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Year 2 > Microbiology of ENT infections > Flashcards

Microbiology of ENT infections Flashcards

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1
Q

How can infections of the throat and pharynx be diagnosed?

A

Throat swab

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2
Q

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

A

Viral infections

NO ANTIBIOTICS

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3
Q

What is the most common cause of bacterial sore throats?

A

Strep pyogenes (group A strep)

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4
Q

How does strep. pyogenes sore throat present?

A

Acute follicular tonsillitis

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5
Q

How is bacterial sore throat treated?

A 
Oral penicillin 
Oral clarithromicin (if allergic)
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6
Q

What is the criteria for prescribing antibiotics to sore throats?

A

Cervical lymphadenopathy
Absence of cough
Purulent tonsils
Fever

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7
Q

What are the features of strep pyogenes?

A

Gram positive cocci chains

Beta haemolytic

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8
Q

What are the acute complications of bacterial sore throat?

A

Peritonsillar abcess (quincy)
Sinusitis
Otitis media
Scarlet fever

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9
Q

What is scarlet fever?

A

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

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10
Q

What protection procedures are indicated in quincy?

A

SICP
Contact precautions
Risk assess for droplet protection

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11
Q

What are the late complications of strep. sore throat?

A

Rheumatic fever

Glomerulonephritis

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12
Q

How does rheumatic fever present?

A

Weeks after sore throat
Pancarditis
Fever
Arthritis

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13
Q

How does glomerulonephritis present?

A

Weeks after sore throat
Haematuria
Albuminuria
Oedema

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14
Q

What causes diptheria?

A

Corynebacterium diphtheriae

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15
Q

How does diptheria present?

A

Severe sore throat

Grey-white pseudomembrane across pharynx

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16
Q

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

A

Cardiotoxic

Neurotoxic

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17
Q

How common is diptheria?

A

Uncommon in UK

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18
Q

The diptheria vaccine is which type of vaccine?

A

Extracted toxin

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19
Q

How is diptheria treated?

A

Supportive
Anti-toxin
Penicillin OR erythromycin

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20
Q

How does oral candida (thrush) present?

A

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

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21
Q

What causes thrush?

A

Candida albicans (usually endogenous)

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22
Q

How is oral candida treated?

A

Nystatin suspension (topically)

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23
Q

What is acute otitis media?

A

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

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24
Q

Which age group gets acute otitis media?

A

Infants & children

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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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