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ENT > Microbiology > Flashcards

Microbiology Flashcards

1
Q

Sore throat, with what else, should be immediately referred to hospital and not examined?

A

Stridor or respiratory difficulty

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2
Q

Pain at the back of the mouth is most likely to be which conditions?

A

Tonsilitis or pharyngitis

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3
Q

What is acute pharyngitis?

A

Inflammation of the oropharynx

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4
Q

Most cases of tonsillitis and pharyngitis are caused by what?

A

Viruses

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5
Q

What age groups are most likely to present with tonsillitis/pharyngitis?

A

5-10 and 15-25

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6
Q

Should throat swabs be carried out routinely in primary care? Why/why not?

A

No- they will most likely just show commensals

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7
Q

If a sore throat and lethargy persists into a second week, what should be suspected? (Especially if the individual is 15-25)

A

Infectious mononucleosis

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8
Q

What are some indications for a referral in an individual with a sore throat?

A

Suspicion of cancer, sore throat for 3-4 weeks, dysphagia/odynophagia for > 3 weeks, stridor or respiratory difficulty

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9
Q

If tonsillitis/pharyngitis is bacterial, what is the most likely cause?

A

Group A strep (strep pyogenes)- strep throat

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10
Q

What 4 factors (Centor criteria) increase the likelihood of a sore throat being caused by GAS?

A

Tonsillar exudates, anterior cervical lymphadenopathy, no cough, fever

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11
Q

Strep throat is most likely in what age group?

A

5-15

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12
Q

What should always be checked in an immunocompromised person with a sore throat?

A

FBCs

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13
Q

If GAS is found to be the cause of a sore throat, what should it be treated with?

A

Penicillin

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14
Q

Patients with GAS throat infections should really be isolated until they have been on antibiotics for how long?

A

48 hours

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15
Q

What are 3 late complications of a GAS sore throat?

A

Rheumatic fever, glomerulonephritis, peritonsillar abscess

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16
Q

How will rheumatic fever present, post GAS throat infection?

A

3 weeks after- fever, arthritis, pancarditis

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17
Q

How will glomerulonephritis present, post GAS throat infection?

A

1-3 weeks after- haematuria, albuminuria, oedema

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18
Q

What organism causes diphtheria?

A

Corynebacterium diphtheriae

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19
Q

How will diphtheria present?

A

Severe sore throat with a grey/white membrane across the pharynx

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20
Q

Describe the toxin produced in diphtheria?

A

Potent exotoxin- cardio/neurotoxic

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21
Q

How should diphtheria be treated?

A

Vaccination, anti-toxins and supportive penicillin/erythromycin

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22
Q

What organism causes oral thrush? Where does this come from?

A

Candida albicans- this is a commensal (endogenous cause)

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23
Q

How will oral thrush present?

A

White patches on red raw mucus membranes

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24
Q

How should oral thrush be treated?

A

Nystatin

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25
Q

What forms the classic triad of infectious mononucleosis?

A

Fever, enlarged lymph nodes, pharyngitis

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26
Q

Apart from those in the classic triad, what are some other symptoms of infectious mononucleosis?

A

Malaise, lethargy, jaundice, rash, splenomegaly, abnormal haematology

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27
Q

What may make the rash in infectious mononucleosis worse?

A

Amoxicillin (do not prescribe)

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28
Q

What is the most classic abnormal haematology in infectious mononucleosis?

A

Atypical lymphocytes (large and irregular)

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29
Q

What is the onset of infectious mononucleosis? How long can it last? How is it treated?

A

Insidious over several days, can last 4 weeks, self-limiting with supportive treatment

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30
Q

What are the risks of infectious mononucleosis?

A

Anaemia, thrombocytopenia, splenic rupture, upper airway obstruction

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31
Q

There is an increased risk of what with infectious mononucleosis, especially in the immunocompromised?

A

Lymphoma

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32
Q

What is the cause of infectious mononucleosis?

A

Epstein barr virus

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33
Q

Epstein barr is a virus of what family? It causes a persistent infection where?

A

Herpes family- infection in epithelial cells, especially of the pharynx

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34
Q

What are the 2 phases of primary infection with EBV?

A

Primary infection in childhood, rarely causing glandular fever. Primary infection > 10 years, often causing glandular fever

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35
Q

Are antivirals effective in glandular fever?

A

No

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36
Q

For how long should sport be avoided after glandular fever? Why?

A

6 weeks- risk of splenic rupture

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37
Q

What is the main investigation for glandular fever? What other tests would you do?

A

EBV IgM (serology). Also blood count and film, and LFTs

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38
Q

The Paul Bunnel and Monospot tests can be used to diagnose what?

A

Infectious mononucleosis

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39
Q

What are the 2 extra points on the modified Centor criteria?

A

Aged < 15 add one point, aged > 44 subtract one point

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40
Q

What is the management for a sore throat with a Centor criteria of < 2?

A

No antibiotic or throat culture necessary

41
Q

What is the management for a sore throat with a Centor criteria of 2-3?

A

Throat culture and treat with antibiotics if positive

42
Q

What is the management for a sore throat with a Centor criteria of > 3?

A

Empirical antibiotics

43
Q

What antibiotics should NEVER be given in infectious mononucleosis?

A

Ampicillin/amoxicillin

44
Q

What is acute otitis media?

A

URTI involving the middle ear by extension of infection up the eustachian tube

45
Q

Acute otitis media is primarily a disease of who?

A

Children and infants

46
Q

How will patients with acute otitis media present?

A

EARACHE, discharge, hearing loss, fever and lethargy

47
Q

Infections of the middle ear are often caused by what? There is often what afterwards?

A

Caused by a virus, followed by a secondary bacterial infection

48
Q

What are the most common bacteria causing acute otitis media?

A

Strep pneumoniae, haemophilus influenzae, moraxella catarrhalis, strep pyogenes

49
Q

How can you test for the cause of acute otitis media?

A

Swab of pus if the eardrum perforates (if this hasn’t happened then you cannot test)

50
Q

How soon does acute otitis media usually resolve?

A

Within 4 days without antibiotics

51
Q

If antibiotics are required for otitis media, what are the 1st and 2nd line choices?

A

1st = oral amoxicillin, 2nd = oral erythromycin

52
Q

What is the usual presentation of acute sinusitis?

A

Mild discomfort over the frontal or maxillary sinuses due to congestion

53
Q

Acute sinusitis is often seen in patients with what?

A

URTI

54
Q

What indicates a secondary bacterial infection of acute sinusitis?

A

Severe pain and tenderness with purulent nasal discharge

55
Q

Are samples taken for acute sinusitis? What are the organisms likely to be?

A

No samples, organisms are the same as for otitis media

56
Q

What defines acute and chronic sinusitis?

A

Acute = < 4 weeks, chronic = > 4 weeks

57
Q

What is the average length of acute sinusitis? Antibiotics should be preserved for who?

A

2.5 weeks, antibiotics should be given to severe, deteriorating cases of > 10 days

58
Q

What is the 1st line antibiotic for acute sinusitis?

A

Penicillin V

59
Q

What is the second line antibiotic for acute sinusitis? Who can this not be used in?

A

Doxycycline, can’t be used in children

60
Q

How long should treatment fro acute sinusitis last?

A

10 days

61
Q

Otitis externa is common in who?

A

Swimmers

62
Q

What are some symptoms of otitis externa?

A

Redness and swelling, pain and discharge, itch and maybe affected hearing

63
Q

What is malignant otitis?

A

A type of otitis externa which extends into the bone surrounding the ear canal (mastoid and temporal bones)

64
Q

Why is malignant otitis fatal without treatment?

A

Osteomyelitis will eventually involve the skull and meninges

65
Q

What are some symptoms of malignant otitis?

A

Pain and headache, more severe than clinical signs would suggest. May be facial nerve palsy.

66
Q

In malignant otitis, what may be found at the bone-cartilage junction?

A

Granulation tissue

67
Q

What are some investigations for malignant otitis?

A

Inflammatory markers, radiological imaging, biopsy and culture

68
Q

What organism is usually the cause of malignant otitis?

A

Pseudomonas aeruginosa

69
Q

What are some risk factors for malignant otitis?

A

Diabetic, radiotherapy to the head and neck, immunocompromised

70
Q

What are the main bacterial causes of otitis externa?

A

Staph aureus and pseudomonas aeruginosa

71
Q

What are the main fungal causes of otitis externa?

A

Aspergillus niger and Candida albicans

72
Q

What is the most common management for otitis externa?

A

Topical aural toilet

73
Q

What is the investigation for otitis externa? What is the relevance of this?

A

Swabs to microbiology- preserve an antibiotic for unresponsive or severe cases

74
Q

If a fungal cause of otitis externa is to be treated, what is used?

A

Topical clometrizole and cleaning of the ear

75
Q

If a bacterial cause of otitis externa is to be treated, what is used?

A

Gentamicin 0.3% drops and cleaning of the ear

76
Q

Which type of herpes simplex is the cause of oral lesions? What is the main infection here?

A

Type 1- primary gingivostomatitis

77
Q

How is herpes simplex transmitted?

A

Saliva content

78
Q

How long does primary gingivostomatitis last for? How can it be treated?

A

Can last for 3 weeks, treat with acyclovir

79
Q

Wheres does herpes simplex establish latency?

A

Trigeminal ganglia

80
Q

Herpetic whitlow is an occupational hazard of what?

A

Dentistry and anaesthetics

81
Q

How is HSV confirmed?

A

PCR

82
Q

What causes herpangina, and hand, foot and mouth disease?

A

Coxsackie (enterovirus)

83
Q

Who does herpangina typically present in? How is it tested for?

A

Children- test with PCR (or just clinical diagnosis)

84
Q

How is coxsackie (enterovirus) spread?

A

Faecal oral

85
Q

Describe aphthous ulcers?

A

Recurrent painful ulcers at the back of the mouth that are round and have inflammatory haloes.

86
Q

Are aphthous ulcers systemic?

A

No, confined to the mouth with no other symptoms

87
Q

How long do aphthous ulcers recur for? How long does a single ulcer last?

A

Childhood- 3rd decade. A single ulcer will last < 3 weeks

88
Q

What is Behcets disease?

A

Recurrent oral and genital ulcers with uveitis (can also involve visceral organs)

89
Q

Where is Behcets disease most common?

A

Middle East and Asia

90
Q

Apart from Behcets disease, what are some other causes of recurrent ulcers in association with systemic disease?

A

Coeliac disease, IBD, Reiter’s syndrome, drug reactions, skin disease

91
Q

Why should penicillin be used over amoxicillin?

A

Less toxic

92
Q

Why would amoxicillin be used over penicillin?

A

Better oral absorption, broader spectrum

93
Q

Where is aspergillus normally found?

A

In the environment (not swimming pool water!)

94
Q

What is worrying about invasive aspergillus?

A

Neutropenic post-chemotherapy and those with COPD

95
Q

What are the 4C antibiotics?

A

Clindamycin, cephalosporins (cefriaxone), co-amoxiclav, ciprofloxacin

96
Q

What antibiotics should be given in orbital cellulitis?

A

IV ceftriaxone, flucloxacillin and metronidazole

97
Q

What is the biggest concern with orbital cellulitis?

A

Cavernous sinus thrombosis

98
Q

What is myringitis?

A

Inflammation of the tympanic membrane

ENT (12 decks)

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