Microbiology Flashcards by Gill Mill

Most common causative organism of bacterial sore throat

Streptococcus pyogenes (group A strep)

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Treatment for group A strep/strep pyogenes

Penicillin

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

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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Name two late complication of strep throat and how they presents

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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Severe sore throat with a grey white membrane across the pharnyx

Diptheria

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Treatment for diptheria

Antitoxin and supportive care

And penicillin/erythromycin

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Treatment for oral candida/thrush

Nystatin

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

Candida/thrush - treat with nystatin

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How would you investigate diseases of the middle ear

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

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Treatment for infections of the middle ear

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

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Treatment for acute sinusitis

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

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What is malignant otitis externa?

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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Risk factors for malignant otitis externa

Diabetes

Radiotherapy to head and neck

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Symptoms of malignant otitis externa

Pain and headache more severe than clinical signs would suggest

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Signs of malignant otitis externa

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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Investigations for malignant otitis externa

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

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Which organism usually responsible for malignant otitis externa?

Pseudomonas aeruginosa

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Otitis externa treatment and treatment based on culture results

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

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Treatment for FUNGAL otitis externa

Clotrimazole

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Atypical lymphocytes

Infectious monenucleosis

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Complications of glandular fever

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

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What virus causes glandular fever

EBV

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Treatment of glandular fever

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

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How to confirm glandular fever

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

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Which HPV type causes oral ulcerations

HSV1 most common, also HSV2

What causes primary gingivostomatitis

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

Treatment of primary gingiostomatitis

Aciclovir

What is herpetic whitlow

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

How to confirm HSV

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

What is herpangina

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

What virus causes herpangina?

Coxsackie virus

Which viruses cause hand, foot and mouth disease?

Coxsackie virus

How to diagnose hand, foot and mouth disease

Diagnose clinically or by PCR test of swab

What is Behcet's disease

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

What is a chancre

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

Which antibiotic must you avoid in glandular fever?

Must avoid ampicillin - will cause rash!!!

Diagnosis of glandular fever

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

These make up 80-90% of cerebellopontine angle tumours

Vestibular schwannoma

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

Vestibular schwanomma

NF II

Bilateral vestibular schwannoma Multiple meningiomas Gliomas Café au lait

NF II

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

NF I

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

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

Cystic fibrosis

pANCA

Microscopic polyangitis

cANCA

Wegeners

Nasopharyngeal carcinoma has a strong association with which virus?

EBV | also association with volatile nitrosamines in food

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

EBV

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

HPV

Commonest tumour in head and neck?

Squamous cell carcinoma

Risk factors for squamous cell carcinoma in head and neck

Majority linked to smoking and alcohol | Also related to HPV

Which HPV is associated with head and neck cancers?

Most related to HPV 16

Sialolithiasis

Salivary gland stones

Paramyxovirus

Mumps, bilateral parotitis Associated orchitis Risk of secondary meningitis

Warthins tumour has a strong association with what?

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

Cetirizine

Anti-histamine

Pseudonephrine

Decongestant

Treatment of nasal polyps

Treat with oral and then topical steroids

Symptoms of acute infective rhinosinusitis

Facial pain Discharge Nasal blockage

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

Refer urgently

When would you use a plain radiograph?

if you think there is an inhaled or ingested foreign body

Imaging modality for skull base

MRI

Imaging modality for larynx

How is most sinus surgery performed now?

FESS | Functional endoscopic sinus surgery

Imaging modality for sensorineural deafness?

MRI

Imaging modality for conductive deafness?

CT | Conductive = CT

Someone with unexplained hoarseness what do you do?

Request a CXR and refer urgently to ENT

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

Ciproflxacin

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?

Amoxicillin and review in 2 weeks

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

Ciprofloxacin to cover for gram negative)

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.

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

Pulsatile lateral neck mass which doesn't move on swallowing

Carotid aneurysm

Unilateral foul smelling discharge and deafness

Cholesteatoma

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

Betahistine

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

Referred pain from nasopharyngeal carcinoma

How long would it take for eardrum to heal?

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