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ENT > Microbiology of ENT infections > Flashcards

Microbiology of ENT infections Flashcards

1
Q

What HSV causes oral ulcers?

A

Types 1 and 2
Type 1 acquired in childhood
HSV1 = oral lesions
Infections through saliva contact

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2
Q

What is primary gingivostomatitis?

A

Disease of pre-school children with a primary infection of HSV1
Systemic upset, lips, buccal mucosa, hard palate affected
Vesicles 1-2 mm
Ulcers

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3
Q

What will HSV2 commonly cause?

A

Genital ulcers

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4
Q

How is primary gingivostomatitis due to HSV1 treated?

A

Aciclovir - used for all herpes simplex infections

May take 3 weeks to recover

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5
Q

Where will HSV remain latent?

A

In the trigeminal ganglia

Will reactivate to re-infect mucosal surfaces

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6
Q

Will aciclovir prevent latency?

A

No

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7
Q

How many people with HSV will get clinical recurrences?

A

Half

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8
Q

How is HSV confirmed in the lab?

A

Swab lesion in virus transport medium to detect the viral DNA via PCR
Red cap

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9
Q

What is a dangerous complication of HSV infection?

A

Herpes simplex encephalitis

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10
Q

What is herpangina?

A

Vesicle/ ulcers on the soft palate

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11
Q

What causes herpangina?

A

Coxsackie enterovirus

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12
Q

What causes hand foot and mouth disease?

A

Coxsackie enterovirus

Diagnose by PCR test of swab in viral transport medium

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13
Q

What is a chancre?

A

Painless indurated ulcer at the site of entry of bacterium treponema pallidum (syphilis)
Most commonly genital but can be oral

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14
Q

What is an aphthous ulcer?

A

Non-viral
Self limiting
Painful ulcer on the mouth that are round or ovoid and have inflammatory halos

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15
Q

How long will an aphthous ulcer last?

A

3 weeks

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16
Q

What recurrent ulcers are associated with systemic disease (non-viral)?

A

Behcet’s disease: recurrent oral and genital ulcers, uveitis, GI, pulmonary, MSK, CV and neurological system involvement
Gluten-sensitive enteropathy or IBD: diarrhoea, wt loss
Reiter’s disease: arthritis
Drug reactions
Skin diseases: lichen planus, pemphigus vulgaris

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17
Q

What are the common age groups for an acute throat infection?

A

Children - 5-10

YA - 15-25

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18
Q

What is acute pharyngitis?

A

Inflammation of the part of the throat behind the soft palate (oropharynx)

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19
Q

What commonly causes a sore throat?

A

Common cold
Influenza
Streptococcal infection

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20
Q

What should you think about is there is ore throat and lethargy into the 2nd week in a patient aged 15-25?

A

Infectious mononucleosis via EBV

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21
Q

What are uncommon causes of acute pharyngitis/tonsillitis?

A

HIV
Gonococcal pharyngitis
Diphtheria

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22
Q

What are non-infectious causes of acute pharyngitis/tonsillitis?

A

Physical irritation - reflux, smoking, alcohol, hay-fever

LOOK FOR RED FLAGS

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23
Q

When should someone with a sore throat be admitted to hospital straight away?

A

Stridor
Resp difficulty
DO NOT attempt to examine the throat - leave to ENT surgeon

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24
Q

What is the natural history of a sore throat?

A

Self-limiting condition that will resolve within 1 week for 85% of people

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25
Q

What are complications of a streptococcal infection?

A

Otitis media (eustachian tube)
Peritonsillar abscess (quinsy)
Para-pharyngeal abscess
Mastoiditis

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26
Q

When should throat cancer be suspected?

A

Persistent sore throat for more than 3 weeks with a neck mass
Pain on swallowing or dysphagia
Red or white patches, or ulceration of the oral/pharyngeal mucosa for more than 3 weeks
Stridor

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27
Q

What is the recommended self care of a sore throat?

A 
Regular analgesia - paracetamol or ibuprofen to relieve pain and fever
Medicated lozenges (local anaesthetic, analgesia or antiseptic)
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28
Q

What can cause a bacterial sore throat?

A 
Streptococcus pyogenes (group A beta haemolytic streptococcus) 
Acute follicular tonsillitis
29
Q

How is streptococcus pyogenes acute follicular tonsillitis treated?

A

Phenoxymethylpenicillin

30
Q

What are complications of streptococcus pyogenes?

A

Rheumatic fever - 3 weeks post sore throat; fever, arthritis and pancarditis
Glomerulonephritis - 1-3 weeks post sore throat; haematuria, albuminuria and oedema

31
Q

What is the CENTOR criteria?

A

Tonsillar exudate
Tender anterior cervical lymph nodes
History of fever above 38
Absence of cough

32
Q

What does a CENTOR score of 3 or 4 signify?

A

Should prescribe antibiotics

33
Q

What is the Fever PAIN criteria?

A 
Fever (last 24 hrs) 
Purulence 
Attend rapidly (w/in 3/7) 
v. Inflamed tonsils
No cough/ coryza
34
Q

What does a score of 4-5 in Fever PAIN signify?

A

65% risk of strep

Prescribe antibiotics

35
Q

What should you do if someone on a DMARD presents with a sore throat?

A

FBC - neutropenia

Withhold DMARD until result is known

36
Q

What can cause neutropenia?

A 
DMARD
Carbimazole - agranulocytosis
Chemo
Leukaemia
Asplenia
Aplastic anaemia
HIV with a low CD4
Patient taking azathioprine post transplant
37
Q

What bacterium causes diphtheria?

A

Corynebacterium diphtheriae (gram negative bacillus)

38
Q

What is the clinical presentation of diphtheria?

A

Severe sore throat with a grey white membrane across the pharynx
Organism produces an exotoxin which is cardiotoxic and neurotoxic

39
Q

What type of vaccine id diphtheria?

A

Toxoid vaccine

40
Q

What is the treatment of diphtheria?

A

Antitoxin and supportive

Penicillin/ erythromycin (pregnant)

41
Q

What is the presentation of infectious mononucleosis?

A 
Fever
Enlarged lymph nodes
Sore throat, pharyngitis, tonsillitis 
Malaise, lethargy
Jaundice/ hepatitis 
Rash
Haematology - lymphocytosis, atypical lymphocytes in blood film 
Splenomegaly
Palatal petechiae
42
Q

What other tests should be run in someone presenting with symptoms of EBV?

A

HIV and CMV - very similar presentation

43
Q

What are potential complications of EBV?

A 
Anaemia
Thrombocytopenia
Splenic rupture - avoid contact sports
Upper airway obstruction 
Increased risk of lymphoma
44
Q

Where will the EBV remain latent?

A

Epithelial cells in the pharynx

45
Q

What is the treatment for EBV?

A

Bed rest
Paracetamol for fever
Avoid contact sport for 6 weeks

46
Q

Should steroids be used for viruses?

A

No - they make it worse

47
Q

How is EBV confirmed in the lab?

A 
EBV IgM for acute infection
IgG for chronic infection
Heterophile antibody - paul bunnell test, monospot test
Blood count and film - lymphocytosis
LFTs
48
Q

What is the presentation of candida?

A

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

49
Q

What can cause candida?

A

Endogenous - post antibiotics, immunosuppressed, smokers, inhaled steroids

50
Q

What is the treatment of candida?

A

Nystatin or fluconazole

51
Q

What is acute otitis media?

A

An URTI involving the middle ear by extension of infection by the eustation tube

52
Q

What can cause acute otitis media?

A

Commonly caused by a virus with a secondary bacterial infection: haemophilus influenzae, streptococcus pneumoniae, streptococcus pyogenes

53
Q

When should you swab an ear?

A

If the ear drum perforates and thereis pus

54
Q

How should middle ear infections be treated?

A

80% resolve in 4 days without antibiotics
1st line: amoxicillin
2nd line: erythomycin

55
Q

What is malignant otitis externa?

A

Extension of otitis externa into the bone surrounding the ear canal (mastoid and temporal)
Without treatment is fatal as the osteomyelitis will involve the skull and meninges

56
Q

What are the symptoms of malignant otitis?

A

Pain
Headache
More severe than clinical signs

57
Q

What are the signs of malignant otitis?

A

Granulation tissue at bone-cartilage junction of ear canal, exposed bone in the ear canal
Facial nerve palsy

58
Q

How should malignant otitis be investigated?

A

PV
CRP
Radiological imagine
Biopsy and culture

59
Q

What are risk factors for malignant otitis?

A

Diabetes

Radiotherapy to head and neck

60
Q

What is otitis externa?

A 
Inflammation of outer ear canal: 
Redness and swelling of ear canal
Itchy
Sore and painful
Discharge or increased ear wax 
Affected hearing
61
Q

What bacteria can cause otitis externa?

A

Staph aureus
Proteus
Pseudomonas aeruginosa - swimming pools

62
Q

What bacteria causes malignant otitis externa?

A

Pseudomonas aeruginosa

63
Q

What fungus can cause otitis externa?

A

Aspergillus niger
Candida albicans
Culture and biopsy

64
Q

What is the management of otitis externa?

A

Topical aural toilet
Swab to microbiology
Topical clotrimazole for aspergillus niger
Gentamicin 0.3% drops for pseudomonas

65
Q

What is acute sinusitis?

A

Mild discomfort over frontal and maxillary sinuses due to congestion
Seen in patients with URTI
Severe pain and tenderness with purulent discharge = bacterial infection

66
Q

What is the management of acute sinusitis?

A

Average length is 2.5 weeks
Antibiotics for severe cases over 10 days
1st line: phenoxymethylpenicillin
2nd line is doxycycline

67
Q

Why should doxycycline not be prescribed in children?

A

Yellow tooth discolouration and dental enamel hypoplasia

68
Q

What are the issues with PO ciprofloxacin?

A 
Ruptured achilles tendon 
Generalised tendonitis
Psychiatric symptoms
Lower threshold for seizures
Pseudomembranous colitis (c.diff)

ENT (20 decks)

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