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Year 2 > Microbiology of ENT infections > Flashcards

Microbiology of ENT infections Flashcards

1
Q

How can infections of the throat and pharynx be diagnosed?

A

Throat swab

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2
Q

What is the cause of the large majority of sore throats? How is this clinically relevant?

A

Viral infections

NO ANTIBIOTICS

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3
Q

What is the most common cause of bacterial sore throats?

A

Strep pyogenes (group A strep)

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4
Q

How does strep. pyogenes sore throat present?

A

Acute follicular tonsillitis

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5
Q

How is bacterial sore throat treated?

A 
Oral penicillin 
Oral clarithromicin (if allergic)
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6
Q

What is the criteria for prescribing antibiotics to sore throats?

A

Cervical lymphadenopathy
Absence of cough
Purulent tonsils
Fever

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7
Q

What are the features of strep pyogenes?

A

Gram positive cocci chains

Beta haemolytic

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8
Q

What are the acute complications of bacterial sore throat?

A

Peritonsillar abcess (quincy)
Sinusitis
Otitis media
Scarlet fever

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9
Q

What is scarlet fever?

A

Infectious bacterial disease (step. pyogenes) causing fever and red rash

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10
Q

What protection procedures are indicated in quincy?

A

SICP
Contact precautions
Risk assess for droplet protection

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11
Q

What are the late complications of strep. sore throat?

A

Rheumatic fever

Glomerulonephritis

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12
Q

How does rheumatic fever present?

A

Weeks after sore throat
Pancarditis
Fever
Arthritis

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13
Q

How does glomerulonephritis present?

A

Weeks after sore throat
Haematuria
Albuminuria
Oedema

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14
Q

What causes diptheria?

A

Corynebacterium diphtheriae

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15
Q

How does diptheria present?

A

Severe sore throat

Grey-white pseudomembrane across pharynx

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16
Q

What is effect does the diptheria endotoxin have on certain tissues?

A

Cardiotoxic

Neurotoxic

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17
Q

How common is diptheria?

A

Uncommon in UK

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18
Q

The diptheria vaccine is which type of vaccine?

A

Extracted toxin

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19
Q

How is diptheria treated?

A

Supportive
Anti-toxin
Penicillin OR erythromycin

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20
Q

How does oral candida (thrush) present?

A

White patches on top of raw, red mucous membranes in the mouth and throat

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21
Q

What causes thrush?

A

Candida albicans (usually endogenous)

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22
Q

How is oral candida treated?

A

Nystatin suspension (topically)

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23
Q

What is acute otitis media?

A

An upper respiratory infection which spreads to the middle ear via the eustachian tube

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24
Q

Which age group gets acute otitis media?

A

Infants & children

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25
Q

How does acute otitis media present?

A

Earache

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26
Q

What is the cause of acute otitis media?

A

Viral –> secondary bacterial infection

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27
Q

Which bacteria commonly cause acute otitis media?

A

Strep pyogenes
Haemophilus influenzae
Strep pneumonia

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28
Q

How is acute otitis media diagnosed?

A

Clinically

Swab can be taken (only if eardrum perforates)

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29
Q

How is acute otitis media treated?

A

Often self resolving

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30
Q

When are antibiotics indicated in the treatment of acute otitis media?

A

Bilateral in

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31
Q

Which antibiotics are used in the treatment of acute otitis media?

A

Amoxicillin

Clarithromycin if allergic

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32
Q

How does acute sinusitis present?

A

Discomfort over maxillary or frontal sinuses due to congestion
Pain which gets worse on bending/moving head in certain directions

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33
Q

What typically precedes acute sinusitis?

A

Upper respiratory tract infection (viral)

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34
Q

What would make you think of secondary bacterial infection with regard to acute sinusitis?

A

Severe pain over sinuses
Purulent nasal discharge
Tenderness

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35
Q

How can acute sinusitis be diagnosed?

A

Clinically

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36
Q

How is acute sinusitis managed?

A

Self resolving
If secondary bacterial infection
- Penicillin
- Doxycycline (NOT IN CHILDREN)

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37
Q

What is otitis externa?

A

Inflammation of the outer ear canal

38
Q

How does otitis externa present?

A 
Redness 
Swelling
Itch 
Pain
Increased ear wax/discharge 
Hearing loss (conductive - secretions or swelling block)
39
Q

What are the bacterial causes of otitis externa?

A

Staph aureus
Pseudomonas
Proteus

40
Q

What are the fungal causes of otitis externa?

A

Aspergillus niger

Candida albicans

41
Q

How is otitis externa managed?

A

Topical aural toilet (i.e clean the ear of debris)

42
Q

How is unresolving otitis externa managed?

A

Swab and culture
Fungal - topical clotrimazole
Bacterial - topical gentamicin (pseudomonas)

43
Q

Which age groups typically get infectious mononucleosis/glandular fever?

A

Adolescents

Young adults

44
Q

How does infectious mononucleosis present?

A 
Fever 
Enlarged lymph nodes
Sore throat/pharyngitis/tonsillitis 
Malaise 
Lethargy 
Palatal petechiae
45
Q

What is the characteristic triad of glandular fever?

A

Enlarged lymph nodes
Pharyngitis
Fever

46
Q

Which lymph nodes are enlarged in glandular fever?

A

All nodes may be enlarged but cervical nodes are often most prominent

47
Q

What are the uncommon signs & symptoms of glandular fever?

A 
Jaundice 
Rash
Leucocytosis (inc white cells)
Atypical lymphocytes
Splenomegaly
48
Q

Describe the onset of glandular fever

A

Insidious

49
Q

How is glandular fever treated?

A

Self limiting
Rest
Avoid sport
Paracetamol (fever)

50
Q

What are the possible complications of glandular fever?

A 
Anaemia 
Thrombocytopenia 
Splenic rupture
Upper airway obstruction 
Increased lymphoma risk (immunosupressed)
51
Q

How are the complications of glandular fever managed?

A

Anaemia & thombocytopenia - steroids
Splenic rupture - no sport for 6 wks
Obstruction - steroids +/- intubation

52
Q

What causes glandular fever?

A

Epstein barr virus

53
Q

Describe the two different outcomes of primary infection with EPV

A

Infected 10 - infectious mononucleosis common

54
Q

How is EPV transmitted?

A

Kissing

55
Q

What would be done in a patient with glandular fever who wanted to return to sport?

A

Abdominal ultrasound to exclude splenomegaly - if no splenomegaly return to sport within a month is allowed

56
Q

How can diagnosis of EPV be confirmed?

A

EPV IgM
Paul bunnel or monospot - heterophile antibody
Blood count + film
LFTs

57
Q

What other causes of illness may mimic EPV? How can you differentiate between these?

A

Cytomegalovirus - no heterophile antibody
Toxoplasmosis - minimal phayngitis
HIV - diarrhoea, clues from history

58
Q

How do humans become infected with toxoplasmosis?

A

Undercooked meat

Contact with cat litter

59
Q

What are the risks of CMV and Toxoplasmosis infection?

A

Congenital infection + foetal damage

60
Q

What are the types of herpes simplex virus?

A

Type 1 - oral

Type 2 - genital

61
Q

How does herpes type 1 spread? When is it usually acquired?

A

Saliva

Childhood

62
Q

What can herpes simplex type 1 cause?

A

Primary gingivostomatitis

Nb - this is severe reaction most cases are asymptomatic

63
Q

How does primary gingivostomatitis present?

A

Vesicles and ulcers on the lips, hard palate and buccal mucosa
Fever
Local lymphadenopathy

64
Q

How gets primary ginigvostomatitis?

A

Pre-school children

65
Q

Which age group typically gets herpes type 2? How is it transmitted?

A

Adults

Sexually

66
Q

How is primary gingivostomatitis (i.e herpes simplex type 1) treated?

A

Acyclovir

67
Q

Describe latency with respect to herpes simplex virus

A

Primary infection –> immune system gets virus under control –> sits inactive in dorsal root ganglia –> dermatomal reactivation later in life/when immune system under stress

68
Q

What is a cold sore?

A

Mild reactivation of herpes simplex virus

69
Q

How can a cold sore be treated?

A

Acyclovir

70
Q

Acyclovir does not prevent latency of herpes simplex. T/F

A

True

71
Q

What is the natural progression of cold sores?

A

Incidence will become less and less over time

72
Q

Recurrent intra-oral lesions are usually herpes simplex virus. T/F

A

False - oral herpetic lesions are but less common intra-orally

73
Q

What is herpetic whitlow?

A

Herpes simplex infection of the finger

74
Q

Who usually gets herpetic whitlow? How can it be prevented?

A

Dentists, anaesthetists

Gloves

75
Q

How can herpes simplex virus infection be confirmed?

A

Swab –> PCR

76
Q

What is a serious complication of herpes simplex infection?

A

Herpes simplex encephalitis

77
Q

What is herpangia?

A

Vesicles/ulcers on the soft palate

78
Q

What causes herpangia?

A

Coxsackie virus (enterovirus)

79
Q

Which age group gets herpangia?

A

Children

80
Q

How is herpangia diagnosed?

A

Clinically

Swab –> PCR

81
Q

What causes hand, foot and mouth disease?

A

Coxsackie virus (enterovirus)

82
Q

What type of outbreaks are usually caused by hand, foot and mouth?

A

Familial

83
Q

How is hand, foot and mouth disease diagnosed?

A

Clinically

Swab –> PCR

84
Q

What is an apthous ulcer?

A

Non-viral, self limiting painful ulcer which is recurrent within the mouth and surrounded by an inflammatory halo

85
Q

What clinical features would point towards an apthous ulcer?

A

Only on mouth
No systemic disease
Childhood –> 3rd decade
Ulcers last

86
Q

What systemic diseases may recurrent ulcers be associated with?

A 
Behcets disease
Coeliac 
IBD
Reiter's triad
Drug reaction
Skin disease
87
Q

How does behcets disease present?

A 
Recurrent ulcers
Uveitis
Genital ulcers
Visceral organ involvement
Middle eastern patients
88
Q

How does primary syphilis present?

A

Painless chancre (indurated ulcer) at entry site

89
Q

What causes syphilis?

A

Treponium pallidum

90
Q

Why should amoxicillin never be given to a patient with a sore throat?

A

Induces rash (non-allergic) in patients with infectious mononucleosis

Year 2 (72 decks)

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