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ENT COPY > Microbiology of ENT > Flashcards

Microbiology of ENT Flashcards

1
Q

general rule for sore throats

A

a sore throat with stridor or respiratory distress is an absolute indication for emergency admission and you should not attempt to examine the throat

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2
Q

differential diagnosis for pain at the back of the throat

A
  • acute pharyngitis

- tonsilitis

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3
Q

acute pharyngitis

A

inflammation of the oropharynx

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4
Q

tonsilitis

A

inflammation of the tonsils

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5
Q

acute pharyngitis and tonality are most common in who

A

children aged 5-10 and young adults aged 15-25

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6
Q

acute pharyngitis and tonsillitis are nearly always caused by

A

a bacterial or viral infection, non-infectious causes (GORD, smoking, hay-fever) are rare

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7
Q

diagnosis of acute pharyngitis/ tonsillitis

A

throat swabs should not regularly be carried out in general practice

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8
Q

common causes of acute pharyngitis/ tonsillitis

A

common cold, influenza, streptoccoccus

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9
Q

less common causes of acute pharyngitis/ tonsillitis

A

HIV, gonococcal pharyngitis, diphtheria

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10
Q

if sore throat and lethargy persists into second week

A

infectious mononucleosis (Glandular fever caused by EBV) should be considered especially if person is aged between 15-25

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11
Q

vast majority of acute pharyngitis/ tonsillitis

A

is viral and does not require antibiotics, only ibuprofen and stay hydrated

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12
Q

what scoring system is used

A

the centor score

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13
Q

the centor score

A

is used to determine the likelihood of acute pharyngitis or tonsillitis being caused by Group A strep and therefore, requiring penicillin

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14
Q

the contort score gives 1 point for each of the following

A
  • exudates on tonsils
  • history of fever
  • absence of cough
  • tender anterior cervical lymph nodes
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15
Q

who is the centor score not used in

A

under 3’s

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16
Q

identifying need for admission or referral

A
  • throat cancer is suspected (persistent sore throat especially if there is a neck mass)
  • sore or painful throat that lasts more than 3 weeks
  • dysphasia or pain on swallowing which lasts longer than 3 weeks
  • red or red/ white patches or ulceration or swelling of the oropharyngeal mucosa for more than 3 weeks
  • person is immunocompromised
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17
Q

if person is taking a DMARD for rheumatoid arthritis

A

but they aren’t unwell enough to warrant admission, withhold the DMARD and carry out a full blood count and consult rheumatologist, if WCC is very low then requires immediate admission

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18
Q

if person is taking carbimazole or PTU

A

it should be stopped immediately and an urgent FBC should be carried out and seek specialist advice (due to risk of agranulocytosis

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19
Q

admit immediately if person is

A

undergoing chemotherapy/ know or suspected leukamiaea/ asplenic/ aplastic anaemia/ or is on immunosuppression post transplant

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20
Q

complications of acute pharyngitis/ tonsillitis

A
  • ottisis media (most common complication)
  • peri-toniilar abscess (quinsy)
  • para-pharyngeal abscess
  • mastoiditis
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21
Q

rare complication of tonsillitis acute pharyngitis

A

lemierres syndrome, which is an infection of the posterior compartment of the lateral pharyngeal space complicated by internal jugular vein thrombophlebitis

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22
Q

most common cause of lemmieres syndrome

A

fusobacterium necrophorum

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23
Q

late complications of strep throat

A
  • rheumatic fever

- glomerulonephritis

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24
Q

rheumatic fever occurs

A

3 weeks after sore throat

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25
Q

rheumatoic fever definition

A

inflammatory disease which can involve the heart, brain, skin and joints caused by group A strep organism

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26
Q

Group A strep produces

A

an enzyme called streptolycin which causes the complete destruction of red blood cells known as beta haemolysis

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27
Q

some group A strep have

A

M protein on their cell wall which is highly antigenic and causes the production of antibodies, which cross react with the cells of the heart, brain, joints and skin which is called molecular mimicry and is a type 2 hypersensitivity reaction

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28
Q

rheumatic fever is most common

A

in children and places of poverty

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29
Q

presentation of rheumatic fever

A
  • pancarditis (inflammation of all 3 layers of the heart muscle, pericarditis can cause a pericardial friction rub)N
  • migratory polyarthritis (large joint get painful and inflamed one after the other)
  • subcutaneous nodules
  • erythema marginatum
  • Sydenham chorea= occurs late about 3 months after infection and is caused by autoimmune reaction of basal ganglia of brain causing rapid movements of the face and arms
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30
Q

long term complications of rheumatic fever

A

infective endocarditis and mitral stenosis

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31
Q

GLOMERULONEPHRITIS CAN OCCUR

A

1-3 weeks post sore throat caused by group A strep

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32
Q

in glomerulonephritis post strep

A

immune complexes form between autoantibodies and antigens and get deposited in the glomerular basement membrane causing inflammation damaging the podocytes allowing larger molecules to filter through causing haematuria, proteinuria, albunaemia

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33
Q

glomerulonephritis post-strep is

A

usually mild and resolves within one month

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34
Q

diphtheria

A

severe bacterial infection caused by a bacteria called corneybacterium diptheria

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35
Q

diphtheria is completely

A

preventable using a toxoid vaccine so it is very rare no

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36
Q

presentation of diphtheria

A

severe sore throat with white/ grey pseudomembrane across the posterior pharynx, produces an exotoxin which is cardiotoxic and neurotoxic

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37
Q

treatment of diphtheria

A

anti-toxin and penicillin/ erythromycin

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38
Q

candida/ thrush

A

caused by a yeast infection called candida albicans

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39
Q

symptoms of candida

A

white patches over red mucous membranes in the throat and mouth

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40
Q

candidiasis mostly occurs in

A

immunocompromised, those who wear dentures, people with diabetes mellitus and those treated with broad spectrum antibiotics

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41
Q

treatment of candidiasis

A

nystatin

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42
Q

acute otitis media cause

A

by an upper respiratory tract infection which spreads via the eustachian tube into the middle ear

43
Q

acute otitis media is predominantly

A

a disease of infants and children

44
Q

presenting complaint of acute otitis media

A

normally earache but can also present with discharge, hearing loss, fever and lethargy

45
Q

acute otitis media is normally caused by

A

a viral infection with a secondary bacterial infection:

  • streptococcus pnuemonia
  • haemophilia influenza
  • streptococcus pyogenes
  • moraxella catarrhalis
46
Q

diagnosis of acute otitis media

A

if the ear drum perforates you can carry out a swab but if not you can’t swab anything

47
Q

management of acute otitis media

A
  • 80% resolve spontaneously wishing 4 days and during this time paracetamol and ibuprofen are given
48
Q

offer an immediate prescription to

A
  • those who are systemically unwell
  • those who are at risk of serious complications due to lung, heart, kidney, neuromuscular or liver disease
  • those who are immunocompromised
  • those who’s symptoms have lasted longer than 4 days and show no sign of improvement
49
Q

antibiotics for acute otitis media

A

1st line= amoxicillin

2nd line= erythromycin

50
Q

also consider offering an antibiotic to

A
  • under 2’s with bilateral acute otitis media

- those with perforated ear drum and/ or discharge in the ear canal

51
Q

acute sinusitis presentation

A

mild discomfort over the maxillary or frontal sinuses due to congestion often seen in patients with an upper respiratory viral infections

52
Q

other presentation of acute sinusitis

A

sever pain with purulent discharge is a sign of a secondary bacterial infection

53
Q

acute sinusitis

A

sinusitis for less than 4 weeks

54
Q

chronic sinusitis

A

sinusitis for more than 4 weeks

55
Q

organisms causing acute sinusitis

A

are similar to those of acute otitis media

56
Q

average length of illness in acute sinusitis

A

is 2.5 weeks antibiotics are only used for severe/ deteriorating cases of more than 10 days duration

57
Q

antibiotics for acute sinusitis

A

1st line= penicillin V for 10 days

2nd line= doxycycline for 10 days but not ever in children

58
Q

why is doxycycline not used in children

A

because it stains teeth yellow

59
Q

otitis externa

A

inflammation of the external acoustic meatus most commonly caused by staph aureus and pseudomonas (also known as swimmers ear)

60
Q

3 subtypes of otitis externa

A
  • localised otitis externa
  • acute diffuse otitis externa
  • chronic diffuse otitis externa
61
Q

other causes of otitis externa

A

fungus: aspergillus niger and candida albicans

62
Q

presentation of otitis externa

A
  • redness and swelling of the skin of the external acoustic meatus
  • may be itchy
  • can become sore and painful
  • may be discharge
  • canal can become blocked causing reduced hearing
63
Q

malignant otitis externa

A

extension of otitis externa into the bone surrounding the ear canal (i.e. mastoid and temporal bone)

64
Q

without treatment malignant otitis externa

A

is a fatal condition because it will cause osteomyelitis of the skull and will spread into the meninges

65
Q

symptoms of malignant otitis externa

A

severe pain and headache

66
Q

signs of otitis media

A
  • granulation tissue at the bone cartilage junction
  • exposed bone in ear canal
  • facial nerve palsy
67
Q

most cases of malignant otitis media

A

are caused by pseudomonas

68
Q

diagnosis of malignant otitis media

A
  • CRP and PV
  • imaging
  • biopsy and culture
69
Q

risk factors for malignant otitis media

A

diabetes, immunocompromised or had previous radiotherapy to the head or neck

70
Q

tayside guidelines for otitis media

A

acute:
1st line= amoxicillin (clarithromycin if penicillin allergic)
recurrent:
considered as 3 or more episodes in 6 months or 5 or more episodes in 12 months

71
Q

tayside acute parotitis guidelines

A
  • consider mumps as differential diagnosis
  • antibiotics= flucloxacillin and metronidazole
    if penicillin allergic doxycycline and metronidazole
72
Q

tayside chronic parotitis guidelines

A

antibiotics not usually required ensure good hydration, oral hygiene and management of dry mouth

73
Q

otitits externa tayside guidelines

A

mild= do not swab, topical acetic acid for 7 days if no improvement after 3 days treat as moderate
moderate= do NOT swab, give OTOMIZE (which contains dexamethasone, neomycin and acetic acid) or Sofradex
if still not resolved after this then swab the ear for culture and treat according to sensitivities

74
Q

sensitivities for otitis externa

A
  • topical gentamycin/ ciprofloxacin

- topical clottrimazole for fungal infection 2-3 times a day intel 14 days after symptoms have resolved

75
Q

if otitis externa associated with

A

cellulitis or disease extended out of ear canal refer to ENT immediately and give oral/ IV antibiotics

76
Q

infectious mononucleosis also known as

A

glandular fever

77
Q

infectious mononucleosis is

A

predominantly a disease of young adults

78
Q

presentation classic triad

A
  • fever
  • lymphadenopathy
  • pharyngitis
79
Q

other symptoms of glandular fever

A
  • tonsilitis
  • malaise/ lethargy
  • jaundice is rare
  • splenomegaly is seen in 50% but rupture is extremely uncommon
80
Q

on haematology infectious mononucleosis causes

A

leukocytosis with atypical lymphocytes which are large and irregular

81
Q

in any viral disease

A

small numbers of irregular lymphocytes can be seen however in infectious mononucleosis they can be more than 15% of the white cells in circulation

82
Q

prognosis of infectious mononucleosis

A
  • protracted but self limiting illness; fever and pharyngitis and lymphdeonpathy can last up to 4 weeks, fatigue can last for months
83
Q

complications of infectious mononucleosis

A

anaemia= autoimmune and treated with steroids

  • thromcytopenia= usually midl and doesn’t need steroids
  • splenic rupture is incredibly rare but avoid sports for 6 weeks
  • URT obstruction can occur rarely requiring steroids and ventilatory support
84
Q

what does infectious mononucleosis cause increased risk of

A

lymphoma particularly in immunosuppressed

85
Q

infectious mononucleosis is caused by

A

the epstein barr virus (EBV) which is a virus of the herpes family it establishes a persistent infection of epithelial cells most notably of the pharynx

86
Q

2 phases of primary infections with EBV

A

primary infection early in childhood rarely results in infectious mononucleosis
primary infection in those over 10 years old commonly causes infectious mononucleosis

87
Q

5-20%

A

of seropositive (EBV IGG POSITIVE) individuals harbour EBV in saliva and over the age of 30, 98% of uk population are EBV IgG positive

88
Q

management of infectious mononucleosis

A

symptomatic= bed rest, paracetamol and avoid sport for 6 weeks

89
Q

what is not affective in infectious mononucleosis

A

anti-vitals

90
Q

what is sometimes used in infectious mononucleosis

A

corticosteroids but only in complicated cases

91
Q

laboratory confirmation of infectious mononucleosis

A
  • EBV IgM
  • Heterophiles antibody (mono spot/ paul- brunet test)
  • blood count and film
  • liver function tests
92
Q

differential diagnosis of infectious mononucleosis

A
  • cytomegalovirus; presents similar but heterophiles antibody negative and fews atypical lymphocytes
  • toxoplasmosis; caused by a protozoa called toxoplasma gondii spread from cats, won’t cause the same extent of pharyngitis
  • primary HIV infection; also would cause diarrhoea
93
Q

both CMV and toxoplasmosis can

A

damage a foetus

94
Q

viral causes of oral ulceration

A
  • herpes simplex virus type 1 which is acquired in childhood and causes oral lesions, infection is through salivary contact
95
Q

primary gingivostomatitis

A
  • disease of pre-school children caused by HSV- 1
  • presents with ulcers of the lips, buccal mucosa and hard palate and vesicles and also causes a fever and local lymphadenopathy
96
Q

primary gingivostomatitis

A

is self-limiting but if it spreads beyond the mouth: acyclovir

97
Q

after primary infection

A

the virus establishes latency in sensory nerve cells and can re-activate to re-infect mucosal surfaces

98
Q

cold sore

A

multiple cycles of latency and recurrent active infection occur, oral herpetic lesions normally caused by herpes simplex virus type 1 but recurrent intra-oral lesions rarely caused by herpes simplex virus

99
Q

rare complication of HSV

A

HSV encephalitis

100
Q

apthous ulcers

A

recurring painful ulcers of the moth that are round and have inflammatory halos

  • absence of systemic disease
  • confined to the mouth
  • being in childhood but reduced recurrent with increasing age
  • each ulcer lasts for around 3 weeks
101
Q

treatment of pathos ulcers

A

self-limiting

102
Q

recurrent ulcers associated with systemic disease

A
  • beechets disease- recurrent oral ulcers, genital ulcers, uveitis and can also affects GI tract, respiratory, MSK, cardio and neurological symptoms
  • coeliac and iBD
  • REACTIVE ARHTRITIS
  • DRUG REACTIONS
  • LICHEN PLANUS AND PEMPHIGUS
103
Q

other causes of oral ulceration

A
  • herapangina
  • hand foot and mouth disease
  • primary syphillis

ENT COPY (12 decks)

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