Microbiology

Question 1

What are the common causes of infection?

Answer 1

Viral or bacterial (non-infectious is not common)

Question 2

When are non-infectious sore throat seen?

Answer 2

physical irritation from reflux, smoking,alcohol

Question 3

What is the most common complication of a sore throat?

Answer 3

otitis media, peri-tonsillar abscess, mastoiditis

Question 4

What is common treatment?

Answer 4

self-limiting

Question 5

What are common causes?

Answer 5

common cold, influenza and strep infection

Question 6

What are less common causes?

Answer 6

HIV, gonoccocal pharyngitis, diptheria

Question 7

When would you refer?

Answer 7

Suspect throat cancer (many weeks of pain in throat + mass)
Pain for more than 3 weeks
Pain/difficulty swallowing >3weeks
Stridor/resp difficulty

Question 8

How will more serious infections be treated?

Answer 8

Antibiotic therapy

Question 9

Why do you need to identify immunosuppressed people?

Answer 9

At greater risk of complications

Question 10

What is most common cause of throat infection?

Answer 10

Strep pyogenes (group a strep)

Question 11

What does it cause?

Answer 11

acute follicular tonsilitis

Question 12

What is the treatment?

Answer 12

Penicillin

Question 13

What infection control do you need to do if patient has resp symptoms and strep pyogenes throat infection?

Answer 13

Drop control (e.g. face mask and apron)

Question 14

What is clinical presentation of diptheria?

Answer 14

severe sore throat with grey/white membrane across the pharynx - produces toxin that is cardiotoxic and neurotoxic

Question 15

What causes diptheria?

Answer 15

Corynebacterium diphtheriae

Question 16

What is treatment?

Answer 16

anti-toxin and supportive and penicillin/erythromycin

Question 17

What causes oral thrush?

Answer 17

candida albicans

Question 18

What is treatment for diptheria?

Answer 18

anti-toxin and supportive and penicillin/erythromycin

Question 19

What causes oral thrush?

Answer 19

candida albicans

Question 20

What is clinical presentation of oral thrush?

Answer 20

white patches on red, raw mucous membranes in throat/mouth

Question 21

What is the treatment of oral thrush?

Answer 21

Nystatin

Question 22

What causes otitis media?

Answer 22

URTI by extention of infection up the eustachian tube

Question 23

Clinical presentation of otitis media?

Answer 23

earache +/- discharge

Question 24

Treatment?

Answer 24

amoxicillin or erythromycin (if not resolved within 4 days)

Question 25

How would you diagnose otitis media?

Answer 25

Swab if tympanic membrane rupture and pus

Question 26

Treatment of otitis media?

Answer 26

amoxicillin or erythromycin (if not resolved within 4 days)

Question 27

What is acute sinusitis?

Answer 27

mild discomfort over frontal and maxillary sinuses due to congestion seen in patients with URTI (viral) - pain and tenderness with purulent discharge suggests secondary bacterial infection.

Question 28

What is a risk factor for otitis externa?

Answer 28

Swimming

Question 29

What is the management otisis externa?

Answer 29

Clean and dry until ear recovers | Swab and use topical clotrimazole or gentamicin drops for more serious infections (or resistant)

Question 30

WHat is infectious mononucleosis?

Answer 30

Glandular fever (disease of young adults)

Question 31

What is infectious mononucleosis?

Answer 31

Glandular fever (disease of young adults)

Question 32

What is clinical presentation of infectious mononucleosis?

Answer 32

``` Fever (all day) lymphadenopathy sore throat pharyngitis tonilitis malaise lethargy (may have jaundice, rash) ```

Question 33

When will the rash appear more florid in infectious mononucleosis?

Answer 33

If amoxicillin is given

Question 34

What will be found in a blood film of someone with mononucleosis?

Answer 34

Atypical lymphocytes | Leukocytosis

Question 35

What are treatment?

Answer 35

Self-limiting

Question 36

What are complications of infectious mononucleosis?

Answer 36

anaemia, thrombocytopenia, splenic rupture (due to splenomegaly), upper airway obstruction, increased risk of lymphoma

Question 37

What is the main cause of infectious mononucleosis?

Answer 37

Epstein-Barr Virus

Question 38

What family is EBV from?

Answer 38

Herpes virus

Question 39

Describe EBV infection?

Answer 39

persistent infection in the epithelial cells (in the pharynx)

Question 40

If a child becomes infected with EBV before 10 years will they present infection?

Answer 40

NO

Question 41

If EBV primary infection occurs >10 what happens?

Answer 41

Present with infectious mononucleosis

Question 42

What is the therapy of infectious mononucleosis?

Answer 42

``` Best rest paracetamol avoid sport anti-virals not clinically effective corticosteroids in complicated cases (in patients with occluded upper airway or thrombocytopenia or anaemia) ```

Question 43

How is infectious mononucleosis confirmed?

Answer 43

``` EBV IgM test Heterophile antibody - monospot test/paul-bunnell test Blood count and film LFTs ```

Question 44

What does cytomegalovirus cause?

Answer 44

similar virus to mononucleosis and is a strain of herpes family

Question 45

What do toxoplasmmosis and cytomegalovirus have in common?

Answer 45

Cause glandulary fever type illness but can affect the foetus and cause foetal defects

Question 46

If negative EBV then what do you test for?

Answer 46

Primary HIV infection

Question 47

What causes gingivostomatitis?

Answer 47

HSV type 1

Question 48

What are the clinical presentation of gingivostomatitis?

Answer 48

ulceration on lips, buccal mucosa and hard palate fever lymphadenopathy may spread beyond mouth (life threatening if eczema)

Question 49

How do you treat gingivostomatitis?

Answer 49

aciclovir

Question 50

Does herpes simplex virus reactivate?

Answer 50

Yes periodically as it is latent in the nerve fibres (cold sores)

Question 51

What can you give to a patient with lots of cold sores?

Answer 51

aciclovir daily to keep latent

Question 52

What is a danger for dentists and anaesthetists?

Answer 52

Herpetic whitlow (but will be prevented with gloves)

Question 53

How do you confirm HSV?

Answer 53

swab for viral DNA PCR

Question 54

What can HSV sometimes present as (rare and serious)?

Answer 54

herpes simplex encephalitis

Question 55

What causes herpangina?

Answer 55

coxsackie virus

Question 56

Where does herpangina effect?

Answer 56

soft palate

Question 57

How is herpangina treated?

Answer 57

self-limiting

Question 58

What are apthous ulcers?

Answer 58

non-viral painful recurring ulcers of that mouth that are round or ovoid and have inflammatory halos

Question 59

Clinical presentation of apthous ulcers?

Answer 59

self-limiting, recurrent, painful, confined to mouth, no systemic disease, ulcer lasts less than 3 weeks

Question 60

What can also cause recurrent ulcers?

Answer 60

Behcet's disease, Crohn's. IBD, drug reactions, skin disease (pemphigus/pemphigoid)

Question 61

When will syphillus been seen at mouth?

Answer 61

when oral sex with someone with a syphylis infection