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ENT > week 1 microbiology > Flashcards

week 1 microbiology Flashcards

1
Q

name some common ENT infections

A

Infections of throat and pharynx
Infections of middle ear and sinuses
Infection of outer ear
Viral ENT infections

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2
Q

what are red flags for sore throat. what to do?

A

stridor or respiratory difficulty is an absolute indication for
admission to hospital, and attempts to examine the throat should be avoided

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3
Q

what are two causes of pain at the back of the mouth?

A

Acute pharyngitis: inflammation of the part of the throat behind the soft palate (oropharynx).

Tonsillitis: inflammation of the tonsils.

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4
Q

what are infections of the throat and pharynx cause by?

A

Caused by a viral or bacterial infection

Non-infectious causes are uncommon (GORD, chronic irritation from cigarette smoke, alcohol, or hay fever).

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5
Q

who does acute throat infections most commonly affect? course of infection?

A

in children aged 5–10 years and in young adults aged 15–25 years

resolve in 3-7days irrespective of cause

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6
Q

complications of sore throat

A

Otitis media (most common),
peri-tonsillar abscess (quinsy),
parapharyngeal abscess,
mastoiditis

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7
Q

diagnosis of sore throat? what to do if sore throat persists?

A

throat swabs not routine.

If sore throat and lethargy persist into the second week, especially if the person is 15-25years of age, infectious mononucleosis should be suspected.
- less common cause = HIV, gonococcal pharyngitis, and diphtheria.

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8
Q

common cause of sore throat

A

usually not life-threatening and include common cold, influenza, streptococcal infection

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9
Q

how to manage sore throat?

A

Giving simple advice = e.g. regular use of paracetamol or ibuprofen to relieve pain and fever, avoidance of hot drinks, adequate fluid intake to avoid dehydration, and the use of simple mouthwashes (e.g. warm salty water) at frequent intervals until the discomfort and swelling subside.

identify people who are IS

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10
Q

what should you use to decide if should give antibiotic treatment for sore throat

A

The Centor clinical prediction score :

[-tonsillar exudate
ƒ. tender anterior cervical lymph nodes
ƒ. history of fever
ƒ. absence of cough.]

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11
Q

what are the red flats needing referral for a sore throat?

A
  • Throat cancer is suspected (persistent sore throat, especially if there is a neck mass)
  • Sore or painful throat lasts for 3 to 4 weeks. There is pain on swallowing or dysphagia for more than 3 weeks
  • Red, or red and white patches, or ulceration or swelling of the oral/pharyngeal mucosa persists for more than 3 weeks
  • Stridor / respiratory difficulty is an emergency
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12
Q

how to treat bacteria sore throat? what percentage of sore throats are viral?

A

2/3rd viral

penicillin, and contact/droplet precautions

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13
Q

what is commonest bacterial cause of sore throat and what is clinical finding?

A

The most common BACTERIAL cause is Streptococcus pyogenes (also known as Group A streptococcus, or Group A Beta Haemolytic Strep)

Clinical: acute follicular tonsillitis

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14
Q

what are the complications of a Streptococcal sore throat?

A

Rheumatic fever:
3 weeks post sore throat
fever, arthritis and pancarditis

Glomerulonephritis:
1-3 weeks post sore throat
haematuria, albuminuria and oedema

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15
Q

what bacteria causes diphtheria?

A

Corynebacterium diphtheriae

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16
Q

PC of diphtheria? why is it not see in UK?

A

severe sore throat with a grey white membrane (psuedomembrane) across the pharynx. The organism produces a potent exotoxin which is cardiotoxic and neurotoxic.

Vaccine preventable

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17
Q

what is the diphtheria vaccine made from? how to treat current diphtheria infection?

A

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

Treatment: antitoxin and supportive and penicillin / erythromycin

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18
Q

what causes oral thrush?

A

Candida albicans

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19
Q

PC of oral thrush?

A

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

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20
Q

cause of oral thrush?

A

antibiotics, steroid (endogenous), IC (HIV, meds…)

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21
Q

treatment of oral thrush?

A

(topical) nystatin (anti-fungal)

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22
Q

what is acute otitis media?

A

An upper respiratory infection involving the middle ear by extension of infection up the Eustachian tube

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23
Q

who does acute otitis media commonly affect? PC?

A

infants + kids

earache, discharge if burst ear drum, hearing loss, fever

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24
Q

infections of middle ear/ acute otitis media causative organisms?

A

Often viral with bacterial secondary infection

Most common bacteria: Streptococcus pneumoniae Haemophilus influenzae, and Streptococcus pyogenes, Moraxella

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25
Q

how to diagnose acute otitis media?

A

swab of pus if eardrum perforates – otherwise samples can’t be obtained

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26
Q

treatment of infections of inner ear?

A

80% resolve in 4 days without antibiotics. - so NSAID + paracetamol

First line – amoxicillin
Second line – erythromycin

AB: if <2, bilateral, ear drum rupture, IC/unwell, symptoms >4 days

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27
Q

acute sinusitis PC of viral infection? bacterial?

A

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

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28
Q

treatment of acute sinusitis

A

Av. length illness 2.5 weeks. Reserve antibiotics for severe/deteriorating cases of >10 days duration.

1ST LINE penicillin V
2ND LINE doxycycline – NOT IN CHILDREN!!!

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29
Q

what is otitis externa?

A

Inflammation of the outer ear canal

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30
Q

PC of otitis externa?

A

itch and red swelling, then sore and painful, discharge, canal blocked, hearing affected.

31
Q

what is Malignant otitis externa ? why does it need to be looked out for?

A

extension of otitis externa into the bone surrounding the ear canal (i.e. the mastoid and temporal bones). Malignant otitis, without treatment, is a fatal condition. Osteomyelitis will progressively involve the skull and meninges

32
Q

Malignant otitis externa symptoms

A

Pain and headache, more severe than clinical signs would suggest.

33
Q

Malignant otitis externa signs

A

Granulation tissue at bone–cartilage junction of ear canal; exposed bone in the ear canal. Facial nerve palsy (drooping face on the side of the lesion).

34
Q

Malignant otitis externa investigations

A

Plasma viscosity / C-reactive protein to demonstrate an inflammatory response, radiological imaging, biopsy, and culture to demonstrate the extent of the osteitis and its cause (usually Pseudomonas aeruginosa).

35
Q

risk factors for Malignant otitis externa?

A

IC - diabetes (high BG, poor IS)and radiotherapy to head and neck

36
Q

causes of Otitis externa?

A

bacterial and fungal

37
Q

bacterial causes of Otitis externa?

A

The most common cause of otitis media is bacterialinfection, caused by Pseudomonas aeruginosa or Staphylococcus aureus

“swimmers ear”

38
Q

fungal causes of Otitis externa?

A

Aspergillus niger

Candida albicans

39
Q

management of Otitis externa?

A

Topical aural toilet.

swab + antimicrobial for unresponsive/severe cases.

treat dependant on culture results =

  • Topical clotrimazole (trade name canesten) for fungal infections
  • Gentamicin 0.3% drops
40
Q

what is infectious mononucleosis? who does it occur in?

A

“Glandular fever”

Disease of young adults

41
Q

PC of infectious mononucleosis

A

[onset over several days] Fever (throughout full day not just evening)
Enlarged lymph nodes
Sore throat, pharyngitis, tonsillitis
Malaise, lethargy

rarer = flank jaundice, rash(becomes more common if amoxicillin is applied), Haematology = Leucocytosis (lymphocytosis) + Presence of atypical lymphocytes in blood film, Splenomegaly, Palatal petechiae (spots of haemorrhage on palate)

42
Q

classic triad of infectious mononucleosis?

A

Fever, pharyngitis and lymphadenopathy

43
Q

prognosis of infectious mononucleosis?

A

Protracted (long + severe) but self limiting illness.

3 weeks feel better

44
Q

complications of infectious mononucleosis?

A

Anaemia, thrombocytopenia
Splenic rupture
Upper airway obstruction
Increased risk of lymphoma, especially in immunosuppressed.

45
Q

what causes infectious mononucleosis?

A

EBV (establishes a persistent infection in epithelial cells)

46
Q

what re the two phases of primary EBV infection? PC of both?

A

Primary infection in early childhood rarely results in infectious mononucleosis

Primary infection in those >10 years often causes infectious mononucleosis (kissing)

47
Q

management of infectious mononucleosis?

A 
Bed rest
Paracetamol (fever+malaise)
Avoid sport (stop spleen rupture)
Antivirals not clinically effective
Corticosteroids may have a role in some complicated cases (upper respiratory obstruction and haemolytic anaemia)
48
Q

how to diagnose?

A

Epstein-Barr virus IgM

Heterophile antibody: Paul-Bunnell test + Monospot test (for weird antibodies produced by B cells)

Blood count and film

Liver function tests (high ALT in some)

49
Q

why in infectious mononucleosis do you get Anaemia and/or thrombocytopenia?

A

RBC and platelets are destroyed by EBV infected Bcells as they release a cascade of AntiBodies. (AI phenomenon - give steroids to treat)

50
Q

other cases of similar illness (Infectious mononucleosis). in who and why is it important to find cause?

A

EBV commonest = 90%+

Cytomegalovirus
Toxoplasmosis
Primary HIV infection/ seroconversion illness

in PREGNANT WOMEN - Cytomegalovirus and Toxoplasmosis damage foetus

51
Q

what to do if recent glanduals fever but no EBV IgM?

A

HIV test (also do risk Hx and presence of diarrhoea = signs)

52
Q

Viral causes of oral ulceration

A

HSV type 1 = oral infection + infection through salvia contact

53
Q

typical HSV infection? worst PC?

A

asymptomatic, primary gingivostomatitis = worst

Disease of pre-school children
primary infection

systemic upset

lips, tongue, buccal mucosa, hard palate have vesicles 1-2mm on it become ulcers

54
Q

where does HSV1 ‘hide’ in the body/latency?

A

trigeminal ganglia (after primary infection).

inactive form of HSV in sensory nerve can reactivate to re-infect mucosal surfaces giving cold sores

55
Q

primary herpetic gingivostomatitis PC, complications + treatment

A
  • have fever + local LN with it
  • 3 week recovery,
  • spreads beyond mouth esp in atopicD; skin gets infected as already weak and can be fatal

aciclovir treatment

56
Q

what causes a cold sore?

A

Reactivation from nerves causes active infection (due to various stimuli)

57
Q

how to treat cold sore? recurrent cold sores?

A

acyclovir

daily acyclovir

[note natural Hx of cold sores in decrease over time]

58
Q

HSV2

A

50% genital herpes, type 2 has > reactivation rate

59
Q

what is a herpetic whitlow?

A

painful and recurring HSV infection of the tip of the finger (used to happen to dentists now gloves prevent it)

60
Q

how to diagnose HSV?

A

swab and PCR

61
Q

what is a rare and potentially fatal complication of HSV infection?

A

Herpes simplex encephalitis

can case temporal lobe necrosis

62
Q

PC of Herpes simplex encephalitis

A

fever, lower consciousness level

63
Q

what is herpangina?

A

vesicles/ulcers on soft palate at back of throat caused by coxsackie viruses.

64
Q

what family is coxsackie virus part of?

A

enterovirus

65
Q

how to diagnose herpangina?

A

PCR/clinical reasoning

66
Q

what is hand foot and mouth disease due to? diagnose?

A

coxsackie viruses (get family outbreaks)

PCR/clinical reasoning

67
Q

what are Apthous ulcers?

A

Non viral, self limiting

Recurring painful ulcers of the mouth that are round or ovoid and have inflammatory halos.

68
Q

Pc of Apthous ulcers?

A

round painful recurring ulcers in mouth that have inflammatory halos.

confined to mouth, no systemic disease.bgan in childhood - 30’s.
each ulcer lasts <3 weeks

69
Q

Recurrent ulcers associated with systemic disease (non viral)

A 
Behçet's disease: Recurrent oral ulcers
Genital ulcers
Uveitis. 
It can also involve visceral organs such as the gastrointestinal tract, pulmonary, musculoskeletal, cardiovascular and neurological systems
Commonest in Middle East and Asia

Gluten-sensitive enteropathy or inflammatory bowel disease:
Diarrhoea, weight loss

Reiter’s disease: Arthritis

Drug reactions

Skin diseases:
lichen planus, pemphigus,or pemphigoid

70
Q

primary syphilis buzzword PC

A

Chancre (commonly genital or oral)

71
Q

what is a Chancre? what happens if left untreated?

A

Painless indurated ulcer at site of entry of bacterium Treponema pallidum

secondary and tertiary syphilis

72
Q

bacteria causing syphilis?

A

Treponema pallidum

73
Q

diagnosing and treating syphilis?

A

fluorescent treponemal antibody absorption test for IgG and IgM antibodies.

IM penicillin

ENT (19 decks)

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