Microbiology of ENT infections Flashcards Preview

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Flashcards in Microbiology of ENT infections Deck (90):
1

How can infections of the throat and pharynx be diagnosed?

Throat swab

2

What is the cause of the large majority of sore throats? How is this clinically relevant?

Viral infections
NO ANTIBIOTICS

3

What is the most common cause of bacterial sore throats?

Strep pyogenes (group A strep)

4

How does strep. pyogenes sore throat present?

Acute follicular tonsillitis

5

How is bacterial sore throat treated?

Oral penicillin
Oral clarithromicin (if allergic)

6

What is the criteria for prescribing antibiotics to sore throats?

Cervical lymphadenopathy
Absence of cough
Purulent tonsils
Fever

7

What are the features of strep pyogenes?

Gram positive cocci chains
Beta haemolytic

8

What are the acute complications of bacterial sore throat?

Peritonsillar abcess (quincy)
Sinusitis
Otitis media
Scarlet fever

9

What is scarlet fever?

Infectious bacterial disease (step. pyogenes) causing fever and red rash

10

What protection procedures are indicated in quincy?

SICP
Contact precautions
Risk assess for droplet protection

11

What are the late complications of strep. sore throat?

Rheumatic fever
Glomerulonephritis

12

How does rheumatic fever present?

Weeks after sore throat
Pancarditis
Fever
Arthritis

13

How does glomerulonephritis present?

Weeks after sore throat
Haematuria
Albuminuria
Oedema

14

What causes diptheria?

Corynebacterium diphtheriae

15

How does diptheria present?

Severe sore throat
Grey-white pseudomembrane across pharynx

16

What is effect does the diptheria endotoxin have on certain tissues?

Cardiotoxic
Neurotoxic

17

How common is diptheria?

Uncommon in UK

18

The diptheria vaccine is which type of vaccine?

Extracted toxin

19

How is diptheria treated?

Supportive
Anti-toxin
Penicillin OR erythromycin

20

How does oral candida (thrush) present?

White patches on top of raw, red mucous membranes in the mouth and throat

21

What causes thrush?

Candida albicans (usually endogenous)

22

How is oral candida treated?

Nystatin suspension (topically)

23

What is acute otitis media?

An upper respiratory infection which spreads to the middle ear via the eustachian tube

24

Which age group gets acute otitis media?

Infants & children

25

How does acute otitis media present?

Earache

26

What is the cause of acute otitis media?

Viral --> secondary bacterial infection

27

Which bacteria commonly cause acute otitis media?

Strep pyogenes
Haemophilus influenzae
Strep pneumonia

28

How is acute otitis media diagnosed?

Clinically
Swab can be taken (only if eardrum perforates)

29

How is acute otitis media treated?

Often self resolving

30

When are antibiotics indicated in the treatment of acute otitis media?

Bilateral in

31

Which antibiotics are used in the treatment of acute otitis media?

Amoxicillin
Clarithromycin if allergic

32

How does acute sinusitis present?

Discomfort over maxillary or frontal sinuses due to congestion
Pain which gets worse on bending/moving head in certain directions

33

What typically precedes acute sinusitis?

Upper respiratory tract infection (viral)

34

What would make you think of secondary bacterial infection with regard to acute sinusitis?

Severe pain over sinuses
Purulent nasal discharge
Tenderness

35

How can acute sinusitis be diagnosed?

Clinically

36

How is acute sinusitis managed?

Self resolving
If secondary bacterial infection
- Penicillin
- Doxycycline (NOT IN CHILDREN)

37

What is otitis externa?

Inflammation of the outer ear canal

38

How does otitis externa present?

Redness
Swelling
Itch
Pain
Increased ear wax/discharge
Hearing loss (conductive - secretions or swelling block)

39

What are the bacterial causes of otitis externa?

Staph aureus
Pseudomonas
Proteus

40

What are the fungal causes of otitis externa?

Aspergillus niger
Candida albicans

41

How is otitis externa managed?

Topical aural toilet (i.e clean the ear of debris)

42

How is unresolving otitis externa managed?

Swab and culture
Fungal - topical clotrimazole
Bacterial - topical gentamicin (pseudomonas)

43

Which age groups typically get infectious mononucleosis/glandular fever?

Adolescents
Young adults

44

How does infectious mononucleosis present?

Fever
Enlarged lymph nodes
Sore throat/pharyngitis/tonsillitis
Malaise
Lethargy
Palatal petechiae

45

What is the characteristic triad of glandular fever?

Enlarged lymph nodes
Pharyngitis
Fever

46

Which lymph nodes are enlarged in glandular fever?

All nodes may be enlarged but cervical nodes are often most prominent

47

What are the uncommon signs & symptoms of glandular fever?

Jaundice
Rash
Leucocytosis (inc white cells)
Atypical lymphocytes
Splenomegaly

48

Describe the onset of glandular fever

Insidious

49

How is glandular fever treated?

Self limiting
Rest
Avoid sport
Paracetamol (fever)

50

What are the possible complications of glandular fever?

Anaemia
Thrombocytopenia
Splenic rupture
Upper airway obstruction
Increased lymphoma risk (immunosupressed)

51

How are the complications of glandular fever managed?

Anaemia & thombocytopenia - steroids
Splenic rupture - no sport for 6 wks
Obstruction - steroids +/- intubation

52

What causes glandular fever?

Epstein barr virus

53

Describe the two different outcomes of primary infection with EPV

Infected 10 - infectious mononucleosis common

54

How is EPV transmitted?

Kissing

55

What would be done in a patient with glandular fever who wanted to return to sport?

Abdominal ultrasound to exclude splenomegaly - if no splenomegaly return to sport within a month is allowed

56

How can diagnosis of EPV be confirmed?

EPV IgM
Paul bunnel or monospot - heterophile antibody
Blood count + film
LFTs

57

What other causes of illness may mimic EPV? How can you differentiate between these?

Cytomegalovirus - no heterophile antibody
Toxoplasmosis - minimal phayngitis
HIV - diarrhoea, clues from history

58

How do humans become infected with toxoplasmosis?

Undercooked meat
Contact with cat litter

59

What are the risks of CMV and Toxoplasmosis infection?

Congenital infection + foetal damage

60

What are the types of herpes simplex virus?

Type 1 - oral
Type 2 - genital

61

How does herpes type 1 spread? When is it usually acquired?

Saliva
Childhood

62

What can herpes simplex type 1 cause?

Primary gingivostomatitis

Nb - this is severe reaction most cases are asymptomatic

63

How does primary gingivostomatitis present?

Vesicles and ulcers on the lips, hard palate and buccal mucosa
Fever
Local lymphadenopathy

64

How gets primary ginigvostomatitis?

Pre-school children

65

Which age group typically gets herpes type 2? How is it transmitted?

Adults
Sexually

66

How is primary gingivostomatitis (i.e herpes simplex type 1) treated?

Acyclovir

67

Describe latency with respect to herpes simplex virus

Primary infection --> immune system gets virus under control --> sits inactive in dorsal root ganglia --> dermatomal reactivation later in life/when immune system under stress

68

What is a cold sore?

Mild reactivation of herpes simplex virus

69

How can a cold sore be treated?

Acyclovir

70

Acyclovir does not prevent latency of herpes simplex. T/F

True

71

What is the natural progression of cold sores?

Incidence will become less and less over time

72

Recurrent intra-oral lesions are usually herpes simplex virus. T/F

False - oral herpetic lesions are but less common intra-orally

73

What is herpetic whitlow?

Herpes simplex infection of the finger

74

Who usually gets herpetic whitlow? How can it be prevented?

Dentists, anaesthetists
Gloves

75

How can herpes simplex virus infection be confirmed?

Swab --> PCR

76

What is a serious complication of herpes simplex infection?

Herpes simplex encephalitis

77

What is herpangia?

Vesicles/ulcers on the soft palate

78

What causes herpangia?

Coxsackie virus (enterovirus)

79

Which age group gets herpangia?

Children

80

How is herpangia diagnosed?

Clinically
Swab --> PCR

81

What causes hand, foot and mouth disease?

Coxsackie virus (enterovirus)

82

What type of outbreaks are usually caused by hand, foot and mouth?

Familial

83

How is hand, foot and mouth disease diagnosed?

Clinically
Swab --> PCR

84

What is an apthous ulcer?

Non-viral, self limiting painful ulcer which is recurrent within the mouth and surrounded by an inflammatory halo

85

What clinical features would point towards an apthous ulcer?

Only on mouth
No systemic disease
Childhood --> 3rd decade
Ulcers last

86

What systemic diseases may recurrent ulcers be associated with?

Behcets disease
Coeliac
IBD
Reiter's triad
Drug reaction
Skin disease

87

How does behcets disease present?

Recurrent ulcers
Uveitis
Genital ulcers
Visceral organ involvement
Middle eastern patients

88

How does primary syphilis present?

Painless chancre (indurated ulcer) at entry site

89

What causes syphilis?

Treponium pallidum

90

Why should amoxicillin never be given to a patient with a sore throat?

Induces rash (non-allergic) in patients with infectious mononucleosis

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