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2 ENT > Microbiology > Flashcards

Microbiology Flashcards

1
Q

how do HSV1 infections spread

A

through saliva contact

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2
Q

symptoms of HSV1

A

oral lesion

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3
Q

what is primary gingivostomatitis

A

disease of preschool children

primary HSV1 infection leading to

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4
Q

symptoms of primary gingivostomatitis

A

systemic upset, fever, lymphadenopathy

lips, buccal mucosa, and hard palate involved

vesicles 1-2mm long

ulcers

may take up to 3 weeks to recover

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5
Q

treatment for primary gingivostomatitis due to HSV1

A

Aciclovir

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6
Q

what happens after primary infection of HSV1

A

Latency

inactive form of the virus is in sensory nerve cells

it can reactivate to re-infect mucosal surfaces

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7
Q

what is a cold sore

A

reactivation from latent HSV1 causes activation

tend to decrease in frequency - only half of infected people get clinical recurrences

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8
Q

treatment for cold sores

A

aciclovir therapy or suppression

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9
Q

how to confirm HSV

A

swab lesion in virus transport medium

detection of viral DNA by PCR

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10
Q

what is herpangina

A

vesicles/ulcers on the soft palate

coxsackie viruses (not HSV)

also tends to be in young children

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11
Q

how do you diagnose herpangina

A

PCR test of swap in viral transport medium

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12
Q

what is hand, foot and mouth disease

A

coxsackie virus infection

family outbreaks common

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13
Q

how do you diagnose hand. foot and mouth disease

A

clinically or by PCR test of swab

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14
Q

what is chancre

A

painless indurated (hardened) ulcer caused by primary syphilis

most commonly genital but can also be oral

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15
Q

what bacteria causes syphilis

A

treponema pallidum

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16
Q

what are pathos ulcers

A

non viral, self limiting, recurring painful ulcers of the mouth

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17
Q

symptoms of apthous ulcers

A

painful ulcers that are round or ovoid and have inflammatory halos

confined to mouth

absence of systemic disease

begin in childhood but chill in 3rd decade

each ulcer lasts <3 weeks

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18
Q

what systemic diseases are associated with recurrent ulcers

A 
Behcet's disease
gluten-sensitive enteropathy or IBD
Reiter's disease
Drug reactions 
Skin diseases
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19
Q

who gets acute throat infection

A

children ages 5-10

young people aged 15-25

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20
Q

presentation of acute throat infection

A

pain at back of mouth

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21
Q

what is acute pharyngitis

A

inflammation of the part of the throat behind the soft palate (oropharynx)

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22
Q

what is tonsillitis

A

inflammation of the tonsils

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23
Q

causes of acute throat infection in primary care

A

viral or bacterial infection

common cold
influenza
streptococcal infection

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24
Q

what are some non infectious causes of acute sore throat

A

uncommon but include:

physical irritation (reflux disease, alcohol, smoking, hay fever)

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25
Q

how do diagnose an acute sore throat

A

history and clinical examination

throat swabs should not be carried out routinely in primary care

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26
Q

complications of an acute sore throat

A

Ottis media
peritonsillar abscess
para-pharyngeal abscess
mastoiditis

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27
Q

management of an acute sore throat

A

self care advice
antibiotics (only where appropriate)
identify and manage immunosuppressed people

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28
Q

when should you refer someone with a sore throat

A

suspicion of throat cancer
lasts 3-4 weeks (pain on swelling for >3 weeks)
red or red and white patches, ulceration or swelling that persists >3 weeks

stridor/respiratory difficulty is an emergency

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29
Q

self care steps for a sore throat

A

regular analgesia (paracetamol, ibuprofen)

medicated lozenges (local anaesthetic, analgesia or antiseptic)

adequate fluid intake

mouthwashes/gargles/spray

30
Q

what is the most common cause of a sore throat

A

VIRAL (doesn’t need antibiotics)

31
Q

what is the most common bacterial cause of a sore throat

A

streptococcus progenies (group a step)

32
Q

clinical presentation of a strep infection (throat)

A

acute follicular tonsillitis

33
Q

treatment for a group A strep infection (strep progenies)

A

penicillin

34
Q

characteristics of strep progenies

A

gram +ve cocci in chains

beta-haemolysis

35
Q

complications of strep progenies infection

A

rheumatic fever
(3 weeks post sore throat, fever, arthritis, pancarditis)

glomerulonephritis
(1-3 weeks post sore throat, haematuria, albuminuria and oedema)

36
Q

you need to score 4/5 of what criteria to have a 65% risk of group A strep infection

A 
5-15 year olds 
tonsillar exudate
tender anterior cervical lymph nodes
history of fever 
absence of cough
37
Q

steps to take if a sore throat presents in someone on DMARDS

A

FBC

seek urgent specialist advice if patient has low white cell count

38
Q

what is neutropenia

A

low neutrophils

increases risk of infection

39
Q

what can cause neutropenia

A

drugs eg. carbimazole
chemo
immunosuppressants

40
Q

when should you consider phnoxymethypenicillin

A

fever or pain score 4/5

Centor 3 or 4

41
Q

what is diphtheria

A

corynebacterium diphtheria infection

42
Q

presentation of diphtheria

A

severe sore throat with grey white membrane across the pharynx

the organism produces a potent exotoxin which is cardiotoxic and neurotoxic

43
Q

why is diphtheria rare

A

there is a vaccine - made from cell-free purified toxin

44
Q

treatment for diphtheria

A

antitoxin and supportive

penicillin/erythromycin

45
Q

what is infectious mononucleosis

A

glandular fever

disease of young adults

46
Q

symptoms of glandular fever

A 
fever 
enlarged lymph nodes
sore throat 
pharyngitis, tonsillitis 
malaise 
lethargy 
jaundice/hepatitis 
rash 
haematology (leucocytosis, prince of atypical lymphocytes in blood film)
splenomegaly 
palatal petechiae
47
Q

complications of glandular fever

A 
anaemia 
thrombocytopenia 
splenic rupture 
upper airway obstruction 
increased risk of lymphoma (especially in immunosuppressed)
48
Q

what virus causes glandular fever

A

eptsein-barr virus

virus of the herpes family which establishes a persistent infection in epithelial cells

49
Q

what are the 2 phases of EBV infection

A

primary in childhood - rarely causes infectious mononucleosis

primary infection in those >10 usually causes mononucleosis

50
Q

management for infectious mononucleosis

A

best rest
paracetamol
avoidance of sport
corticosteroids (controversial)

51
Q

investigations for EBV

A

EBV IgM
Heterophile antibody
blood count and film
liver function tests

52
Q

how does an oral candida infection present

A

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

53
Q

causes of candida

A

endogenous (post antibiotics, immunosuppressed, smokers, inhaled steroids)

54
Q

treatment for oral candida

A

nystatin or fluconazole

55
Q

what is acute otitis media

A

upper respiratory infection involving the middle ear by extension of the virus u the Eustachian tube

most common in infants and children

56
Q

what are the most common bacteria to infect the middle ear

A

h. influenzas
strep pneumoniae
strep pyroxenes

usually viral with bacterial as a secondary infection

57
Q

how do you diagnose middle ear infections

A

swab of pus if eardrum perforated

otherwise a sample can’t be obtained

58
Q

treatment for middle ear infections

A

(80% resolves in 4 days)

first line - amoxicillin
second line - erythromycin

59
Q

what is malignant otitis

A

an extension of an ottis media into the bones surrounding the ear canal

without treatment is fatal as osteomyelitis will progressively involve the skull and meninges

60
Q

symptoms of malignant otitis

A

pain and headache - more severe than clinical signs would suggest

61
Q

signs of malignant otitis

A

granulation tissue at the bone-cartilage junction of the ear canal

exposed bone in ear canal

facial nerve palsy

62
Q

what investigations are done for malignant otitis

A

plasma viscosity/C-reactive protein to demonstrate and inflammatory response

imaging

biopsy and culture

63
Q

what are some risk factors for malignant otitis

A

diabetes

radiotherapy

64
Q

what is otitis externa

A

inflammation of the outer ear canal

65
Q

clinical signs of otitis externa

A

redness and swelling of the skin of the ear canal
itchy (esp in early stages)
sore and painful
discharge or increased earwax

if the canal becomes blocked by swelling or secretions hearing loss can be occur

66
Q

what are some bacterial causes of otitis externa

A

staphylococcus aures
proteus spp
pseudomonas aeruginosa

67
Q

what are some fungal causes of otitis externa

A

aspergillus niger

Candida albicans

68
Q

management of otitis externa

A

swab for microscopy
prescription of antimicrobials are for unresponsive or severe cases

treat depending on culture results:

topical clotrimazole (canesten) 
gentamicin
69
Q

presentation of acute sinusitis

A

mild discomfort over frontal or maxillary sinuses due to congestion

seen in patients with upper respiratory viral infections

70
Q

what would indicate a secondary bacterial infection in acute sinusitis

A

severe pain and tenderness with purulent nasal discharge

71
Q

treatment for acute sinusitis

A

av length of illness 2.5 weeks
antibiotics for severe

1st- phenoxymethylpenicilln
2nd - doxycycline (not in children)

2 ENT (15 decks)

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