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ENT > Microbiology > Flashcards

Microbiology Flashcards

1
Q

List viruses that are common causes of oral ulceration

A

Herpes Simplex - type 1
Coxsackie virus - herpangia and hand, foot and mouth
Primary syphilis

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2
Q

What type of herpes simplex causes oral disease

A

Type 1

This type is acquired in childhood

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3
Q

How do you become infected by HSV1

A

Saliva contact

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4
Q

Describe primary gingivostomatitis caused by HSV1

A

Occurs in pre-school children
Ulcers and vesicles on the lips, buccal mucosa and hard palate
Systemic upset - fever, lymphadenopathy
Kids may struggle to eat

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5
Q

How can you treat primary gingivostomatitis caused by HSV1

A

Aciclovir treatment

May take up to 3 weeks to recover

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6
Q

Can herpes become latent?

A

YES

after primary infection it’s inactive form can stay in nerve cells and reactivate to re-infect the mucosal surfaces

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7
Q

What is the major complication of herpes infection

A

herpes simplex encephalitis (high mortality)

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8
Q

How do you diagnose HSV in the lab

A

Swab the lesion - may need to pop it to get fluid
Use viral swab with appropriate transport medium
PCR carried out to detect viral DNA

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9
Q

What is herpangia

A

You get vesicles/ulcers on the soft palate
Caused by coxsackie
Diagnosed by swab and PCR

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10
Q

Describe hand foot and mouth disease

A

Caused by coxsackie viruses
Get gingival stomatitis
Blisters on hand, feet and in the mouth (surprise, surprise)
Can be diagnosed by PCR but often not needed

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11
Q

Describe the presentation of a syphilis ulcer

A 
Called a chancre 
Appears at the site of bacterium entry 
Thick and boggy ulcer 
Occurs in mouth or on genitals 
Sexually transmitted
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12
Q

What are apthous ulcers

A

Non-viral ulcers that are usually self limiting
Recurrent, painful ulcers that are confined to the mouth
Round/oval with inflammatory halo
Do not come with systemic disease

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13
Q

Which systemic diseases can cause recurrent, non-viral ulcers

A 
IBD or coeliac 
Reiter's disease - arthritis 
Drug reactions 
Skin disease - pemphigus/goid 
Behcet's disease
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14
Q

Which age groups are commonly affected by acute throat infections

A

Children age 5-10

Young people 15-25

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15
Q

What are the most common causes of sore throat

A

Mostly viral or bacterial
Common cold, influenza and strep
Less common is HIV and diphtheria

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16
Q

If sore throat and lethargy persist into a second week, what is suspected

A

Infectious mononucleosis

Especially if aged 15-25

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17
Q

What causes infectious mononucleosis

A

Epstein-Barr virus

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18
Q

List some non-infectious causes of sore throat

A

Reflux
Smoking - chronic irritation
Hay fever
Physical irritation

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19
Q

What can a sore throat lead on to

A

Otitis media
Peri-tonsillar abscess
Para-pharyngeal abscess
Mastoiditis

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20
Q

At what point would a sore throat need referred

A

If throat cancer is suspected - persistent
Sore throat lasting 3-4 weeks
Dysphagia
Red, white patched or ulceration that lasts more than 3 weeks
Respiratory difficulty - emergency

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21
Q

What self-care advice should be given to patients with a sore throat

A

Regular analgesia
Medicated lozenges
Avoid hot drinks
Ensure good fluid intake

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22
Q

What is the most common cause of bacterial sore throat

A

Strep pyogenes

AKA Group A strep

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23
Q

How can you treat a strep pyogenes sore throat

A

Penicillin

24
Q

What are some complications of strep pyogenes infection

A

Rheumatic fever

Glomerulonephritis

25
Q

Describe the histological appearance of strep pyogenes

A

Gram positive
Cocci chains
Beta haemolysis - golden

26
Q

List some of the CENTOR criteria for diagnosing a group A strep sore throat

A 
Age under 15 
Tonsillar exudate 
Tender anterior cervical lymph nodes 
History of fever 
Absence of cough

If scoring 3 or 4 should get antibiotics

27
Q

List causes of neutropenia

A 
Drugs - carbimazole 
Chemotherapy 
Leukaemia
Aplastic anaemia  
HIV with low CD4 
Immunosuppressants
28
Q

List the clinical features of diphtheria

A

Severe sore throat

Grey/white membrane across pharynx

29
Q

How do you treat diphtheria

A

Antitoxin
Supportive treatment
penicillin/erythromycin

30
Q

What is infective mononucleosis also known as

A

Glandular fever

31
Q

What are the symptoms of infective mononucleosis

A 
Fever 
Enlarged lymph nodes 
Sore throat, pharyngitis, tonsillitis 
Malaise 
Lethargy - will last months 
Jaundice 
Rash 
Atypical lymphocytes 
Splenomegaly
32
Q

List potential complications of infective mononucleosis

A

Anaemia
Thrombocytopenia
Treated with steroids

Splenic rupture - avoid sport for 6 weeks
Upper airway obstruction
Increased risk of lymphoma

33
Q

EBV rarely causes infection in children - true or false

A

True

If infected in childhood you are usually asymptomatic

34
Q

How do you treat infective mononucleosis

A

Bed rest
Paracetamol
Avoid sport
Steroids for some complications (rare as can make it worse)

35
Q

How do you confirm EBV infection in the lab

A 
EBV IgM 
Paul-Bunnel test 
Monospot test 
Blood count and film 
LFTs
36
Q

How does a candida infection present

A

White patches on red, raw mucous membranes

37
Q

When should you do further investigation for a candida infection

A

If recurrent

May indicate a T cell problem

38
Q

How can you treat a candida infection

A

Nystatin or fluconazole

39
Q

What is acute otitis media

A

An upper respiratory infection involving the middle ear by extension of infection up the Eustachian tube
Present with ear pain

40
Q

Which bacteria are the most common causes of otitis media

A

Haemophilus influenza
Strep pneumoniae
Strep pyogenes

41
Q

How do you treat a middle ear infection

A

Majority resolve in 4 days without antibiotics
Amoxicillin first line
Then erythromycin

42
Q

What is malignant otitis externa

A

Infection of the outer ear that extends into the bone
Can be fatal
Get severe pain and headache

43
Q

What are the clinical signs of otitis externa

A 
Redness and swelling of the canal 
May be itchy 
Pain 
Discharge or increased ear wax 
Hearing can be affected
44
Q

List bacterial causes of otitis externa

A

Staph aureus
Proeteus
Pseudomonas - swimmers

45
Q

List fungal causes of otitis externa

A

Aspergillus niger

Candida albicans

46
Q

Describe the presentation of acute sinusitis

A

Mild discomfort over frontal or maxillary sinuses due to congestion
Patient often has a URTI
Severe pain and tenderness with purulent discharge suggests bacterial infection

47
Q

How do you treat sinusitis

A

Usually lasts 2.5 weeks
If case is severe or deteriorating and lasts more than 10 days, give antibiotics
Phenoxymethylpenicillin or doxycycline

48
Q

What type of antibiotics would you give for otitis media and externa

A

Media needs oral

External uses topical (drops)

49
Q

What virus causes glandular fever

A

EBV

50
Q

What are the signs of glandular fever

A 
Sore throat - red/inflamed 
Exudate on tonsils 
Cervical lymphadenopathy
Tiredness  
Atypical lymphocytes
51
Q

What is a common cause of swimmers ear?

A

Apergillus niger = black mould

Not picked up from water itself but the wet environment created by swimming makes it easier to grow

52
Q

What type of infection is swimmer’s ear

A

otitis externa

53
Q

Which criteria are used to determine the likelihood of a strep sore throat

A

Centor criteria

54
Q

What are the rare complications of a strep sore throat

A

glomerulonephritis

rheumatic fever

55
Q

What is the most common causative organism of bacterial tonsillitis

A

Strep pyogenes

ENT (9 decks)

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