Microbiology

Question 1

How is herpes simplex virus transmitted?

Answer 1

Saliva

Question 2

Who often gets herpes simplex virus?

Answer 2

Pre-school children

Question 3

How does gingivostomatitis present?

Answer 3

Vesicles and ulcers may have systemic upset and lymphadenopathy if it spreads beyond the mouth

Question 4

How is herpes simplex virus treated?

Answer 4

Acyclovir

Question 5

Name the investigation that can be used to diagnose herpes

Answer 5

PCR for viral DNA

Question 6

Where does herpes virus sit inactive?

Answer 6

In sensory nerve cells

Question 7

What is herpangina?

Answer 7

Vesicles/ulcers on the soft palate due to coxsakie virus

Question 8

Who usually gets herpangina?

Answer 8

Young children

Question 9

How is herpangina diagnosed?

Answer 9

PCR swab

Question 10

How does primary syphilis present?

Answer 10

Painless indurated ulcer at site of entry of bacterium can be genital or oral lesions

Question 11

What is apthous disease?

Answer 11

Non-viral self limiting recurrent painful ulcers of the mouth

Question 12

Describe apthous ulcers

Answer 12

Round of ovoid with inflammatory halos confined to the mouth

Question 13

How long do apthous ulcers generally last?

Answer 13

3 weeks

Question 14

What diseases are associated with recurrent ulcers?

Answer 14

• bechet’s
• coeliac/IBD
• reiter’s disease
• drug reactions
• skin diseases

Question 15

Describe bechet’s disease

Answer 15

Recurrent oral/genital ulcers, uveitis may also involve visceral organs

Question 16

Where is bechet’s disease most commonly found?

Answer 16

Middle east/asia

Question 17

When should infectious mononucleosis be considered?

Answer 17

In a 15-25 year old patient with a sore throat persisting for 2 weeks

Question 18

What causes infectious mononucleosis?

Answer 18

Epstein Barr Virus

Question 19

State the complications of a sore throat

Answer 19

• otitis media
• peri-tonsillar abscess
• para-pharyngeal abscess
• mastoiditis

Question 20

When is admission for a sore throat required?

Answer 20

• suspected throat cancer
• > 3/4 weeks of dysphagia
• Red/white patches, ulceration or swelling
• stridor or respiratory problems

Question 21

What portion of sore throats are viral?

Answer 21

2/3

Question 22

What is the most common cause of a bacterial tonsillitis?

Answer 22

Strep pyogenes

Question 23

How is acute follicular tonsillitis treated?

Answer 23

Penicillin - phenoxymethylpenicillin

Question 24

Name two late complications of acute follicular tonsillitis

Answer 24

• rheumatic fever

- glomerulonephritis

Question 25

Name two criteria that can be used to assess the need for antibiotics

Answer 25

CENTOR | PAIN

Question 26

Describe the centor criteria

Answer 26

Tonsillar exudate Tender anterior cervical lymph nodes History of fever No cough

Question 27

Describe the pain criteria

Answer 27

Purulence Attend rapidly Inflamed tonsils No cough

Question 28

What must be done for a patient on a DMARD?

Answer 28

Full blood count - beware of agranulocytosis

Question 29

Describe the appearance of diphtheria

Answer 29

Severe acute sore throat with a grey/white membrane across the pharynx

Question 30

What is special about diphtheria?

Answer 30

Produces exotoxin - cardiotoxic and neurotoxic

Question 31

Where is diphtheria most common?

Answer 31

Russia - huge decrease since vaccination

Question 32

How is diphtheria treated?

Answer 32

Antitoxin, supportive care, penicillin/erythromycin

Question 33

State the infectious mononucleosis triad

Answer 33

- fever - pharyngitis - lymphadenopathy

Question 34

What are the signs/symptoms of EBV?

Answer 34

``` Jaundice/hepatitis Rash Haematology (leucocytosis, atypical lymphocytes) Splenomegaly Palatal petechiae ```

Question 35

What is the treatment for EBV?

Answer 35

Self limiting, bed rest and paracetamol

Question 36

What must never be prescribe to a patient with tonsillitis and why?

Answer 36

Amoxicillin - macular rash can occur is EBV present

Question 37

What are the complications of EBV?

Answer 37

Anaemia, thrombocytopenia, splenic rupture, hepatitis, airway obstruction, lymphoma

Question 38

What investigations can be done on a patient with suspected EBV?

Answer 38

IgM, hetrophil antibody, blood count, LFTs

Question 39

Describe oral candida

Answer 39

White patches on red, raw mucous membranes in the throat and mouth

Question 40

What can cause oral thrush?

Answer 40

Antibiotics, immunosuppressed, smoking, steroids

Question 41

How is oral thrush treated?

Answer 41

Nystatin or fluconazole

Question 42

Describe the histology of cytomegalovirus in comparison to EBV

Answer 42

No heterophil antibody and fewer atypical lymphocytes

Question 43

What is acute otitis media often due to?

Answer 43

Upper respiratory tract infection moves through eustachian tube

Question 44

When is a swab indicated in otitis media?

Answer 44

When the ear drum perforates

Question 45

What bacteria commonly cause acute otitis media?

Answer 45

H.influenza, strep pneumonia, strep pyogenes,

Question 46

What is otitis externa?

Answer 46

Inflammation of the outer ear canal

Question 47

How does otitis externa present?

Answer 47

Red/swollen skin of ear canal Itchy becomes sore and painful Increased wax/discharge May affect hearing

Question 48

Name the bacteria causes of otitis externa

Answer 48

Staph aureus, proteus, pseudomonas

Question 49

Name the fungal causes of otitis externa

Answer 49

Aspergillus candida

Question 50

How it otitis externa managed?

Answer 50

Culture dependent - topical clotrimazole | Topical aural toilet

Question 51

What is malignant otitis?

Answer 51

Extension of otitis external into bone surrounding ear canal (mastoid and temporal bone) - can become osteomyelitis and involve skull and meninges

Question 52

What are the signs/symptoms of malignant otitis?

Answer 52

Pain, headache, granulation tissue at bone-cartilage junction, exposed bone, facial nerve palsy

Question 53

What investigations should be carried out on a patient with suspected malignant otitis?

Answer 53

Plasma viscosity/CRP, radiological imagine, biopsy and culture

Question 54

What are the risk factors for malignant otitis?

Answer 54

Diabetes | Head and neck radiotherapy

Question 55

Describe the presentation of acute sinusitis

Answer 55

Mild discomfort over frontal/maxillary sinuses due to congestion usually with URTI

Question 56

What indicates acute sinusitis is bacterial?

Answer 56

Pain, tenderness with purulent nasal discharge

Question 57

If a patient has acute sinusitis for more than 10 days or is very systemically unwell what should be done?

Answer 57

Phenoxymethylpenicillin or doxycycline