East and Asia
35
Q

Syphilis
Mainsymptom?
Causative organism?

A

Painless indurated ulcer at site of entry of bacterium Treponema pallidum.

ENT (10 decks)

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