Lecture 13- Eyes, Ear, Nose and Throat Infections

Question 1

Conjunctivitis

Answer 1

Infection/inflammation of the conjunctiva; commonly referred to as “pink eye”

Question 2

What is the conjunctiva ?

Answer 2

Mucuous membrane than covers to outside of the eyes and under the eyelids which lubricate the eyes and prevent pathogen entry

Question 3

Risk factors for pink eye?

Answer 3

Exposure to someone, contact lenses, allergies, trauma, immunocompromised, prior ocular infections

Question 4

List the most common causes of bacterial conjunctivitis

Answer 4

Streptococcus pneumonia, haemophilia influenzae, stap aureus, pseudomonas aeruginosa

Question 5

Which infectious entities with pink eye are most common in neonates?

Answer 5

Chlamydia trach, neisseria gonorrhea

Question 6

What are the most common causes of viral conjunctivitis ?

Answer 6

Adenovirus
Enterovirus
VSZ
Herpes simplex (neonates)

Question 7

When diagnosing conjunctivitis, what do we need to determine?

Answer 7

If this is bacterial or viral done with gram stain and culture

Question 8

How do we treat bacterial conjunctivitis ?

Answer 8

Antibiotics unless HSV

Question 9

How do we treat viral conjunctivitis?

Answer 9

Supportive care

Question 10

What is otitis external?

Answer 10

Swimmers ear

Question 11

What causes swimmers ear?

Answer 11

Pseudomonas spp

Question 12

HOw do we treat otitis external?

Answer 12

Aimed at drying the area with alcohol

Question 13

Can swimmers ear be caused by fungus or anything else?

Answer 13

Yes. Some fungi, prolonged antibiotic use, and dermatophytes

Question 14

Otitis media- describe the structure implicated

Answer 14

The tubs that link nasopharynx to the middle ear; draining normal secretions from the middle ear which regulate pressure in the middle ear to equalize it with the outside

Question 15

What happens when the eustasian tubes become blocked

Answer 15

Pathogensis of otitis media

Question 16

Which bacteria can lead to otitis media?

Answer 16

streptococcus pneumonia, haemophilia influenzar, others in the upper resp tract

Question 17

What viral infections can lead to otitis media?

Answer 17

RSV, influenza, adenovirus

Question 18

How do we diagnose otitis media ?

Answer 18

Otoscope for inflammation and this is followed up with microbiology

Question 19

How do we trat otitis media?

Answer 19

Acute and prophylactic treatment with recurrent infections

Question 20

MOst episoes of pharyngitis are…

Answer 20

Viral

Question 21

List some viruses that can cause pahryngitis

Answer 21

mono, adenovirus, influenza, common cold, RSV, HSV, acute HIV

Question 22

List some bacterial species that can lead to pharyngitis

Answer 22

Streptococcus pyogenes, acranobacterium hemolyticum, chlamyda trach, neisseria gono, corynebacterium diphtheria

Question 23

What test is used for mono

Answer 23

rapid monospot test which has 90% sensitivity when tested in the first 2-3 weeks in the blood

Question 24

How do you test for bacterial pharyngitis?

Answer 24

Throat swab for group A strep to be treated with penicillin

Question 25

When someone has croup, laryngitis, or bronchitis- what is it really?

Answer 25

Tracheobronchitis which may be bacterial or viral

Question 26

Viral tracehobronchitis infections?

Answer 26

RSV, influenza, parainfluenza

Question 27

Bacterial aetiologies of tracheobronchitis ?

Answer 27

Bordetella pertussis (whooping cough)

Question 28

Why is the influenza virus so virulent?

Answer 28

Paralyze cilia, antigenic drift, antigenic shift

Question 29

Describe the parainfluenza virus?

Answer 29

Croup in children- inflammation of the larynx but will lead to bronchitis in older children/adults

Question 30

How do you detect parainfluenza virus?

Answer 30

Typically clinical, should confirm if being hospitalized

Question 31

RSV- respiratory syncytial virus

Answer 31

RSV leads to bronchitis (inflammation of the bronchus); can be severe in young and old which can lead to pneumonia and can require hospitalization

Question 32

How do you diagnose or detect RSV

Answer 32

Nasopharyngeal swab or wash, rapid antigen detection (good for RSV only), virus culture, PCR, combination of several tests

Question 33

Bordertella pertussis

Answer 33

Whooping cough, transmitted by droplets, gram negative organisms that infect respiratory epithelial cells

Question 34

Clinical manifestations of whooping cough

Answer 34

Mild upper respiratory tract infection, cough, leads to uncontrolled cough and whoop and vomiting

Question 35

Vaccine for whooping cough

Answer 35

DTap: aP- acellular pertussis vaccine, recent evidence suggests aP vaccine immunity wanes

Question 36

How do you detect bordetella pertussis ?

Answer 36

Culture not done as it needs specialized media, PCR testing of NPG swab - can lead to kennel cough

Question 37

What are the two types of pneumonia

Answer 37

CAP and HAP

Question 38

What is pneumonia

Answer 38

Inflammation and infection of the lungs that may be caused by bacteria, viruses, and fungi

Question 39

Pneumonia

Answer 39

Acute onset: classic symptoms, fever, SOB, and productive cough More serious in older people and infants

Question 40

What can cause CAP (community acquired pneumonia)?

Answer 40

Streptococcus pneumonia, haemophilia influenza, legionella pneumophila, chlaymydia pneumonia, mycoplasma pneumonia, staph aureus

Question 41

What sample do you need to submit to a lab for CAP

Answer 41

SPUTUM, NOT SALIVA as well as blood cultures- we worry about bacteremia

Question 42

What are some things to look out for that show atypical CAP

Answer 42

Protracted illness, less sputum production (dry cough), age, travel, animal exposure, typically harder to diagnose because organisms not in lab algorithm

Question 43

Mycoplasma pneumonia

Answer 43

Common in school aged kids, spreads via resp droplets, no cell wall, hard to culture, 100 day cough, detected with PCR and serology

Question 44

Chlamydia pneumonia

Answer 44

Common cause of illness with most cases being mild or asymptomatic, persistent cough, malaise, bad if immunocompromised, detected with PCR

Question 45

Do people still use cell lines?

Answer 45

NO

Question 46

Legionella pneumophila

Answer 46

Gram negative bacili

Question 47

Where can you find legionella pneumophila?

Answer 47

Water- cooling towers, air conditioners, hot tubs

Question 48

Who is at high risk with legionella pneumophila infection?

Answer 48

older, smoker, COPD- under diagnosed alot Urinary antigen and PCR

Question 49

Ventilator associate pneumonia- VAP

Answer 49

Dx with blood culture, suctioning, bronchial washing causative agents change with onset

Question 50

Causative agents: Early onset VAP

Answer 50

Hemophilus influenza Streptococcus pneumoniae Staph aureus E. coli Klebsilla (antibiotic sensitive)

Question 51

Late onset causative agents of VAP

Answer 51

Pseudomonas aeruginosa MRSA Acinetobacter Strains are multiple antibiotic resistant

Question 52

What causes tuberculosis ?

Answer 52

Mycobacterium tuberculosis (MTB)

Question 53

Most TB infections are ___________ with 10% progressing to __________

Answer 53

Latent, disease

Question 54

Are there specific host factors which can predispose you to TB disease?

Answer 54

No

Question 55

How is TB spread?

Answer 55

Droplets

Question 56

Very _______ doses of tb are required for infection

Answer 56

small

Question 57

How do we detect TB?

Answer 57

culture, this can take 6 weeks and look for antibodies with a skin test or direct smears leading to PCR

Question 58

How do you control TB infection?

Answer 58

Isolation, negative pressure room- report to PHU, prolonged treatment of 6-9 months