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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
what is a sore throat an immediate admission to hospital?
airway obstruction/ respiratory difficulty
26
what is the danger pathway in otitis media?
otitis media > peri-tonsillar abscess (quinsy) > parapharyngeal abscess > mastoiditis
27
management of a sore throat
- self care e.g. regular analgesia, lozenges, fluid, etc. | - prescribe antibiotics if needed e.g. bacterial tonsilitis (penicillin)
28
why do you manage strep pyogenes tonsilitis with antibiotics?
there is risk of complications
29
complications in strep pyogenes
rheumatic fever | glomerulonephritis
30
presentation of rheumatic fever
3 weeks post sore throat there is fever, arthritis and pancarditis
31
presentation of glomerulonephritis
1-3 weeks post sore thraot there is haematuria, albuminuria and oedema
32
what criteria is used to assess whether antibiotics should be given in tonsilitis?
FeverPAIN (or CENTOR)
33
describe the categories in the FeverPAIN criteria
``` fever purulence (pus on tonsils) attend rapidly (within 3 days) inflamed tonsils no cough ```
34
risk factors for strep pyogenes tonsilitis
``` DMARDs increased risk of neutropenia e.g. carbimazole (idiosyncratic neutropenia) chemotherapy leukaemia asplenia aplastic anaemia HIV immunosuppressed ```
35
when should phenoxymethylpenicillin be considered in tonsilitis?
FeverPAIN score is 4-5 or CENTOR score is 3-4
36
red flags in throat problems
- 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
presentation of diphtheria
sore throat | grey-white membrane across the pharynx
38
what does the organism in diphtheria produce?
potent exotoxin which is cardiotoxic and neurotoxic
39
what kind of vaccine is used to manage diphtheria?
toxoid vaccine
40
management of diphtheria
antitoxin | support penicillin/erythromycin
41
presentation of infectious mononucleosis
``` fever enlarged lymph nodes sore throat pharyngitis tonsillitis malaise lethargy jaundice/hepatitis rash leucocytosis presence of atypical lymphocytes splenomegaly palatal petechiae ```
42
complications of infectious mononucleosis
anaemia, thrombocytopenia splenic rupture upper airway obstruction increased risk of lymphoma, especially in immunosuppressed
43
cause of infectious mononucleosis
EBV
44
diagnosis of infectious mononucleosis
EBV IgM heterophile antibody- Paul Bunnell test or Monospot test blood count and film LFTs
45
management of infectious mononucleosis
bed rest paracetamol avoid sport corticosteroids in complicated cases
46
other causes of a similar illness to EBV
CMV toxoplasmosis primary HIV
47
presentation of candida
white patches on red | raw mucous membranes in throat/mouth
48
causes of candida
endogenous substances e.g. post-antibiotics, immunosuppressants, smoking and ICS
49
when should candida be investigated?
if reccurent
50
management of candida
nystatin | fluconazole
51
define acute otitis media
URTI involving the middle ear by extension of infection up eustachian tube
52
presentation of acute otitis media
otalgia
53
cause of acute otitis media
most commonly viral but can have secondary bacterial (H, influenzae, strep pneumonia and strep pyogenes)
54
diagnosis of acute otitis media
swab of eardrum if perforates (otherwise samples cannot be obtained)
55
management of acute otitis media
most resolve without antibiotics first line=amoxicillin second line= erythromycin
56
define malignant otitis externa
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
what happens if malignant otitis externa is not treated?
it is fatal
58
presentation of malignant otitis externa
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
investigations for malignant otitis externa
plasma viscosity/CRP radiological imaging biopsy culture (pseudomonas aeruginosa)
60
risk factors for malignant otitis externa
diabetes | radiotherapy of head and neck
61
define otitis externa
inflammation of the outer ear canal
62
presentation of otitis externa
``` redness swelling of skin in canal itchy pain discharge/earwax if canal becomes blocked then hearing can be affected ```
63
bacterial causes of otitis externa
staph aureus proteus spp pseudomonas aeruginosa
64
fungal causes of otitis externa
aspergillus niger | candida albicans
65
management of otitis externa
swabs for unresponsive/severe cases topical clotrimazole for aspergillus gentamicin drops
66
presentation of acute sinusitis
discomfort over frontal and maxillary sinuses due to congestion URTI if bacterial then purulent discharge and severe pain
67
antibiotic use in acute sinusitis
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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