Clinical Micro - Ent

Front 1

In Sinus infections of children you see a lot more single species involvement, including: _, _ and _

Back 1

HI, moraxella, and strep pneumonia!!!

Front 2

_ is common as a nosocomial infection from nasal tubes or catheters

Back 2

Pseudomonas aeruginosa

Front 3

MC bacterial for nasal vestibulitis?

Back 3

Staphylococcus aureus

Front 4

Fungal sinusitis are divided into non invasive and invasive infections. Invasive infections will spread to _ and _, they include what spp?

Back 4

CNS and eyes

Rhizopus spp., Mucor spp., Absidia spp.

Front 5

What is the MC potential complication of bacterial sinusitis?

Back 5

Preorbital swelling

Front 6

T/F The best way to diagnose a sinus infection is a culture of nasal drainage

Back 6

FALSE
These provide little information as they pick up all the normal flora too.
Head CT/MRI may be useful (not X ray), and so is transillumination.

Front 7

Patient comes in complaining of ear pain. Hx reveals she just returned from a vacation in Cancun. Otoscope reveals purulent black, green, and white discharge. What is the likely organism?

Back 7

Aspergillus

This is describing Otomycosis, a fungal infection of the ear. The key here is the "rainbow" of otorrhea - bacterial tends to be monochromatic

Front 8

What is the most common organism for Furunculosis (infected hair follicle in outer third of ear canal)?

Back 8

Staph Aureus

Front 9

External ear infections are MOSTLY bacterial, and although typically polymicrobial _ and _ are almost always involved.

Back 9

Pseudomonas aeruginosa and Staph aureus

Front 10

The traditional treatment of an external ear infection is _

Back 10

10 day course of ear drops - gentamicin and hydrocortisone

Front 11

Your 86 yo patient comes in complaining of ear pain. You suspect malignant otitis externa.

What study do you do?

Back 11

RAISED ESR (if + then do a CT or MRI to look for bone erosion)

Front 12

Malignant Otitis Externa is usually what organism? Where does the infection spread?

Back 12

Pseudomonas aeruginosa

Bone

Front 13

Your 86 yo patient comes in complaining of ear pain and has a raised ESR. What is the dx, and most likely organism?

Back 13

Malignant Otitis Externa

Pseudomonas aeruginosa

Front 14

What are the 'key players' in Otitis Media?

Back 14

Streptococcus pneumoniae
non-typable Haemophilus influenza
Moraxella catarrhalis

Front 15

Viral/Bacteria/Both infections are most common in ENT

Back 15

Viral infections are most common

Viral infections with bacterial superinfections are next.

*Bacteria alone is rare, but may be found in pharyngitis

Front 16

Laryngitis is characterized by _.

How can you differentiate this from epiglottitis?

Back 16

hoarseness

One way is onset, laryngitis is of gradual onset whil epiglottitis occurs rapidly.

Front 17

Rhinovirus is (+/- , ss/ds rna/dna) virus

H. Influenza is a gram (+/-) (cocci/bacillus)

Moraxella catarrhalis is a is a gram (+/-) (cocci/bacillus)

Back 17

(+) ssRNA


gram - bacillus

gram - diplococci

Front 18

What are the most likely bacterial causes of acute laryngitis?

Back 18

Moraxella catarrhalis
Group A Streptococcus
Heamophilus influenzae

(remember that most cases are of viral origin alone)

Front 19

3 yo boy presents with a barking cough and inspiratory stridor.

What time of the year is this infection most likely to occur in?

What is the pathogen?

Back 19

Fall and winter

parainfluenza

Front 20

3 yo boy presents with fever, irritability, and dysphagia. He is sitting forward in his Mom's lab drooling. Lateral neck film shows a "+" thumb sign. What is the likely pathogen?

Back 20

Haemophilus Influenza type B

Front 21

Chronic laryngitis is usually associated with _ or _

Back 21

laryngeal cancer or fungal infections

Front 22

Patient presents with sore throat and cough. PE shows reddening and slight edema of the nasopharyngeal mucosa but no exudate. This is most likely due to what pathogen?

Back 22

Viral

Front 23

Typically, viral pharyngitis does not produce an exudate, however, _ and _ are two viruses that may produce exudate

Back 23

Adenovirus and EBV

Front 24

Patient presents with fever and sore throat. PE shows inflammed tonsils and pharynx with exudate. What is the mc pathogen to cause this?
How do you diagnose?

Back 24

Strep pyogenes

Rapid strep and culture

Front 25

What is the MC complication of streptococcal pharyngitis?

Back 25

peritonsillar abscess

Front 26

99% of the time, if you see a child with exudative pharyngitis without a cough (or even with a cough), it's probably...

Back 26

strep throat

Front 27

Child presents with sore thorat and fever. PE reveals an exudative pharyngitis and scarlatiniform rash. What is the likely organism?

Back 27

Staph aureus

(the scarlantiform rash is what distinguishes this from strep, which is MC)

Front 28

Yersinia enterocolitica pharyngitis is primarily associated with _

Back 28

animals and their byproducts

--> the patient will have a hx of farming or skinning animals

Front 29

20 yo presents with sore throat and rash. PE reveals an erythematous pharynx and rash over his arms and legs. Throat culture reveals gram positive bacilli. What is the organism?

Back 29

Corynebacterium (arcanobacterium haemolyticum)

BC of the rash, it is often confused with Staph Aureus, however culture shows a gram positive bacilli. Staph Aureus would have been gram + cocci.

Front 30

A 22 yo female presents with sore throat, headache, shortness of breath and difficulty swallowing. She is a recent immigrant from South America. PE shows a grey membrane covering the pharynx and soft palate. What do you suspect?

Back 30

Corneybacterium diptheria


Two things to note: She is an immigrant (this is vaccinated against in the US), and the GREY membrane - which is essentially a give away for diptheria

Front 31

Infectious mononucleosis is a result of what pathogen?

Back 31

Ebstein Barr virus

Front 32

Fusbacterium necrophorum is the cause of _

Back 32

Lemierre Syndrom (secondary to another infections - patient will have pharyngitis which gets better then a lot worse!)

(this is a gram neg bacilli, anaerobe)

Front 33

odynophagia and dysphagia, along with substernal chest pain are the mc symptoms of _

What are the mc pathogens?

Back 33

esophagitis

Candida albicans and herpes virus

(bacterial is uncommon even in immunocompromised but may include lactobacillus, beta hemolytic strep)

Front 34

Patient presents with difficulty swallowing and painful swallowing.
Endoscopy shows diffuse, linear, yellow-white plaques adherent to the mucosa. What is the pathogen?

Back 34

Candida

(esophagitis)

Front 35

Patient presents with difficulty swallowing and painful swallowing.
Endoscopy shows several large, swallow, superficial ulcerations. Dx?

Back 35

CMV esophagitis

Front 36

Patient presents with difficulty swallowing and painful swallowing.
Endoscopy shows multiple, small deep ulcerations. Dx?

Back 36

Herpes esophagitis

Front 37

what is the responsible pathogen in hand, foot and mouth disease?

Back 37

Picornavirus

Front 38

Acute necrotizing ulcerative gingivitis is caused by _

Back 38

treponema spp (not t pallidum)

It presents as acute painful gingival inflammation and necrosis, often with bleeding, bad breath,fever, and cervical lymphadenopathy.

Front 39

a 24 yr medical student presents with fever and acute painful gingiva. PE shows necrotic and bleeding gums, bad breath, and enlarged cervical lymph nodes. Dx?

Back 39

Acute necrotizing ulcerative givitis - by treponema

Front 40

Patient has a molar pulled and then 3 weeks later they have a swollen jaw that has yellowish pus. Microscopic examination shows sulfur granules.
What is the responsible pathogen?

Back 40

actinomycosis Israelii

--> this is "lumpy jaw"

Front 41

Apthous ulcer may be assoviated with what virus?

Back 41

HHV-6

Front 42

Paramyxovirus most famously causes _

What type of virus is this?

Back 42

mumps

(-) ss RNA

Front 43

What is the mc organism that causes sialadenitis?

Back 43

Staph aureus

Front 44

A 54 year old male presents to his primary care physician with a hard, red, painless swelling on his left mandible that has been growing over the past few weeks and has now begun to ooze pus. No other significant findings on physical examination. Head X-ray shows no bone erosion. Prior to the appearance of the mass, he had undergone a tooth extraction.
Which of the following is a likely cause of this infection?

Back 44

Actinomyces israelii

(lumpy jaw - following a tooth extraction)

Front 45

How would you differentiate N. brasiliensis from A. israelii?

Back 45

Acid Fast staining

Front 46

Anaerobic, gram +, branching filamentous bacteria that may fragment into bacillary forms

Back 46

Actinomyces israelii
causes lumpy jaw - following tooth extractions

Front 47

What is the likely organism when a patient who has pharyngitis subsequently develops thrombophlebitis?

Back 47

Fusobacterium necrophorum

Front 48

An 18 month old female presents with irritability together with bilateral, profuse, and foul smelling ear discharge of 2 months duration. The patient had recurrent upper respiratory tract infections last year, but her mother failed to administer the complete antibiotic course.
What test would help to identify the specific condition involved?

Back 48

Pneumatic otoscopy

Front 49

An 18 month old female presents with irritability together with bilateral, profuse, and foul smelling ear discharge of 2 months duration. The patient had recurrent upper respiratory tract infections last year, but her mother failed to administer the complete antibiotic course.
If you found bilateral perforated tympanic membranes, what condition does this case likely represent?

Back 49

Chronic suppurative otitis media

Front 50

78 yo female presents with intense ear pain. She also has slurred speech and PE shows a slightly 'droopy' face. You are unable to look in the ear due to the pain and swelling. Lab shows a markedly raised ESR. Dx? Pathogen?

Back 50

Malignant otitis externa

most likely due to pseudomonas aeruginosa

Front 51

A 62 year old male presents with a 4 day history of left eye swelling and left frontal headache. He has also noted increasing left ptosis over this time as well. A CT scan shows marked fluid levels in both ethmoid sinuses and inflammatory changes lateral to the left medial rectus muscle. Fluid shows a aseptate hyphae with right angle branching on KOH. Organism?

Back 51

Rhizopus

(Invasive fungal infection ---> involvement of the eye. Could be rhizopus, mucor, or absidia)