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ENT SM > Microbiology of ENT infections > Flashcards

Microbiology of ENT infections Flashcards

1
Q

When obtaining a throat swab, what should you try and do

A

Swab the tonsil and scripts on either side of the tonsil

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2
Q

What type of infection causes the majority of sore throats

A

Viral infection

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3
Q

What is the most common bacterial cause of a sore throat

A

Streptococcus pyogenes (Group A strep)

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4
Q

What is the treatment for a group A strep

A 
Oral penicillin (NOT amoxicilin) 
if penicillin allergic, give clarithryomycin
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5
Q

why should amoxicillin not be given for a bacterial sore throat

A

It can cause patients to come out in a rash if they have glandular fever

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6
Q

What are the 4 criteria in the ENT infection management guidance for sore throats

A 
Fever 
pussy discharge
inflamed lymph nodes 
NO cough 
BACTERIAL
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7
Q

If there is a cough present, what does this suggest

A

It is more likely to be a viral cause

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8
Q

Describe the histological appearance of streptococcus pyogenes

A 
Gram positive cocci chains 
Beta haemolysis (complete)
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9
Q

What are some acute complications of a streptococcal sore throat

A

peritonsillar abscess (quinsy
Sinusitis / ottis media
scarlet fever

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10
Q

What might a quinsy require

A

surgical drainage

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11
Q

What infection control measures are required for a strep pyogenes quinsy in hospital

A

Standard infection control
contact precautions
risk assess need for droplet precautions (may need masks for being around patients that are sneezing and coughing)

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12
Q

What are some late complications of a streptococcal sore throat

A

Rheumatic fever

Glomerulonephritis

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13
Q

Describe the symptoms of Rheumatic fever

A 
3 weeks post sore throat 
fever 
arthritis 
pancarditis
endocarditis 
heart failure

Rare in the UK

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14
Q

Describe the symptoms of Glomerulonephritis

A 
1-3 weeks post sore throat 
Haematuria 
albuminuria 
oedema 
Blood and protein in the urine
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15
Q

Why do these late complications of a streptococcal sore throat occur

A

Due to cross reacting antibodies reacting

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16
Q

What is a major symptom of diphtheria

A

A hugely swollen throat

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17
Q

What is the causative organism of diphtheria

A

Corynebacterium diphtheriae

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18
Q

What are the clinical symptoms of diphtheria

A

Severe sore throat with swelling around the neck with a grey white membrane across the pharynx.

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19
Q

Describe the appearance of Corynebacterium diphtheriae on gram film

A

Small gram positive rod

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20
Q

What is a major complication of diphtheria and how does this arise

A

Respiratory arrest in children

the throat is being completely blocked

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21
Q

Describe the vaccine for diphtheria

A

cell -free purified form of the toxin

Very safe and has almost ruled out diphtheria in the UK

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22
Q

What is the treatment for Diphtheria

A

Antitoxin and supportive and penicillin/ erythromycin (e.g. intubation and ventilation)

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23
Q

What is the causative organism of thursh in the mouth

A

Candida albicans (yeast infection)

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24
Q

What is the clinical appearance of thrush

A

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

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25
Q

What is the treatment for thrush

A

Nystatin suspension topically on the tongue

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26
Q

What is acute otitis media

A

An URI involving the middle ear by extension of infection up the eustachian tube

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27
Q

Who is most likely to develop acute otitis media and how do they present

A

Disease of infants and children

Present with extreme earache

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28
Q

Why are children more prone to acute otitis media

A

The eustachian tube tends to be quite flat and does not drain as well as in adults

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29
Q

What are the most common bacteria to cause an infection of the middle ear

A

Haemophilus influenzae
Streptococcus pneumoniae
Streptococcus pyogenes

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30
Q

How can we make a diagnosis of a middle ear infection

A

Can only do this if the ear drum has perforated

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31
Q

What is the treatment for a middle ear infection

A

80% resolve themselves in 4 days (i.e. just viral)

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32
Q

What do the ENT infection management guidelines say in relation to treating middle ears

A

Amoxicillin (not penicillin) should be considered for those presenting bilaterally and for children under the age of 2
or if there is obvious pus coming from the ear canal

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33
Q

How does acute sinusitis present

A

mild discomfort over frontal or maxillary sinuses due to congestion often seen in patients with UTVI
Severe pain and tenderness with purulent nasal discharge indicates a secondary bacterial infection

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34
Q

What is the treatment for acute sinusitis

A

If no complications then avoid antibiotics
Where indicated penicillin
2nd line doxycycline (not in children)

35
Q

Why is doxycycline not given to children

A

Stains the teeth and the bones

36
Q

Who are unlikely to develop acute sinusitis

A

Children

37
Q

What is otitis externa

A

Inflammation of the outer ear canal

38
Q

What is the clinical presentation of otitis externa

A

Redness and swelling of the skin of the ear canal
May be itchy (in early stages)
can become sore and painful
may be a discharge or increased amounts of ear wax
Hearing can be affected

39
Q

What are the main bacterial causes of otitis external

A

Staphylococcus aureus
Proteus spp and other cloakrooms
Pseudomonas aeuginosa

40
Q

Who is most likely to develop otitis external

A

Swimmers

41
Q

What are the 2 fungal causes of Otitis external

A

Aspergillus niger

Candida albicans

42
Q

What do fungal organisms do

A

They don’t invade and just feed on the debris and wax in the EAM

43
Q

What is the best treatment for fungal otitis external

A

Clean out the ear as much as possible and get rid of debris

44
Q

What should be given for a Pseudomonas infection of the external ear

A

Topical gentamicin

45
Q

What is another term for infection mononucleosis

A

Glandular fever

46
Q

How does glandular fever usually present

A 
Fever
Enlarged lymph nodes 
sore throat 
pharyngitis
tonsilitis
malaise 
lethargy
47
Q

What is the classic triad of symptoms in glandular fever

A

Fever
pharyngitis
lymphadenopathy

48
Q

What are some unusual signs of glandular fever

A

Jaundice / hepatitis
Lacy, red, rash (amoxicillin makes worse)
Splenomegaly
Palatal petachiae (pin point bruising of hard palate)

49
Q

What are the complications of glandular fever

A 
Self limiting 
anaemia, thrombocytopenia 
Splenic rupture 
upper airway obstruction 
doubled risk of lymphoma
50
Q

What is the cause of glandular fever

A

Epstein Barr virus (EBV)

51
Q

What are the two phases of primary infection with EBV

A

Primary infection nearly childhood rarely results in infectious mononucleosis
Primary infection in those >10 often causes infectious mononucleosis

52
Q

What is the therapy for glandular fever

A

bed rest
paracetamol
avoid sport (US to exclude splenomegaly before contact sport)
Corticosteroids possibility

53
Q

How can we make a laboratory confirmation of glandular fever

A

Epstein -baBarr virus IgM

54
Q

What are some other causes of similar illness

A

Cytomegalovirus
Toxoplasmosis
Primary HIV infection

55
Q

What do you have to watch out for when testing for a primary HIV infection

A

May be falsely negative for about a week

56
Q

What are the types of Herpes simplex virus

A

Types 1 and 2

57
Q

When is type 1 acquired

A

Childhood

58
Q

What does HSV1 cause

A

Oral lesions

Infection is through saliva

59
Q

Who can be affected by primary gingivostomatitis

A

Pre-school children

60
Q

What areas of the body are affected by primary gingivostomatitis

A

Lips
buccal mucosa
hard palate

61
Q

What is the cause of primary gingivostomatitis

A

HSV1

62
Q

What are the symptoms of primary gingivostomatitis

A

Fever

local lymphadenopathy

63
Q

What is the treatment for primary gingivostomatitis

A

Aciclovir

64
Q

How do cold sores end up reappearing

A

The virus travels up through the nerve axons and becomes latent in the trigeminal ganglia and the virus becomes inactive.
Periodically it can reactivate and go back down the axon and re-infect mucosal surfaces

65
Q

What does acyclovir not prevent

A

Latency

66
Q

What might cause the HSV1 to reactivate

A

Sunburn
Immunosuppressed
Hormonal changes

67
Q

How many infected people get clinical recurrences of cold sores

A

Half of infected people

68
Q

Who is at risk of Herpetic whitlow

A

Dentists and anaesthetics

Using gloves is essential in prevention

69
Q

Where does Herpetic whitlow affect

A

Between the nail and normal skin

70
Q

How is a confirmation of HSV made

A

Swab of the lesion and viral DNA by PCR

71
Q

In the brain, what can Herpes simplex cause

A

Encephalitis leading to necrosis of the temporal lobe

72
Q

how does herpes simplex encephalitis present

A

Fever and a changed mental state e.g. sleepy, change in personality or grand mal seizure

73
Q

What causes Herpangina

A

Coxsackie viruses

74
Q

How is a diagnosis of Herpangina made

A

Clinically or by PCR test of swab in viral transport medium

75
Q

How does Herpangina present

A

Shallow ulcers on the roof of the mouth

soft palate

76
Q

What causes Hand, foot and mouth disease

A

Coxsackie virus

77
Q

What is the clinical presentation of hand, foot and mouth disease

A

Vesicles on the hand, feet and buttocks

Often family outbreaks

78
Q

What are apthous ulcers

A

Non viral, self limiting, recurring painful ulcers on the mouth that are round or ovoid and have inflammatory hals

79
Q

How long does each apthous ulcer last

A

Less than 3 weeks

80
Q

What organism causes Primary syphilis

A

Treponema pallidum

81
Q

Where is the most common site of primary syphilis

A

Genital but oral lesions can be the site of entry

82
Q

What could happen if primary syphilis was left undiagnosed and untreated

A

Can progress to secondary and tertiary syphilis

83
Q

What are some symptoms of Behcet’s disease

A

Recurrent oral ulcers
Genital ulcers
Uveitis
Common in Middle east and asia

84
Q

What other systemic diseases can cause apthous ulcers

A 
Beech's disease
Gluten sensitive enteropathy 
IBD
Eritrea's disease
Drug reactions 
Skin diseases

ENT SM (19 decks)

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