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ENT > Microbiology > Flashcards

Microbiology Flashcards

1
Q

Who is most likely to get an acute throat infection?

A

children aged 5–10 years

young adults aged 15–25 years

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2
Q

If sore throat and lethargy persist into the second week, especially if the person is 15-25years of age what should be suspected?

A

Glandular fever (infectious mononucleosis)

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3
Q

When would a sore throat be referred?

A
  • Persistent sore throat, with neck mass (cancer)
  • Sore throat lasts for 3 to 4 weeks
  • pain on swallowing/dysphagia for >3 weeks
  • Red or white patches/ulceration/swelling of the oral/pharyngeal mucosa persists for >3 weeks
  • Stridor / respiratory difficulty is an emergency
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4
Q

What is the most common bacterial cause of acute follicular tonsillitis?

A

Streptococcus pyogenes

Group A Beta Haemolytic Strep)

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5
Q

What is bacterial tonsillitis treated with?

A

Penicillin

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6
Q

A patient with strep. pyogenes tonsillitis should be isolated until they have been on antibiotics for 48 hrs. TRUE/FALSE?

A

TRUE

Droplet precautions should also be taken as patient can spread infection by coughing

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7
Q

What are the late complications of strep. throat?

A
  • Rheumatic fever (3 weeks after)

- Glomerulonephritis (1-3 weeks after)

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8
Q

How does diptheria present in the throat?

A

severe sore throat with a grey white pseudomembrane across the posterior pharynx

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9
Q

Why is the diptheria exotoxin particularly dangerous during infection?

A

cardiotoxic and neurotoxic

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10
Q

What complications can the diptheria pseudomembrane cause?

A

Can obstruct the airway

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11
Q

What is the diptheria vaccine made of?

A

cell-free purified toxin extracted from a strain of C. diphtheriae
=> a toxoid vaccine

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12
Q

What is the treatment for diptheria?

A

antitoxin and supportive and penicillin / erythromycin

antibiotics dont make much difference on their own - the anti-toxin is important in treatment

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13
Q

What microbe is known to cause oral thrush?

A

Candida albicans

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14
Q

How does oral thrush appear in the mouth

A

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

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15
Q

How is oral thrush treated?

A

nystatin or fluconazole

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16
Q

What is otitis media?

A

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

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17
Q

Who usually gets otitis media?

A

infants and children

Present with earache

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18
Q

What bacteria usually infect the middle ear?

A

Streptococcus pneumoniae
Haemophilus influenzae
Streptococcus pyogenes
Moraxella

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19
Q

Are middle ear infections usually bacterial or viral?

A

Viral but often with secondary bacterial infection

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20
Q

Can the middle ear be swabbed for culture?

A

Swab of pus taken if eardrum perforates to release it – otherwise samples can’t be obtained

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21
Q

What treatment is most commonly used for infections of the middle ear?

A

80% resolve in 4 days without antibiotics.

1st line – amoxicillin
2nd line – erythromycin

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22
Q

What is the most common presenting feature in acute sinusitis?

A

Mild discomfort over frontal or maxillary sinuses due to congestion

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23
Q

Severe pain and tenderness with purulent nasal discharge in acute sinusitis indicates what?

A

Secondary bacterial infection

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24
Q

What cases of sinusitis should antibiotics be reserved for?

A

severe/deteriorating cases of >10 days duration.

1ST LINE penicillin V
2ND LINE doxycycline – NOT IN CHILDREN!!!

25
Q

What is otitis externa?

A

inflammation of the outer ear canal

26
Q

How does otitis externa usually present?

A
  • Red/swollen ear canal skin
  • May be itchy
  • Can become sore and painful
  • May be discharge, or increased ear wax
  • Canal becomes blocked = hearing affected
27
Q

What is Malignant otitis externa?

A

extension of otitis externa into the bone surrounding the ear canal (i.e. the mastoid and temporal bones

28
Q

Why can Malignant otitis externa be fatal?

A

Osteomyelitis can erode into skull and meninges

29
Q

What signs can indicate malignant otitis externa?

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)
30
Q

What bacteria usually cause malignant otitis externa?

A

Staph aureus

Pseudomonas aeruginosa

31
Q

What can predispose to malignant otitis externa?

A

diabetes and radiotherapy to head and neck

32
Q

What fungal infections can cause otitis externa?

A 
Aspergillus niger (black spores visible)
Candida albicans
33
Q

What are the main symptoms in glandular fever?

A

Fever
Enlarged lymph nodes
Sore throat, pharyngitis, tonsillitis
Malaise, lethargy

34
Q

What rarer signs can be seen in glandular fever?

A 
Jaundice/hepatitis
Rash
Leucocytosis (lymphocytosis)
Presence of atypical lymphocytes in blood film
Splenomegaly
Palatal petechiae
35
Q

What complications can arise from glandular fever?

A
  • Anaemia, thrombocytopenia
  • Splenic rupture (warn pt if they do contact sport)
  • Upper airway obstruction
  • Increased risk of lymphoma, especially in immunosuppressed
36
Q

What virus causes infectious mononucleosis (glandular fever)?

A

Epstein-Barr virus (one of herpes family)

37
Q

Primary infection in early childhood rarely results in infectious mononucleosis. TRUE/FALSE?

A

TRUE

but infection >10 often results in getting the infection

38
Q

What is the treatment for infectious mononucleosis?

A 
Bed rest
Paracetamol
Avoid sport
Antivirals not clinically effective
Corticosteroids may have a role in some complicated cases
39
Q

What lab investigations can assist in the diagnosis of glandular fever?

A

Epstein-Barr virus IgM
Heterophile antibody
Blood count and film
Liver function tests

40
Q

What other viruses cause illness similar to that of infectious mononucleosis?

A

Cytomegalovirus
Toxoplasmosis
Primary HIV infection
seroconversion illness

41
Q

What is the CENTOR criteria for distribution of antibiotics in tonsillitis?

A

(1 point for each => need 3/4 for antibiotics)

  • Tonsillar exudate
  • Tender anterior cervical lymph nodes
  • Fever of >38
  • Absence of cough
42
Q

What is the FEVER PAIN criteria for antibiotics in tonsillitis?

A 
Fever in last 24hrs?
Purulence?
Attend rapidly? (within 3 days)
Very inflamed tonsils
No cough/cold
43
Q

How should patients on DMARDs with a suspected throat infection be managed?

A

FBC

withhold DMARD whilst waiting on blood results

44
Q

When is Herpes simplex Type 1 usually acquired?

A

Childhood

45
Q

What symptoms usually present in a Primary gingivostomatitis due to HSV1 infection?

A

Ulcerating lesion
Local lymphadenopathy
Fever

46
Q

How long does it take to recover from a Primary gingivostomatitis (HSV1) infection?

A

3 weeks

47
Q

How is Primary gingivostomatitis in HSV1 treated?

A

Aciclovir

48
Q

Where does the herpes simplex virus usually lie latent?

A

Trigeminal ganglion

49
Q

Everyone who gets a primary HSV1 infection wll get recurrence. TRUE/FALSE?

A

FALSE

but factors such as immunosuppression can increase risk of recurrence

50
Q

HSV2 is more likely to recur than HSV1. TRUE/FALSE

A

TRUE

and more related to genital infection

51
Q

What is the potentially dangerous complication of the herpes simplex virus?

A

HSV encephalitis - temporal lobe necrosis

52
Q

What is herpangina?

A

Vesicles/ulcers on soft palate

53
Q

What virus causes herpangina?

A

Coxsackie

54
Q

What other condition is caused by coxsackie virus?

A

Hand, foot and mouth

55
Q

Why do GPs commonly not do viral swabs for hand, foot and mouth?

A

Nothing else similar presents in the same age range

usually children - can cause family outbreaks

56
Q

What are aphthous ulcers?

A

Non viral
Recurring painful ulcers of the mouth
Round or ovoid shape
Have inflammatory halos

57
Q

What systemic disease can cause recurrent ulcers?

A 
Behçet's disease 
Coeliac or IBD
Reiter’s disease
Drug reactions
Skin diseases
58
Q

WHat is a Chancre and what condition is it seen in?

A
  • Painless ulcer at site of entry of bacterium Treponema pallidum (usually genitals or oral)
  • Syphilis infection

ENT (20 decks)

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