Microbiology

Question 1

what are some viral causes of oral ulceration?

Answer 1

herpes simplex virus (HSV)
herpangina
hand, foot and mouth disease
primary syphilis (bacteria)

Question 2

which type of HSV causes oral lesions?

Answer 2

type 1

Question 3

what is primary gingivostomatitis?

Answer 3

vesicles and ulcers on lips, buccal mucosa and hard palate

Question 4

presentation of HSV

Answer 4

primary gingivostomatitis
fever
local lymphadenopathy

Question 5

management of HSV

Answer 5

acyclovir

Question 6

what is a cold sore?

Answer 6

HSV has established latency in a sensory nerve root and can be reactivated

Question 7

diagnosis of HSV

Answer 7

swab to detect viral DNA by PCR

Question 8

presentation of herpangina

Answer 8

vesicles/ ulcers on soft palate

Question 9

cause of herpangina

Answer 9

coxsackie virus (enterovirus)

Question 10

diagnosis of herpangina

Answer 10

swab

Question 11

what causes hand, foot and mouth disease?

Answer 11

coxsackie virus

Question 12

diagnosis of hand, foot and mouth disease

Answer 12

swab

Question 13

presentation of primary syphilis

Answer 13

chancre is a painless indurated ulcer at the site of bacterial entry

Question 14

what are apthous ulcers?

Answer 14

non-viral ulcers

Question 15

presentation of apthous ulcers

Answer 15

painful with inflammatory halos

Question 16

what conditions are recurrent ulcers associated with?

Answer 16

HSV

IBD, etc.

Question 17

what is tonsilitis?

Answer 17

inflammation of the tonsils

Question 18

causes of tonsilitis

Answer 18

bacterial
viral= coryza, influenza, strep
less common= HIV, gonococcal pharyngitis and diphtheria
non-infectious causes

Question 19

non-infectious causes of tonsilitis

Answer 19

physical irritation e.g. GORD, tobacco, alcohol, hay-fever

Question 20

cause of infectious mononucleosis?

Answer 20

EBV (herpes family)

Question 21

presentation of infectious mononucleosis

Answer 21

sore throat
lethargy 
15-25 most common
fever
enlarged lymph nodes
other= jaundice/hepatitis, rash, leucocytosis, splenomegaly and palatal petechiae

consider as differential in tonsillitis especially if lethargy persists.

Question 22

when should infectious mononucleosis be suspected?

Answer 22

lethargy persists in second week

Question 23

two criteria’s that are used for tonsilitis

Answer 23

CENTOR

FeverPAIN

Question 24

describe the FeverPAIN criteria

Answer 24

fever
purulence
attend rapidly w3/7
inflamed tonsils
no cough

Question 25

when should phenoxymethylopenicillin be considered in tonsilitis?

Answer 25

score 4-5 on FeverPAIN

Question 26

late complications of strep pyogenes

Answer 26

rheumatic fever | GM

Question 27

presentation of rheumatic fever in strep pyogenes

Answer 27

3 weeks post sore throat with fever, arthritis and pancarditis

Question 28

presentation of GM in strep pyogenes

Answer 28

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

Question 29

presentation of diphtheria

Answer 29

sore throat grey-white membrane across pharynx exotoxin is cardio and neurotoxic

Question 30

management of diptheria?

Answer 30

vaccine

Question 31

complications of EBV

Answer 31

``` anaemia thrombocytopenia splenic rupture upper airway obstruction increased risk of lymphoma (immunosuppressed) ```

Question 32

diagnosis of EBV

Answer 32

EBV IgM Paul-Bunnel test or Monospot test for heterophile Ab blood count and film LFTs

Question 33

management of EBV

Answer 33

bed rest paracetamol avoid sport steroids in complicated cases

Question 34

presentation of candida in the mouth

Answer 34

white patches on red and raw mucous membranes

Question 35

causes of candida in the mouth

Answer 35

post-antibiotics immunosuppressants smoking inhaled steroids

Question 36

management of candida in the mouth

Answer 36

nystatin | fluconazole

Question 37

how can a throat infection cause otitis media?

Answer 37

extension of infection up the eustachian tube

Question 38

causes of otitis media

Answer 38

most viral with secondary bacterial (H. influenza, strep pneumonia and pyogenes)

Question 39

management of otitis media

Answer 39

most resolve without antibiotics

Question 40

how can otitis media lead to facial palsy?

Answer 40

facial nerve is exposed in the middle ear and can swell

Question 41

how can otitis media cause mastoiditis?

Answer 41

otitis media > peri-tonsillar abscess (quinsy) > parapharyngeal abscess > mastoiditis

Question 42

what is otitis externa?

Answer 42

inflammation of the outer ear canal

Question 43

presentation of otitis externa

Answer 43

``` redness swelling itch pain discharge/ earwax potential for hearing loss ```

Question 44

bacteria causes of otitis externa

Answer 44

staph aureus proteus pseudomonas aeruginosa

Question 45

fungal causes of otitis externa

Answer 45

aspergillus | candida

Question 46

what is malignant otitis externa?

Answer 46

extension of otitis externa into the bone surrounding the ear canal e.g. mastoid and temporal

Question 47

risk if malignant otitis externa is not treated?

Answer 47

death due to risk of osteomyelitis of the skull

Question 48

presentation of malignant otitis externa

Answer 48

pain and headache (more severe than clinical signs suggest) granulation tissue at bone-cartilage junction facial nerve palsy (drooping on side of lesion)

Question 49

diagnosis of malignant otitis externa

Answer 49

CRP imaging biopsy cultures

Question 50

RF for malignant otitis externa

Answer 50

DM | radiotherapy of head and neck

Question 51

presentation of acute sinusitis

Answer 51

discomfort over frontal and maxillary sinuses URTIs severe pain with purulent discharge if bacterial

Question 52

management of acute sinusitis

Answer 52

antibiotics are only used in severe cases >10 days 1st line= phenoxymethylpenicillin 2nd line= doxycycline (NOT in children)