Microbiology Flashcards
Most common causative organism of bacterial sore throat
Streptococcus pyogenes (group A strep)
Treatment for group A strep/strep pyogenes
Penicillin
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
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
Severe sore throat with a grey white membrane across the pharnyx
Diptheria
Treatment for diptheria
Antitoxin and supportive care
And penicillin/erythromycin
Treatment for oral candida/thrush
Nystatin
White patched on red, raw mucous membranes in throat/mouth
Candida/thrush - treat with nystatin
How would you investigate diseases of the middle ear
You can take a swab if the eardrum perforates, otherwise samples can’t be obtained
Treatment for infections of the middle ear
80% resolve in 4 days without treatment
1st line - amoxicillin
2nd line - erythromycin
Treatment for acute sinusitis
Reserve treatment for really severe cases
1st line Penicillin V
2nd line doxycycline (not in children)
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
Risk factors for malignant otitis externa
Diabetes
Radiotherapy to head and neck
Symptoms of malignant otitis externa
Pain and headache more severe than clinical signs would suggest
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)
Investigations for malignant otitis externa
Plasma viscosity and CRP to demonstrate an inflammatory response, radiological imaging, biopsy and culture
Which organism usually responsible for malignant otitis externa?
Pseudomonas aeruginosa
Otitis externa treatment and treatment based on culture results
1) give topical aural toilet
2) Clotrimazole for fungal infections
3) Gentamicin 0.3% drops
Treatment for FUNGAL otitis externa
Clotrimazole
Atypical lymphocytes
Infectious monenucleosis
Complications of glandular fever
Protracted but self-limiting illness Anaemia, low platelets Splenic rupture Upper airway obstruction Increased risk of lymphoma, especially in immunosuppressed
What virus causes glandular fever
EBV
Treatment of glandular fever
Bed rest Paracetamol Avoid sport Antivirals not clinically effective Corticosteroids may have a role in some complicated cases
How to confirm glandular fever
Epstein virus IgM
Heterophile antibody - paul bunnell test, monospot test
Blood count and film
LFTs
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
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
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
CT
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
