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ENT > Microbiology > Flashcards

Microbiology Flashcards

1
Q

which age groups are more susceptible to acute throat infections?

A

5-10 years

15-25 years

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2
Q

if a patient presents with pain at the back of the mouth it could be?

A

acute pharyngitis

tonsilitis

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3
Q

what is acute pharyngitis?

A

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

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4
Q

what is tonsillitis?

A

inflammation of the tonsils

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5
Q

what are the causes of throat pain?

A

viral or bacterial infection

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6
Q

what are the common causes of a sore throat in primary care?

A

usually no life threatening

common cold, influenza, streptococcal

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7
Q

when should infectious mononucleosis be suspected?

A

if sore throat and lethargy persists into the second week, patient aged 15-25 years

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8
Q

what are the less common causes of sore throats?

A

HIV (esp. seroconversion), gonococcal pharyngitis, diphtheria - according to patient history

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9
Q

what should be considered in a patient aged 15-25 years old with a persistent sore throat into its second week?

A

infectious mononucleosis/glandular fever (caused by ebstain Barr virus)

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10
Q

what are non-infectious causes of sore throats?

A

GORD, chronic irritation from cigarette smoke, alcohol or hay fever

look for red flags if persistent

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11
Q

how should sore throats be diagnosed?

A

history and clinical examination

throat swabs should not be carried out routinely in primary care management

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12
Q

what is an indication for admission to hospital if presented with a sore throat?

A

stridor or respiratory difficult and attempts to examine the throat should be avoided

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13
Q

sore throats are usually:

A

self- limiting
resolve in 3 days in 40% of people
within 1 week in 85% of people
irrespective of whether due to streptococcus

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14
Q

what other conditions are associated with a sore throat?

A

otitis media (most common)
peri-tonsillar abscess (quinsy)
para-pharyngeal abscess
mastoiditis

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15
Q

how to manage sore throats?

A

self-care advice: giving simple advice
prescribing antibiotics ONLY where appropriate
identify and manage immunosuppressed people
and those who need admission/referral

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16
Q

when is throat cancer suspected?

A

persistent sore throat , esp if there is a neck mass

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17
Q

which patients with sore throats need admission or referral?

A

suspected throat cancer patients
sore/painful throat lasts for 3-4 weeks, pain on swallowing or dysphagia for more than 3 weeks
red, or red and white patches or ulceration or swelling of the oral/pharyngeal mucosa persists for more than 3 weeks

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18
Q

how can one self-care when having a sore throat?

A 
regular analgesia (paracetamol or ibuprofen to relieve pain and fever)
Medicated lozenges (local anaesthetic , analgesia or antiseptic)
(avoidance of hot drinks
adequate fluid intake to avoid dehydration
Mouthwashes / gargles/ spray – less evidence)
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19
Q

does everyone with a sore throat need antibiotics?

A

vast majority don’t as they are viral infections

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20
Q

what is the most common bacterial cause of a sore throat?

A

streptococcus pyogenes aka group A streptococcus or group A Beta hemolytic Strep

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21
Q

what is the clinical presentation of bacterial sore throats?

A

acute follicular tonsillitis

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22
Q

what is the treatment of bacterial sore throats?

A

penicillin

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23
Q

streptococcus pyogenes:

A

gram positive cocci chains

complete beta-hemolysis

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24
Q

what complications are seen 3 weeks post strep pyogenes infection?

A

rheumatic fever: fever, arthritis and pancarditis

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25
Q

what complications are seen 1-3 weeks post strep pyogenes infection?

A

glomerulonephritis: hematuria, albuminuria and edema

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26
Q

what is the centor score of 0,1,2 mean?

A

17% risk of getting GAS

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27
Q

what is the center score of 3 or 4 mean?

A

32 to 56% of getting GAS

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28
Q

what determines who is likely to get GAS?

A

age, local prevalence and seasonal variation

most likely in 5-15 year olds

progressively less likely in younger/older patients

developed in US Eds for adults but used widely

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29
Q

what is the criteria for calculating the score likelihood of getting GAS?

A 
center criteria: 
tonsillar exudate
ƒtender anterior cervical lymph nodes
ƒhistory of fever (>38)
ƒabsence of cough

One point each
Out of 4 points

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30
Q

what is another criteria for calculating risk of getting GAS?

A

Fever PAIN criteria:

Fever (Last 24 hours)
ƒPurulence
Attend rapidly (w/in 3/7)
V. Inflammed tonsils
No cough/ corryza

One point each

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31
Q

a 0 or 1 score in the fever pain criteria =

A

13 to 18% risk

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32
Q

a 2 or 3 score in the fever pain criteria =

A

34 to 40% risk

33
Q

a 4 or 5 score in the fever pain criteria =

A

62 to 65% risk

34
Q

the fever pain criteria:

A

is not validated for use in children under three years, it is developed in UK Gland 2013 for back up/delayed prescriptions

35
Q

a person with a sore throat on DMARDs should:

A

seek urgent specialist advice/referral if the person has a low white cell count or deteriorates

FBC checked

provide symptomatic relief
consider prescribing an antibiotic taking into account potential interactions with DMARDs

withhold the DMARD while awaiting the result and until discussed with the hospital rheumatology service (or follow local protocols)

36
Q

what causes neutropenia?

A

drugs like carbimazole - idiosyncratic neutropenia

chemotherapy known/suspected leukaemia, asplenia, aplastic anaemia or HIV with low CD4 count or is taking immunosuppressive drug following a transplant

37
Q

what is the management of neutropenia?

A

an urgent FBC and withhold the drug until the result is available. Seek specialist advice. Consider prescribing an antibiotic.
Seek immediate specialist advice or referral.
Check an urgent Full Blood Count urgent

38
Q

when should you consider phenoxymethylpenicillin?

A

fever pain score of 4 or 5

center score of 3 or 4

39
Q

what causes diphtheria?

A

corynebacterium diphtheriae

40
Q

what is the clinical presentation of diphtheria?

A

severe sore throat with a grey white membrane across the pharynx. the organism produces a potent exotoxin which is cardiotoxic and neurotoxic

41
Q

is there a vaccine to prevent diphtheria?

A

yes, made from a cell-free purified toxin extracted from a strain of C diphtheria, toxoid vaccine

42
Q

what is the epidemiology of diphtheria?

A

rare but increased in certain parts of the world e.g. Russia

43
Q

what is the treatment of diphtheria?

A

antitoxin and supportive

penicillin/erythromycin

44
Q

what Is the presentation of infectious mononucleosis?

A

“glandular fever” - disease of young adults

fever
enlarged lymph nodes
sore throat, pharyngitis, tonsilitis
malaise, lethargy

45
Q

what are the other signs and symptoms of infectious mononucleosis?

A

Jaundice/hepatitis
Rash

Haematology
Leucocytosis (lymphocytosis)

Presence of atypical lymphocytes in blood film
Splenomegaly
Palatal petechiae

46
Q

what is the prognosis of infectious mononucleosis?

A

protracted but self limiting illness

47
Q

what are the complications of infectious mononucleosis?

A

Anaemia, thrombocytopenia
Splenic rupture
Upper airway obstruction
Increased risk of lymphoma, especially in immunosuppressed.

48
Q

what causes infectious mononucleosis?

A

EBV

virus of the herpes family - establishes infection in epithelial cells (notably in the pharynx)

49
Q

what are the two phases of primary infection with EBV?

A

Primary infection in early childhood rarely results in infectious mononucleosis

Primary infection in those >10 years often causes infectious mononucleosis

50
Q

how to manage infectious mononucleosis?

A 
Bed rest
Paracetamol
Avoid sport
Antivirals not clinically effective
Corticosteroids may have a role in some complicated cases
51
Q

how do you confirm infectious mononucleosis?

A

Epstein-Barr virus IgM

Heterophile antibody
Paul-Bunnell test
Monospot test

Blood count and film
Liver function tests

52
Q

what are other causes of similar illnesses like infectious mononucleosis?

A

Cytomegalovirus
Toxoplasmosis

Primary HIV infection
seroconversion illness

53
Q

which organism causes candida?

A

Candida albicans (vs non-albicans)

54
Q

what is the clinical presentation of candida?

A

white patches on red, aw mucosa membranes in throat/mouth

55
Q

what causes candida?

A

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

56
Q

how to investigate for candida?

A

investigate if recurrent

57
Q

what is the treatment of candida?

A

nystatin or fluconazole

58
Q

what is acute otitis media?

A

an URTI involving the middle ear by extension of infection up the Eustachian tube

59
Q

who gets acute otitis media?

A

predominantly infants and children

60
Q

what is the presentation of acute otitis media?

A

earache

61
Q

what are causes of infections of the middle ear?

A

often viral with bacterial secondary infection

62
Q

what is the most common bacteria that cause infections of the middle ear?

A

H. influenzae
Strep. pneumonia
strep. pyogenes

63
Q

how to diagnose infections of the middle ear?

A

swab of pus if eardrum perforates otherwise samples can’t be obtained

64
Q

what is the treatment of infections of the middle ear?

A

Treatment
80% resolve in 4 days without antibiotics.
First line – amoxicillin
Second line – erythromycin

65
Q

what is malignant otitis external?

A

it is an extension of otitis external into the bone surrounding the ear canal

(i.e. the mastoid and temporal bones). Malignant otitis, without treatment, is a fatal condition. Osteomyelitis will progressively involve the skull and meninges

66
Q

what are the symptoms with malignant otitis?

A

Pain and headache, more severe than clinical signs would suggest.

67
Q

what are the signs of malignant otitis?

A

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

68
Q

what are the investigations of malignant otitis?

A

Plasma viscosity / C-reactive protein to demonstrate an inflammatory response, radiological imaging, biopsy, and culture to demonstrate the extent of the osteitis and its cause (usually Pseudomonas aeruginosa).

69
Q

what are the risk factors for malignant otitis?

A

diabetes and radiotherapy to head and neck

70
Q

what is otitis externa?

A

inflammation of the outer ear canal

71
Q

what are the clinical features of otitis externa?

A

Redness and swelling of the skin of the ear canal
It may be itchy (especially in the early stages)
Can become sore and painful
There may be a discharge, or increased amounts of ear wax
If the canal becomes blocked by swelling or secretions, hearing can be affected

72
Q

what are the bacterial causes of otitis externa?

A

Staphylococcus aureus
Proteus spp
Pseudomonas aeruginosa

73
Q

what are the fungal causes of otitis externa?

A

aspergillus niger

Candida albicans

74
Q

what is the management of otitis externa?

A

Topical aural toilet.
Swab to microbiology and prescription of antimicrobial reserved for unresponsive or severe cases
Treat depending on culture results

75
Q

what is the treatment of otitis externa?

A 
Topical clotrimazole (trade name canesten) for Aspergillus niger, 
Gentamicin 0.3% drops
76
Q

what is acute sinusitis?

A

Mild discomfort over frontal or maxillary sinuses due to congestion

seen in patients with upper respiratory viral infections.

severe pain and tenderness with purulent nasal
discharge indicates secondary bacterial infection

Often no samples available

77
Q

what causes acute sinusitis?

A

similar organisms as in otitis media

78
Q

what is the treatment of acute sinusitis?

A

Av. length illness 2.5 weeks.

antibiotics for severe/deteriorating cases of >10 days duration.

1ST LINE phenoxymethylpenicillin

2ND LINE doxycycline – NOT IN CHILDREN!!!

ENT (13 decks)

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