Microbiology

Question 1

When should a sore throat be considered a medical emergency?

Answer 1

when combined with stridor or respiratory difficulty

Question 2

What are the causes of inflammation by non-infectious means?

Answer 2

uncommon but include physical irritation eg from GORD; chronic irritation from cigarette smoke; alcohol or hayfever

Question 3

Who do acute throat infections most common affect?

Answer 3

those aged 5-10 a nd 15-25`

Question 4

What are the complications of a sore throat?

Answer 4

otitis media; peri-tonsillar abscess (quinsy); parapharyngeal abscess and mastoiditis

Question 5

What should be suspected if sore throad and lethargy persist into the second week in 15-25 yos?

Answer 5

infectious mononucleosis

Question 6

What are the causes for referral or admission with a sore throat?

Answer 6

if throat cancer is suspected; pain on swalling/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

Question 7

What score should be used to assist decision on whether to give an antibiotic?

Answer 7

Centor clinical prediction score

Question 8

What are the components of the Centor score?

Answer 8

tonsillar exudate; tender anterior cervical lymph nodes; hx of fever; absence of cough

Question 9

What is the most common cause of bacterial sore throad?

Answer 9

step. pyogenes

Question 10

what is the treatment for strep. pyogenes?

Answer 10

penicillin

Question 11

What is seen on microbiology of strep. pyogenes?

Answer 11

gram positive cocci in chain; beta-haemolysis (complete)

Question 12

What are the late complications of strep. sore throat?

Answer 12

rheumatic fever; glomerulonephritis

Question 13

What are the signs of rheumatic fever?

Answer 13

fever; arthritis and pancarditis

Question 14

What are the signs of glomerulonephritis?

Answer 14

haematuria; albuminuria and oedema

Question 15

When does rheumatic fever arise after strep throat?

Answer 15

3 week post

Question 16

When does glomerulonephritis arise after a strep throat?

Answer 16

1-3 weeks post

Question 17

What are the features of Diphtheria?

Answer 17

severe sore throat with a grey white (pseudo) membrane across the pharynx

Question 18

How does the organims cause illness?

Answer 18

a potent exotoxin

Question 19

Why is diphtheria so serious?

Answer 19

the exotoxin is cardiotoxic and neurotoxic

Question 20

What is the vaccine for diptheria made from?

Answer 20

toxoid

Question 21

What is the treatment for diphtheria?

Answer 21

antitoxin and supportive and penicillin/erythromycin

Question 22

What are the signs of candida/thrush?

Answer 22

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

Question 23

What is the treatment for candida?

Answer 23

nystatin

Question 24

What is acute otitis media?

Answer 24

a URTI involving the middle ear by extension of infection up the eustachian tube

Question 25

Who gets otitis media?

Answer 25

infants and children

Question 26

What are infections ofr the middle ear often caused by?

Answer 26

viral with bacterial secondary infection

Question 27

What are the most common bacteria causing infections of the middle ear?

Answer 27

haemophilus influenzae; strep. pneumoniae; strep. pyogenes

Question 28

How can a sample be obtained for infections of the middle ear?

Answer 28

swab of pus if eardrum perforates, otherwise samples cant be obtained

Question 29

What is the first line antibiotic for infections ofr the middle ear?

Answer 29

amoxicillin

Question 30

What is second line antibiotic for middle ear infefctions?

Answer 30

erythromycin

Question 31

What are the signs of acute sinusitis?

Answer 31

mild discomfort over frontal or maxillary sinuses due to congestion often seen with URTI

Question 32

What would indicate a secondary bacterial infection with acute sinusitis?

Answer 32

severe pain and tenderness with purulent discharge

Question 33

When should antibiotics be given with sinusitis?

Answer 33

for severe/deteriorating cases of more than 10 days

Question 34

What is the first line antibiotic for sinusitis?

Answer 34

penicillin V

Question 35

What is the second line antibiotic for sinusitis?

Answer 35

doxycycline

Question 36

Who should doxycycline NOT be given to?

Answer 36

children

Question 37

What is otitis externa?

Answer 37

inflammation fo the outer ear canal

Question 38

What are the signs of otitis externa?

Answer 38

redness and swelling of the skin of the ear canal; itchiness; sore and painful; discharge or increased wav

Question 39

What is malignant otitis?

Answer 39

an extension of otitis externa in to the bone surrounding the ear canal which is fatal without treatment

Question 40

What bones does malignant otits affect?

Answer 40

mastoid and temporal bones

Question 41

What are the symptoms and signs of malignant otits?

Answer 41

pain and hedache, more severe than clinical signs would suggest; granulation tissue at bone-cartilage junction of ear canal; exposed bone in the ear canal; facial nerve palsy

Question 42

What is facial nerve palsy?

Answer 42

drooping face on the side of the lesion

Question 43

What are the investigations for malignant otitis?

Answer 43

PV; CRP; imagin; biopsy and culture

Question 44

What is the most common bacteria in malignant otitis?

Answer 44

pseudomonas

Question 45

What are the risk factors for malignant otitis?

Answer 45

DM; PMH of radiotherapy

Question 46

What are the bacterial causes of otitis externa?

Answer 46

staph. aureus; proteus; pseudomonas; aspergillus; candida

Question 47

What is the treatment for otitis externa?

Answer 47

topical aural toilet

Question 48

When should a swab and prescription be done for otitis externa?

Answer 48

unresponsive and severe cases

Question 49

What might you prescribe for otitis externa depending on the culture results?

Answer 49

topical clotramizole or gentamicin drops

Question 50

What is the classic triad seen in infectious mononucleosis?

Answer 50

fever; pharyngitis and lymphadenpathy

Question 51

What are other signs of glandular fever?

Answer 51

jaundice/hepatitis; rash; leucocytosis; presence of stypical lymphocytes in blood film; splenomegaly; palatal petechiae

Question 52

What antibiotic results in a rash with glandular fever?

Answer 52

ampicillin or amoxicillin

Question 53

What do the atypical lymphocytes seen with glandular fever look like?

Answer 53

activated cytotoxic T lymphocytes- larger, irregular nucleus and high level of ribosomes

Question 54

What are complications of glandular ever?

Answer 54

anaemia; thrombocytopania; splenic rupture; upper airway obstrucition; increased risk of lymphoma esp. in immunosuppressed

Question 55

What should be avoided following glandular fever and why?

Answer 55

avoid sports for 6 weeks- splenic rupture

Question 56

What virus causes glandular fever?

Answer 56

EBV

Question 57

What are the 2 phases of primary infection with EBV?

Answer 57

early childhood- rarely results in glandular fever; in over 10s often causes

Question 58

What is the therapy for glandular fever?

Answer 58

ebd rest; avoid sport; paracetamol

Question 59

How is glandular fever comfrimed in the lab?

Answer 59

EBV IgM; monospot- heterophile antibody; blood count and film; LFTs

Question 60

How can you differentiate between EBV and CMV which cause very similar disease??

Answer 60

no heterophile antibody and fewer atypical lymphocytes

Question 61

When is type 1 HSV typically acquired?

Answer 61

childhood

Question 62

What does type 1 HSV cause?

Answer 62

oral lesions

Question 63

How is HSV transferred?

Answer 63

salivary contact

Question 64

What disease can occur with primary infection of HSV type 1?

Answer 64

primary gingivostomatitis

Question 65

What are the signs of primary gingivostomatitis?

Answer 65

systemic upset-fever, local lymphadenopathy; lips, buccal mucosa, hard palate affected with vesicles and ulcers

Question 66

How is primary gingivostomatitis treated?

Answer 66

aciclovir

Question 67

Where is herpes held latent?

Answer 67

inactive form of virus in sensory nerve cells of trigeminal ganglia (nerve that serves the area of the mouth)

Question 68

Does aciclovir prevent latency?

Answer 68

no

Question 69

What is the percentage of people that get clinical reoccurences with HSV1?

Answer 69

half

Question 70

What would recurrent intra-oral lesions indicate?

Answer 70

Rarely cause by HSV so likely to be something else

Question 71

What is herpetic whitlow?

Answer 71

HSV infected in fingers

Question 72

How is HSV confirmed in the lab?

Answer 72

swab of lesion and viral DNA detected by PCR

Question 73

What is a complication of HSV in the CNS?

Answer 73

herpes simplex encephalitis

Question 74

What causes herpangina?

Answer 74

coxsackie virus-enterovirus

Question 75

What are the signs of herpangina?

Answer 75

vesicles/ulcers on soft palate

Question 76

What patient group gets herpangina?

Answer 76

children

Question 77

What virus causes hand, foot and mouth disease?

Answer 77

coxsakcie virus

Question 78

What are apthous ulcers?

Answer 78

recurring painful ulcers of the mouth that are round or ovoid and have inflammatory halos- each ulcer lasts less than 3 weeks; absence of systemic disease

Question 79

What causes apthous ulcers?

Answer 79

non-viral, self limiting

Question 80

What is the triad seen with Behcets disease?

Answer 80

recurrent oral ulcers; genital ulcers and uceitis

Question 81

Where is Behcets most common?

Answer 81

middle east and asia

Question 82

What is the triad foudn with Reiters ?

Answer 82

Noninfectious urethritis Arthritis Conjunctivitis

Question 83

What are the cahracteritics of a chancre?

Answer 83

painless indurated ulcer at site of entry of Treponema pallidum

Question 84

What is a chancre a sign of?

Answer 84

syphilis