Microbiology of ENT infections

Question 1

Most common cause of bacterial sore throat

Answer 1

Most sore throats are viral!

Most common bacterial cause is Group A strep

Question 2

Abx for acute follicular tonsilits

Answer 2

Penicillin

unable to swallow IV benzylpenicillin

Question 3

Gram positive cocci chains

Beta-haemolysis

Answer 3

Strep pyogenes

Question 4

Strep pyogenes quinsy in hospital infection control

Answer 4

SICP’s
Contact precaution
Risk assess need for droplet precaution

Question 5

Fever, arthritis, pancarditis

3 weeks post sore throat

Answer 5

Rheumatic fever

Question 6

Late complications of strep. sore throat

Answer 6

Rheumatic fever

Glomerulonephritis!!

Question 7

What type of toxin produced by diptheria?

Answer 7

Exotoxin!

this is cardiotoxic and neurotoxic

Question 8

Treatment for diptheria

Answer 8

Treatment: Antitoxin and Supportive and Penicillin/erythromycin

Question 9

Country with diptheria

Answer 9

Russia

Question 10

Diptheria toxin

Answer 10

Vaccine - The vaccine is made from a cell-free purified toxin extracted from a strain of C. diphtheriae

Question 11

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

Answer 11

Candidia/thrush

Question 12

Treatment for Thrush

Answer 12

Nystatin

Question 13

Difference between acute sinusitis and secondary bacterial infection

Answer 13

Mild discomfort over frontal or maxillary sinuses due to congestion often seen in patients with upper respiratory viral infections.
However, severe pain and tenderness with purulent nasal discharge indicates secondary bacterial infection

Question 14

Abx for sinusitis

only give is more than 10 days

Answer 14

1st line penicillin V

2nd line: doxycycline (not in children!!)

Question 15

Treatment for aspergillus niger

Answer 15

Topical clotrimazole

Question 16

Treatment for Otitis externa

Answer 16

Topical aural toilet.
Swab reserved for unresponsive cases
Then treat depending on culture results.
Eg Topical clotrimazole (trade name canesten) for Aspergillus niger, along with thorough aural toilet

Question 17

Prognosis and complications of glandular fever

Answer 17

Protracted but self limiting illness
Anaemia, thrombocytopenia
Splenic rupture
Upper airway obstruction
Increased risk of lymphoma, especially in immunosuppressed.

Question 18

Lab confirmation of glandular fever

Answer 18

Heterophile antibody
Paul-Bunnell test
Monospot test
Epstein-Barr virus IgM
Blood count and film

Question 19

Two phases of primary infection with EBV

Answer 19

Primary infection in early childhood rarely results in infectious mononucleosis

Primary infection in those >10 years often causes infectious mononucleosis

Question 20

Primary gingivostomatitis due to HSV1

Answer 20

Disease of pre-school children
primary infection
systemic upset
lips, buccal mucosa, hard palate
vesicles 1-2mm
ulcers

Question 21

Treatment for primary gingivostomatitis due to HSV1

Answer 21

Fever, local lymphadenopathy
May take up to 3 weeks to recover
spread beyond mouth
aciclovir treatment

Question 22

Occupational hazard of dentistry

Use of gloves essential in prevention

Answer 22

Herpetic whitlow

Question 23

Lab confirmation of HSV

Answer 23

Swab of lesion in virus transport medium

detection of viral DNA by PCR

Question 24

What is herpangina?

Answer 24

Vesicles/ulcers on soft palate
CHILDHOOD INFECTION!
Due to coxsackie virus!

Question 25

Which virus causes herpangina?

Answer 25

Coxsackie!! (not HSV)

Question 26

Diagnosis of herpangina

Answer 26

diagnosis clinically or by PCR test of swab in viral transport medium

Question 27

Hand foot and mouth disease

Answer 27

Also due to coxsackie viruses (enteroviruses)
family outbreaks common
diagnosis clinically or by PCR test of swab in viral transport medium