Microbiology

Question 1

What is the basic diagnostic test for infection of the throat and pharynx?

Answer 1

Well-taken swab

Question 2

The vast majority of throat infections are viral. True/False?

Answer 2

True

Thus don’t need antibiotics

Question 3

What is the most common bacterial cause of sore throat?

Answer 3

Strep. pyogenes, causing acute follicular tonsillitis

Question 4

What is the treatment for acute follicular tonsillitis?

Answer 4

Oral benzylpenicillin

Clarithromycin if pen-allergic

Question 5

Describe Strep. pyogenes

Answer 5

Gram +ve cocci in chains

Beta-haemolysis (complete)

Question 6

List some acute complications of Streptococcal sore throat

Answer 6

Otitis media
Peritonsillar abscess (quinsy)
Scarlet fever

Question 7

List some late complications of Streptococcal sore throat

Answer 7

Rheumatic fever

Glomerulonephritis

Question 8

Describe the clinical appearance of diphtheria

Answer 8

Severe sore throat
White membrane across pharynx
Exotoxin that is cardiotoxic and neurotoxic

Question 9

There is a vaccine for diphtheria. What supportive treatment can be given?

Answer 9

Antitoxin

Penicillin/erythromycin

Question 10

Describe the clinical appearance of oral thrush (Candida)

Answer 10

White patches on red mucous membranes in mouth

Question 11

What is the treatment for oral thrush?

Answer 11

Nystatin suspension (topical)

Question 12

What is otitis media?

Answer 12

URTI of middle ear caused by extension of infection through the Eustachian tube

Question 13

List the main causes of otitis media

Answer 13

Usually viral

Secondary bacteria: H. influenzae, Strep. pneumoniae + pyogenes

Question 14

What aids diagnosis of otitis media?

Answer 14

Swab of pus if eardrum perforates

Question 15

Most otitis media resolves on its own. True/False?

Answer 15

True

Self-limiting within 4 days

Question 16

Which antibiotics may be given for severe/bilateral acute otitis media?

Answer 16

Amoxicillin

Doxycycline if pen-allergic

Question 17

What is acute sinusitis?

Answer 17

Discomfort over frontal/maxillary sinuses due to viral congestion
If severe pain, tenderness and rhinorrhoea, consider secondary bacterial infection

Question 18

If uncomplicated, avoid antibiotics in acute sinusitis. True/False?

Answer 18

True

Self-limiting within 2.5 weeks

Question 19

Which antibiotics are indicated for acute sinusitis?

Answer 19

PERSISTS FOR LONGER THAN 10 DAYS
Penicillin
Doxycycline BUT NOT IN CHILDREN

Question 20

Describe the clinical appearance of otitis externa

Answer 20

Red, swollen ear canal
Itchy
Painful
Discharge/earwax
Reduced hearing

Question 21

List the main bacterial and fungal causes of otitis externa

Answer 21

Staph. aureus, Pseudomonas

Aspergillus, candida

Question 22

List treatment of otitis externa

Answer 22

Topical aural toilet (cleaning)
Swab if unresponsive then treat according to culture
Clotrimazole for fungal
Gentamicin for Pseudomonas

Question 23

What is another name for infectious mononucleosis?

Answer 23

Glandular fever - disease of young adults with some URT features

Question 24

What is the classic triad of glandular fever?

Answer 24

Fever
Pharyngitis
Lymphadenopathy

Question 25

List some complications of glandular fever

Answer 25

Splenic rupture Upper airway obstruction Thrombocytopenia Lymphoma

Question 26

What is the main cause of glandular fever?

Answer 26

EBV

Question 27

What are the 2 phases of EBV infection?

Answer 27

Primary infection in children rarely progresses | Primary infection in those over 10yrs usually progresses

Question 28

Outline treatment of glandular fever

Answer 28

Bed rest Paracetemol Avoid sport Corticosteroid

Question 29

Antivirals are not effective for glandular fever. True/False?

Answer 29

True

Question 30

What lab tests are done for EBV?

Answer 30

IgM Heterophile antibody - Paul-Bunnel, Monospot test LFTs Blood count

Question 31

CMV infection may be similar to EBV - how to distinguish?

Answer 31

CMV has no hererophile antibodies

Question 32

List the two main differential diagnoses of pain at the back of the mouth

Answer 32

Acute pharyngitis | Tonsilitis

Question 33

List red flags for throat and pharynx pathology, suggestive of cancer

Answer 33

``` Persistent sore throat/ painful mouth Neck mass Dysphagia Hoarseness Red/ white patches or ulcers 3-4 weeks duration ```

Question 34

What should you be suspicious of if a throat and pharynx infection lasts longer than 2 weeks?

Answer 34

Infectious mononucleosis

Question 35

What is the main viral cause of primary gingivostomatitis or oral ulceration?

Answer 35

HSV

Question 36

Outline the treatment for primary gingivostomatitis

Answer 36

Aciclovir for 3 weeks

Question 37

How should HSV infection be diagnosed?

Answer 37

PCR of swab