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ENT > Microbiology > Flashcards

Microbiology Flashcards

1
Q

Most common causative organism of bacterial sore throat

A

Streptococcus pyogenes (group A strep)

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2
Q

Treatment for group A strep/strep pyogenes

A

Penicillin

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3
Q

What should you do with the patient who has strep A/strep pyogenes

A

Isolate the patient until they have been on antibiotics for 48 hours
Droplet precautions i.e. wear mask and gloves and apron

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4
Q

Name two late complication of strep throat and how they presents

A

Rheumatic fever - occurs three weeks post sore throat, fever arthritis and pancarditis

Glomerulonephritis
1-3 weeks post sore throat
Haematuria, albuminuria and oedema

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5
Q

Severe sore throat with a grey white membrane across the pharnyx

A

Diptheria

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6
Q

Treatment for diptheria

A

Antitoxin and supportive care

And penicillin/erythromycin

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7
Q

Treatment for oral candida/thrush

A

Nystatin

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8
Q

White patched on red, raw mucous membranes in throat/mouth

A

Candida/thrush - treat with nystatin

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9
Q

How would you investigate diseases of the middle ear

A

You can take a swab if the eardrum perforates, otherwise samples can’t be obtained

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10
Q

Treatment for infections of the middle ear

A

80% resolve in 4 days without treatment
1st line - amoxicillin
2nd line - erythromycin

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11
Q

Treatment for acute sinusitis

A

Reserve treatment for really severe cases
1st line Penicillin V
2nd line doxycycline (not in children)

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12
Q

What is malignant otitis externa?

A

An extension of otitis externa into the bone surrounding the ear canal (i.e. the mastoid and temporal bones)

Malignant otitis is fatal without treatment

Osteomyelitis will progressively involve the skin and the meninges

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13
Q

Risk factors for malignant otitis externa

A

Diabetes

Radiotherapy to head and neck

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14
Q

Symptoms of malignant otitis externa

A

Pain and headache more severe than clinical signs would suggest

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15
Q

Signs of malignant otitis externa

A

Granulation tissue at bone-cartilage junction of ear canal – exposed bone in the ear canal
Facial nerve palsy (drooping of face on the side of the lesion)

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16
Q

Investigations for malignant otitis externa

A

Plasma viscosity and CRP to demonstrate an inflammatory response, radiological imaging, biopsy and culture

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17
Q

Which organism usually responsible for malignant otitis externa?

A

Pseudomonas aeruginosa

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18
Q

Otitis externa treatment and treatment based on culture results

A

1) give topical aural toilet
2) Clotrimazole for fungal infections
3) Gentamicin 0.3% drops

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19
Q

Treatment for FUNGAL otitis externa

A

Clotrimazole

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20
Q

Atypical lymphocytes

A

Infectious monenucleosis

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21
Q

Complications of glandular fever

A 
Protracted but self-limiting illness
Anaemia, low platelets
Splenic rupture
Upper airway obstruction
Increased risk of lymphoma, especially in immunosuppressed
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22
Q

What virus causes glandular fever

A

EBV

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23
Q

Treatment of glandular fever

A 
Bed rest
Paracetamol
Avoid sport
Antivirals not clinically effective
Corticosteroids may have a role in some complicated cases
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24
Q

How to confirm glandular fever

A

Epstein virus IgM
Heterophile antibody - paul bunnell test, monospot test
Blood count and film
LFTs

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25
Q

Which HPV type causes oral ulcerations

A

HSV1 most common, also HSV2

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26
Q

What causes primary gingivostomatitis

A 
HSV 1
Disease of pre-school children
primary infection
systemic upset
lips, buccal mucosa, hard palate
vesicles 1-2mm
ulcers
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27
Q

Treatment of primary gingiostomatitis

A

Aciclovir

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28
Q

What is herpetic whitlow

A

Basically when someone gets herpes on their hands - why dentists have to use gloves

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29
Q

How to confirm HSV

A

Swab of lesion - detection of viral DNA by PCR (red top)

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30
Q

What is herpangina

A

Vesicles and ulcers on soft palate caused by coxsackie virus
Similar patient age range to primary HSV (gingivostomatitis- i.e. school children)

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31
Q

What virus causes herpangina?

A

Coxsackie virus

32
Q

Which viruses cause hand, foot and mouth disease?

A

Coxsackie virus

33
Q

How to diagnose hand, foot and mouth disease

A

Diagnose clinically or by PCR test of swab

34
Q

What is Behcet’s disease

A

Recurrent oral ulcers
Genital ulcers
Uveitis
It can also involve visceral organs such as the GI tract, pulmonary, MSK and cardiovascular and neurological systems

Commones in middle east and asia

35
Q

What is a chancre

A

Painless indurated ulcer at site of entry of bactierum treponema pallidum

Most common site it genital but oral lesions can be the site of entry

If left undiagnosed, can progress to secondary and tertiary syphillis

36
Q

Which antibiotic must you avoid in glandular fever?

A

Must avoid ampicillin - will cause rash!!!

37
Q

Diagnosis of glandular fever

A

Atypical lymphocytes in peripheral blood
+ve monospot/paul bunnell
Low CRP <100

38
Q

These make up 80-90% of cerebellopontine angle tumours

A

Vestibular schwannoma

39
Q

Associated with the vestibular portion of the vestibulocochlear nerve (VII)

A

Vestibular schwanomma

40
Q

NF II

A

Bilateral vestibular schwannoma
Multiple meningiomas
Gliomas
Café au lait

41
Q

Bilateral vestibular schwannoma
Multiple meningiomas
Gliomas
Café au lait

A

NF II

42
Q

Widespread neurofibromas. Bony defects, café au lait spots, axillary freckling, Lisch nodules

A

NF I

43
Q

NF I

A

Widespread neurofibromas. Bony defects, café au lait spots, axillary freckling, Lisch nodules

44
Q

A young person has nasal polyps, what should you consider?

A

Cystic fibrosis

45
Q

pANCA

A

Microscopic polyangitis

46
Q

cANCA

A

Wegeners

47
Q

Nasopharyngeal carcinoma has a strong association with which virus?

A

EBV

also association with volatile nitrosamines in food

48
Q

Seen in association with Burkitt’s lymphoma, other B-cell lymphomas and Hodgkin’s lymphoma

A

EBV

49
Q

Squamous papilloma in head and neck cancers is linked with which virus?

A

HPV

50
Q

Commonest tumour in head and neck?

A

Squamous cell carcinoma

51
Q

Risk factors for squamous cell carcinoma in head and neck

A

Majority linked to smoking and alcohol

Also related to HPV

52
Q

Which HPV is associated with head and neck cancers?

A

Most related to HPV 16

53
Q

Sialolithiasis

A

Salivary gland stones

54
Q

Paramyxovirus

A

Mumps, bilateral parotitis
Associated orchitis
Risk of secondary meningitis

55
Q

Warthins tumour has a strong association with what?

A

Strong association with smoking
Usually males over the age of 50
(benign tumour)

56
Q

Cetirizine

A

Anti-histamine

57
Q

Pseudonephrine

A

Decongestant

58
Q

Treatment of nasal polyps

A

Treat with oral and then topical steroids

59
Q

Symptoms of acute infective rhinosinusitis

A

Facial pain
Discharge
Nasal blockage

60
Q

You think a child has a foreign body in their nose what do you do

A

Refer urgently

61
Q

When would you use a plain radiograph?

A

if you think there is an inhaled or ingested foreign body

62
Q

Imaging modality for skull base

A

MRI

63
Q

Imaging modality for larynx

A

CT

64
Q

How is most sinus surgery performed now?

A

FESS

Functional endoscopic sinus surgery

65
Q

Imaging modality for sensorineural deafness?

A

MRI

66
Q

Imaging modality for conductive deafness?

A

CT

Conductive = CT

67
Q

Someone with unexplained hoarseness what do you do?

A

Request a CXR and refer urgently to ENT

68
Q

Otitis externa in diabetics, what antibiotic should you treat with?

A

Ciproflxacin

69
Q

A 3-year-old boy is brought to surgery. His mum reports that he has been complaining of a sore left ear for the past 2-3 weeks. This morning she noticed some ‘green gunge’ on his pillow. On examination his temperature is 37.8ºC. Otoscopy of the right ear is normal. On the left side the tympanic membrane cannot be visualised as the ear canal is full with a yellow-green discharge. What is the most appropriate action?

A

Amoxicillin and review in 2 weeks

70
Q

Otitis externa in diabetics, what antibiotic should you treat with?

A

Ciprofloxacin to cover for gram negative)

71
Q

A 28-year-old Bangladeshi woman presents with a three day history of sweats, headache, lethargy and muscle aches. On examination she has bilateral tender swellings in the submandibular region.

A

Reactive lymph nodes - she probably has the flu

  • By far the most common cause of neck swellings
  • there may be a history of local infection or generalised viral illness
72
Q

Pulsatile lateral neck mass which doesn’t move on swallowing

A

Carotid aneurysm

73
Q

Unilateral foul smelling discharge and deafness

A

Cholesteatoma

74
Q

Apparently can help prevent attacks of Menieres even though stephen jones says no

A

Betahistine

75
Q

A 74-year-old man presents with an 8-week history of right sided otalgia. This is associated with a sore throat and odynophagia. He smokes 20 cigarettes every day and is known to be a heavy drinker. On examination of the ear, there are no abnormalities noted

A

Referred pain from nasopharyngeal carcinoma

76
Q

How long would it take for eardrum to heal?

A

Takes 6-8 weeks, so if someone perforates their eardrum then watch and wait and if it persists beyond 6 weeks, refer to ENT

ENT (3 decks)

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