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ENT > Microbiology > Flashcards

Microbiology Flashcards

1
Q

viral causes of oral ulceration

A

herpes simplex virus (HSV)
herpangina
hand, foot and mouth disease

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2
Q

which type of HSV tends to cause oral lesions?

A

type 1

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3
Q

how does HSV type 1 tend to be acquired?

A

through saliva in childhood

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4
Q

cause of primary gingivostomatitis

A

HSV1 in childhood

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5
Q

describe the presentation of primary gingviostomatitis

A

vesicles and ulcers on lips, buccal mucosa and hard palate

can have systemic upset- fever and local lymphadenopathy

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6
Q

how long can it take to recover from primary gingviostomatitis

A

3 weeks

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7
Q

management of primary gingviostomatitis

A

acyclovir

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8
Q

what happens after a primary infection with HSV1?

A

the virus establishes latency in a sensory nerve cell and reactivation presents as a cold sore

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9
Q

diagnosis of HSV

A

swabs in a viral transport medium used to detect viral DNA by PCR

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10
Q

cause of herpangina

A

Coxsackie virus

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11
Q

presentation of herpangina

A

vesicles/ulcers on the soft palate that presents in pre-school

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12
Q

diagnosis of herpangina

A

swab in viral transport medium

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13
Q

cause of hand, foot and mouth disease

A

Coxsackie viruses

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14
Q

diagnosis of hand, foot and mouth disease

A

PCR of swab in viral transport medium

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15
Q

describe primary syphilis presentation

A

painless indurated ulcer at the site of entry of the bacterium (chancre)

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16
Q

cause of syphilis

A

bacterium

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17
Q

what can happen if primary syphilis is left untreated?

A

can progress to secondary and tertiary syphilis

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18
Q

cause of apthous ulcers

A

non-viral

stress, injury, familial, certain foods, lack of vitamins, etc.

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19
Q

presentation of apthous ulcers

A

recurring painful ulcers that are round/ovoid with inflammatory halos
confined to the mouth with absence of systemic disease

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20
Q

how long do apthous ulcers last?

A

3 weeks

begin in childhood, tend to ablate in 3rd decade

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21
Q

recurrent ulcers associated with systemic diseases of non-viral causes include

A 
Behcet's disease
gluten-sensitive enteropathy or IBD
Reiter's disease (arthritis)
drug reaction
skin disease e.g. lichen planus, pemphigoid and pemphigus
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22
Q

define acute pharyngitis

A

inflammation of the throat behind the soft palate (oropharynx)

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23
Q

what distinguishes tonsilitis from infectious mononucleosis?

A

sore throat or lethargy persists into the second week, patient aged 15-25

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24
Q

non-infectious causes to irritation of the throat and pharynx

A

GORD
chronic irritation from cigarettes
alcohol
hayfever

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25
Q

what is a sore throat an immediate admission to hospital?

A

airway obstruction/ respiratory difficulty

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26
Q

what is the danger pathway in otitis media?

A

otitis media > peri-tonsillar abscess (quinsy) > parapharyngeal abscess > mastoiditis

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27
Q

management of a sore throat

A
  • self care e.g. regular analgesia, lozenges, fluid, etc.

- prescribe antibiotics if needed e.g. bacterial tonsilitis (penicillin)

28
Q

why do you manage strep pyogenes tonsilitis with antibiotics?

A

there is risk of complications

29
Q

complications in strep pyogenes

A

rheumatic fever

glomerulonephritis

30
Q

presentation of rheumatic fever

A

3 weeks post sore throat there is fever, arthritis and pancarditis

31
Q

presentation of glomerulonephritis

A

1-3 weeks post sore thraot there is haematuria, albuminuria and oedema

32
Q

what criteria is used to assess whether antibiotics should be given in tonsilitis?

A

FeverPAIN (or CENTOR)

33
Q

describe the categories in the FeverPAIN criteria

A 
fever
purulence (pus on tonsils)
attend rapidly (within 3 days)
inflamed tonsils
no cough
34
Q

risk factors for strep pyogenes tonsilitis

A 
DMARDs
increased risk of neutropenia e.g. carbimazole (idiosyncratic neutropenia)
chemotherapy
leukaemia
asplenia
aplastic anaemia
HIV
immunosuppressed
35
Q

when should phenoxymethylpenicillin be considered in tonsilitis?

A

FeverPAIN score is 4-5 or CENTOR score is 3-4

36
Q

red flags in throat problems

A
  • persistent sore throat, neck mass (cancer)
  • sore throat with pain or dysphagia that lasts 3-4 weeks
  • red or red and white patches, ulceration or swelling of oral/pharyngeal mucosa for more than 3 weeks
  • stridor/respiratory difficulty
37
Q

presentation of diphtheria

A

sore throat

grey-white membrane across the pharynx

38
Q

what does the organism in diphtheria produce?

A

potent exotoxin which is cardiotoxic and neurotoxic

39
Q

what kind of vaccine is used to manage diphtheria?

A

toxoid vaccine

40
Q

management of diphtheria

A

antitoxin

support penicillin/erythromycin

41
Q

presentation of infectious mononucleosis

A 
fever
enlarged lymph nodes
sore throat
pharyngitis
tonsillitis
malaise
lethargy
jaundice/hepatitis
rash
leucocytosis
presence of atypical lymphocytes 
splenomegaly
palatal petechiae
42
Q

complications of infectious mononucleosis

A

anaemia, thrombocytopenia
splenic rupture
upper airway obstruction
increased risk of lymphoma, especially in immunosuppressed

43
Q

cause of infectious mononucleosis

A

EBV

44
Q

diagnosis of infectious mononucleosis

A

EBV IgM
heterophile antibody- Paul Bunnell test or Monospot test
blood count and film
LFTs

45
Q

management of infectious mononucleosis

A

bed rest
paracetamol
avoid sport
corticosteroids in complicated cases

46
Q

other causes of a similar illness to EBV

A

CMV
toxoplasmosis
primary HIV

47
Q

presentation of candida

A

white patches on red

raw mucous membranes in throat/mouth

48
Q

causes of candida

A

endogenous substances e.g. post-antibiotics, immunosuppressants, smoking and ICS

49
Q

when should candida be investigated?

A

if reccurent

50
Q

management of candida

A

nystatin

fluconazole

51
Q

define acute otitis media

A

URTI involving the middle ear by extension of infection up eustachian tube

52
Q

presentation of acute otitis media

A

otalgia

53
Q

cause of acute otitis media

A

most commonly viral but can have secondary bacterial (H, influenzae, strep pneumonia and strep pyogenes)

54
Q

diagnosis of acute otitis media

A

swab of eardrum if perforates (otherwise samples cannot be obtained)

55
Q

management of acute otitis media

A

most resolve without antibiotics
first line=amoxicillin
second line= erythromycin

56
Q

define malignant otitis externa

A

this is extension of otitis externa into the bone surrounding the ear canal e.g. mastoid or temporal (osteomyelitis can progress to skull and meninges)

57
Q

what happens if malignant otitis externa is not treated?

A

it is fatal

58
Q

presentation of malignant otitis externa

A

pain
headache
granulation tissue at bone-cartilage junction of ear canal, exposed bone in the ear canal
facial nerve palsy (drooping on side of the lesion)

59
Q

investigations for malignant otitis externa

A

plasma viscosity/CRP
radiological imaging
biopsy
culture (pseudomonas aeruginosa)

60
Q

risk factors for malignant otitis externa

A

diabetes

radiotherapy of head and neck

61
Q

define otitis externa

A

inflammation of the outer ear canal

62
Q

presentation of otitis externa

A 
redness
swelling of skin in canal
itchy
pain
discharge/earwax
if canal becomes blocked then hearing can be affected
63
Q

bacterial causes of otitis externa

A

staph aureus
proteus spp
pseudomonas aeruginosa

64
Q

fungal causes of otitis externa

A

aspergillus niger

candida albicans

65
Q

management of otitis externa

A

swabs for unresponsive/severe cases
topical clotrimazole for aspergillus
gentamicin drops

66
Q

presentation of acute sinusitis

A

discomfort over frontal and maxillary sinuses due to congestion
URTI
if bacterial then purulent discharge and severe pain

67
Q

antibiotic use in acute sinusitis

A

only is severe/deteriorating cases of >10 days duration

  • 1st line= phenoxymethylpenicillin
  • 2nd line= doxycycline (NOT in children)

ENT (35 decks)

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