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ENT SM > Microbiology of ENT infections > Flashcards

Microbiology of ENT infections Flashcards

(84 cards)

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1
Q

When obtaining a throat swab, what should you try and do

A

Swab the tonsil and scripts on either side of the tonsil

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2
Q

What type of infection causes the majority of sore throats

A

Viral infection

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3
Q

What is the most common bacterial cause of a sore throat

A

Streptococcus pyogenes (Group A strep)

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4
Q

What is the treatment for a group A strep

A 
Oral penicillin (NOT amoxicilin) 
if penicillin allergic, give clarithryomycin
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5
Q

why should amoxicillin not be given for a bacterial sore throat

A

It can cause patients to come out in a rash if they have glandular fever

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6
Q

What are the 4 criteria in the ENT infection management guidance for sore throats

A 
Fever 
pussy discharge
inflamed lymph nodes 
NO cough 
BACTERIAL
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7
Q

If there is a cough present, what does this suggest

A

It is more likely to be a viral cause

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8
Q

Describe the histological appearance of streptococcus pyogenes

A 
Gram positive cocci chains 
Beta haemolysis (complete)
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9
Q

What are some acute complications of a streptococcal sore throat

A

peritonsillar abscess (quinsy
Sinusitis / ottis media
scarlet fever

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10
Q

What might a quinsy require

A

surgical drainage

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11
Q

What infection control measures are required for a strep pyogenes quinsy in hospital

A

Standard infection control
contact precautions
risk assess need for droplet precautions (may need masks for being around patients that are sneezing and coughing)

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12
Q

What are some late complications of a streptococcal sore throat

A

Rheumatic fever

Glomerulonephritis

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13
Q

Describe the symptoms of Rheumatic fever

A 
3 weeks post sore throat 
fever 
arthritis 
pancarditis
endocarditis 
heart failure

Rare in the UK

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14
Q

Describe the symptoms of Glomerulonephritis

A 
1-3 weeks post sore throat 
Haematuria 
albuminuria 
oedema 
Blood and protein in the urine
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15
Q

Why do these late complications of a streptococcal sore throat occur

A

Due to cross reacting antibodies reacting

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16
Q

What is a major symptom of diphtheria

A

A hugely swollen throat

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17
Q

What is the causative organism of diphtheria

A

Corynebacterium diphtheriae

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18
Q

What are the clinical symptoms of diphtheria

A

Severe sore throat with swelling around the neck with a grey white membrane across the pharynx.

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19
Q

Describe the appearance of Corynebacterium diphtheriae on gram film

A

Small gram positive rod

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20
Q

What is a major complication of diphtheria and how does this arise

A

Respiratory arrest in children

the throat is being completely blocked

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21
Q

Describe the vaccine for diphtheria

A

cell -free purified form of the toxin

Very safe and has almost ruled out diphtheria in the UK

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22
Q

What is the treatment for Diphtheria

A

Antitoxin and supportive and penicillin/ erythromycin (e.g. intubation and ventilation)

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23
Q

What is the causative organism of thursh in the mouth

A

Candida albicans (yeast infection)

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24
Q

What is the clinical appearance of thrush

A

White patches on red, raw inflamed mucous membranes in the throat / mouth

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25
What is the treatment for thrush
Nystatin suspension topically on the tongue
26
What is acute otitis media
An URI involving the middle ear by extension of infection up the eustachian tube
27
Who is most likely to develop acute otitis media and how do they present
Disease of infants and children | Present with extreme earache
28
Why are children more prone to acute otitis media
The eustachian tube tends to be quite flat and does not drain as well as in adults
29
What are the most common bacteria to cause an infection of the middle ear
Haemophilus influenzae Streptococcus pneumoniae Streptococcus pyogenes
30
How can we make a diagnosis of a middle ear infection
Can only do this if the ear drum has perforated
31
What is the treatment for a middle ear infection
80% resolve themselves in 4 days (i.e. just viral)
32
What do the ENT infection management guidelines say in relation to treating middle ears
Amoxicillin (not penicillin) should be considered for those presenting bilaterally and for children under the age of 2 or if there is obvious pus coming from the ear canal
33
How does acute sinusitis present
mild discomfort over frontal or maxillary sinuses due to congestion often seen in patients with UTVI Severe pain and tenderness with purulent nasal discharge indicates a secondary bacterial infection
34
What is the treatment for acute sinusitis
If no complications then avoid antibiotics Where indicated penicillin 2nd line doxycycline (not in children)
35
Why is doxycycline not given to children
Stains the teeth and the bones
36
Who are unlikely to develop acute sinusitis
Children
37
What is otitis externa
Inflammation of the outer ear canal
38
What is the clinical presentation of otitis externa
Redness and swelling of the skin of the ear canal May be itchy (in early stages) can become sore and painful may be a discharge or increased amounts of ear wax Hearing can be affected
39
What are the main bacterial causes of otitis external
Staphylococcus aureus Proteus spp and other cloakrooms Pseudomonas aeuginosa
40
Who is most likely to develop otitis external
Swimmers
41
What are the 2 fungal causes of Otitis external
Aspergillus niger | Candida albicans
42
What do fungal organisms do
They don't invade and just feed on the debris and wax in the EAM
43
What is the best treatment for fungal otitis external
Clean out the ear as much as possible and get rid of debris
44
What should be given for a Pseudomonas infection of the external ear
Topical gentamicin
45
What is another term for infection mononucleosis
Glandular fever
46
How does glandular fever usually present
``` Fever Enlarged lymph nodes sore throat pharyngitis tonsilitis malaise lethargy ```
47
What is the classic triad of symptoms in glandular fever
Fever pharyngitis lymphadenopathy
48
What are some unusual signs of glandular fever
Jaundice / hepatitis Lacy, red, rash (amoxicillin makes worse) Splenomegaly Palatal petachiae (pin point bruising of hard palate)
49
What are the complications of glandular fever
``` Self limiting anaemia, thrombocytopenia Splenic rupture upper airway obstruction doubled risk of lymphoma ```
50
What is the cause of glandular fever
Epstein Barr virus (EBV)
51
What are the two phases of primary infection with EBV
Primary infection nearly childhood rarely results in infectious mononucleosis Primary infection in those >10 often causes infectious mononucleosis
52
What is the therapy for glandular fever
bed rest paracetamol avoid sport (US to exclude splenomegaly before contact sport) Corticosteroids possibility
53
How can we make a laboratory confirmation of glandular fever
Epstein -baBarr virus IgM
54
What are some other causes of similar illness
Cytomegalovirus Toxoplasmosis Primary HIV infection
55
What do you have to watch out for when testing for a primary HIV infection
May be falsely negative for about a week
56
What are the types of Herpes simplex virus
Types 1 and 2
57
When is type 1 acquired
Childhood
58
What does HSV1 cause
Oral lesions | Infection is through saliva
59
Who can be affected by primary gingivostomatitis
Pre-school children
60
What areas of the body are affected by primary gingivostomatitis
Lips buccal mucosa hard palate
61
What is the cause of primary gingivostomatitis
HSV1
62
What are the symptoms of primary gingivostomatitis
Fever | local lymphadenopathy
63
What is the treatment for primary gingivostomatitis
Aciclovir
64
How do cold sores end up reappearing
The virus travels up through the nerve axons and becomes latent in the trigeminal ganglia and the virus becomes inactive. Periodically it can reactivate and go back down the axon and re-infect mucosal surfaces
65
What does acyclovir not prevent
Latency
66
What might cause the HSV1 to reactivate
Sunburn Immunosuppressed Hormonal changes
67
How many infected people get clinical recurrences of cold sores
Half of infected people
68
Who is at risk of Herpetic whitlow
Dentists and anaesthetics | Using gloves is essential in prevention
69
Where does Herpetic whitlow affect
Between the nail and normal skin
70
How is a confirmation of HSV made
Swab of the lesion and viral DNA by PCR
71
In the brain, what can Herpes simplex cause
Encephalitis leading to necrosis of the temporal lobe
72
how does herpes simplex encephalitis present
Fever and a changed mental state e.g. sleepy, change in personality or grand mal seizure
73
What causes Herpangina
Coxsackie viruses
74
How is a diagnosis of Herpangina made
Clinically or by PCR test of swab in viral transport medium
75
How does Herpangina present
Shallow ulcers on the roof of the mouth | soft palate
76
What causes Hand, foot and mouth disease
Coxsackie virus
77
What is the clinical presentation of hand, foot and mouth disease
Vesicles on the hand, feet and buttocks | Often family outbreaks
78
What are apthous ulcers
Non viral, self limiting, recurring painful ulcers on the mouth that are round or ovoid and have inflammatory hals
79
How long does each apthous ulcer last
Less than 3 weeks
80
What organism causes Primary syphilis
Treponema pallidum
81
Where is the most common site of primary syphilis
Genital but oral lesions can be the site of entry
82
What could happen if primary syphilis was left undiagnosed and untreated
Can progress to secondary and tertiary syphilis
83
What are some symptoms of Behcet's disease
Recurrent oral ulcers Genital ulcers Uveitis Common in Middle east and asia
84
What other systemic diseases can cause apthous ulcers
``` Beech's disease Gluten sensitive enteropathy IBD Eritrea's disease Drug reactions Skin diseases ```

ENT SM (19 decks)

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