Diseases of the Respiratory System Flashcards
1
Q
what causes tb
A
Mycobacterium TB
2
Q
What happens in primary TB
A
Macrophages phagocytose bacteria - unable to kill them
Macrophages carried back to hilar lymph nodes
Intracellular bacteria growth in bacteria
Disseminated via lymph and bloodstream
3
Q
Where is the most common site for TB to activate
A
The periphery of the mid zone of the lung
4
Q
What is the bodies immune response to TB
A
Mostly cell mediated (not much antibody response)
Granulomas form - central area of epitheliod and histiocyte cells - activates langerhans and macrophages to kill TB
Surrounding lymphocytic cell infiltration
Central area of caseous necrosis - fibrosis and calcification of lesions, bacilli slowly die
5
Q
What are the primary symptoms of TB
A
Influenza like - absent/mild
Do a CXR and tuberculin skin test
6
Q
How many does TB reactivate in
A
10%
7
Q
What is TB called when its read to the hilar lymph nodes
A
Ghon focus
8
Q
How do we histologically diagnose TB
A
Look for granulomas and ZN test
9
Q
What other tests can we do for TB
A
Skin testing
IFN-gamma release test
But these don’t really look for the active disease
10
Q
What type of tissue samples do we need to test for TB
A
Fresh tissue samples
NOT formalin fixed
11
Q
What can cause reactivation of Tb
A
Immunosuppression Alcohol Malnutrition Western countries - men over 50 HIV Silicosis, CRF, gastrectomy Anti-TNF alpha drugs e.g. infliximab
12
Q
What is tense to keep the tomb walls strong i TB
A
TNF alpha
13
Q
Pathogenesis of TB
A
Coalescing tubercles - central caseous necrosis
Cavitation
14
Q
Where does TB typically reactivate
A
In the apexes of the lungdue to highest oxygen tensions
15
Q
Symptoms of secondary TB
A
Chornic productive cough - haemoptysis
Weight loss, fever, night sweats
16
Q
How do we treat TB
A
2 months: Isonizaid, rifampicin, pyrazinamide, ethambutol/streptomycin
4 months: Izonizaid, rifampicin
Drug combination reduces risk of resistance
17
Q
What are some extra-pulmonary sites of TB
A
Pleura Lymph nodes - enlalrged in chest and neck Bone - spine Kidneys Epididymins Bran/meninges Intestine Pericardium
18
Q
How can we get intestinal TB
A
Can swallow respiratory pathogens
Or
From unpasterusied milk due to M. Bovis
19
Q
What is atypical TB
A
Non tuberculous mycobacteria
Environmental organism
Lack of person-person complex
20
Q
Describe the effects of mycobacterium avium complex in HIV infected
A
Disseinated disease
21
Q
Descrive the effects of non-HIV infected mycobacterium avid complex
A
Pulmonary TB like
Young children - cervical lymphadentitis
22
Q
Describe what happens in TB meningitis
A
Inisidious onset
personality change
focal neurological deficit
mild headache/meningism (although the typical fever, night sweats, anorexia and weight loss may be absent)
23
Q
Where does TB multiple in TB meningitis
A
Multiplies at the base of the brain asking basilar inflammation
24
Q
What does the BCG vaccine contain
A
Attenuated M Bovis
25
How to we treat atypical TB
Comibination
Prolonged
Macrolides - clarithromycin/azithromycin
26
What are two TB specific antigens
ESAT6
| CPF10
27
How long do we treat extra pulmonary TB
Other sites except meningeal = 6 months
| Meningial = 12 months
28
What do we also give to treat meningitis and pericarditis with TB infectino
Corticosteroids initially
29
What are the 2nd line drugs for TB
Amikaxin
Ethionamide
Cycloserine
Fluoroquinolones
30
What are MDR TB resistant to
Isonazoid and rifampicin
31
what is EDR TB resistatin to
Isonazoid and rifampicin
| Fluroquionolones
32
What are XDR TB resistant to
All first line and 2nd line TB drugs
33
What type of bacteria is TB
Gram +ve
| Slender Bacilli
34
What are mycobacteria different to other bacteria
Unusual cell wall - high life content and mycolic acid
Slow growing - divide every 24 hours not 20 minutes
Different staining characteristics - poor uptake of gram stains (form ghost cells)
Retain certain stains without decolorisation by acid/alcohol
35
How does treatment of mycobacteria different
Requires much longer courses of treatment
36
How much of the world is infected with TB
1/3
37
Why has TB Increased in the developed world
HIV infection
Breakdown of control programmes
Increased global migration
Increased travel
38
What do we call TB if it has disseminated
Miliary TB
39
Who does military TB occur in
Very young/old/immunocompromised
Primary disaease
Secondary disease - erosion of necrotic tubercle into blood vessels
40
Is TB a notigiable disease
YES
41
Why do we do molecular type profiles on TB
To workout who acquired TB from where
42
What do we do if there isn't sputa for us to culture in TB
Induced sputa - nevulised saline
Gastric aspirates
Renal - sterile pyuria
CSF
43
Is nucleic acid amplification - PCR good for diagnosing TB?
Rapid
But less sensitive tan culture
Not 100% specific
44
What does a positive MGIT culture mean for TB
Shows speciation
45
What do the TB specific antigens not cross react with
M. Bovis BCG
46
What causes leprosy
M. Leprae
| There two extreme clinical forms
47
What is Tuberculoid leprosy
Th1 type
Macules/plaques on the skin
Nerve: ulnar and common peroneal
Immune system can control it
48
What is lepratomous TB
Th2 type
Subcutaneous tissue accumlation
Ear lobes: face -leonine facies
Immune system can't control it
49
What can cause pulmonary vasculitis
Wegeners & Churg strauss - necrotizing granulomatous vasculitis
Good pastures syndrome
50
What is good pastures syndrome
Anti-glomerular basemnt membrane antibodies
| Causes intra-alveolar haemorrhage and glomerunephritis
51
What is bronchietctasis
Permanent dilation of the bronco and bronchioles caused by destruction of muscle and elastic tissue
Results from chronic necrotising tissue
52
What are the symptoms of bronchiectasis
Cough fever, and foul smelling sputum
53
What is COPD
Chronic bronchitis and emphysema
54
How do we define chronic bronchitis
Cough and sputum for 3 months in each of 2 consecutive years
55
What histologically changes in chronic bronchitis
Mucous gland hyperplasioa and hypersecretion
Infection by secondary low virulence bacteria
Chronic inflammation
Wall weakness/destruction
Centrilobular emphysema
56
What is asthma
Chronic airway inflammation
| Type 1 hypersensitivity reaction
57
What are the histological changes in asthma
Mast cell degranulation
Bronchial wall smooth muscle hypertrophy
Mucous gland hyperplasia and repsiratory bronchiolitis
Causes centrilobular emphysema
58
What is an interstitial lung disease
A disease of pulmonary connective tissue e.g the alveolar walls (inflammation and fibrosis)
It is a restrictive lung disease
59
What occurs in acute interstitial lung disease
Diffuse alveolar damage
Death and destruction of type I pneumocytes
Hyperplasia of type II pneumocytes
60
What does acute interstitial lung disease look like histologically
Acute intersitial pneumonia
61
What are the symptoms of chronic interstitial lung disease
```
Dyspnoea
Clubbing
Cachexia
Cough
Honeycombl lung
```
62
What does honeycomb lung show
Chronic intersitial lung disease
63
Causes of chronic interstitial lung disease
```
Pulmonary fibrosis
Pneumoconiocsis
Sarcodosis
Silicosis
Asbestos
Hypersensitive pneumonitis
```
64
What is pulmonary fibrosis
Chronic interstitial lung disease
Usaully occurs sub pleual and lwoer lobes
Histologically intersitial pneumonia
65
what is sarcoidosis
Non caseating perilymphatic pulmonary granulomas - fibrosis
Hilar lymph nodes usually affected
Usually get hypercalcaemia and elevated ACE
Commonly young women
66
What would hypercalcaemia and elevated ACE indicate
Sarcoidosis
67
What are pneumoconiocosis
the dust disease causing chronic interstitial lung disease
68
What is silicosis
a chornic intersitial lung disease
69
How does silicosis cause disease
Silica kills phagocytosing macrophages
Fibrosis and fibrotic noodles in the nodes
Possible TB reactivation and increased risk of lung carcinoma
70
What does asbestos cause
Intersitial fibrosis in a usual interisitial pneuomnia fashion
71
What can cause hypersensitive pneumonitis aka extrinsic allergic alveolitis
Farmers lung - due to antimyocytes in hay
Pigeon fanciers lung to pigeon antigens
It is a type II hypersensitivity reaction
72
Are the majority of lung cancers malignant or benign
90% ar malignant
73
What are non-small carcinomas
Squamous cell
Adenocarcinoma
Large cell neuroendocrine and undifferentiated large cell neuroendorcrine
74
What are small cell carcinomas
All neuroendocrine
75
What are carcinoid tumours
Low grade neuroendocrine tumours - they are the low grade equicalent of small cell
76
Are carcinoid tumours associated with smoking
NO - they are not malignant
77
Where do squamous carcinomas occur
Mostly central/main/upper lobe
78
Histologically what do squamous carcinomas look like
Keratinisation - look for keratin pearls
Desmosomes linking cells
Can breach basement membrane
90% occurs in smokine
79
What would hypercalcaemia due to PTH related peptide indicate
squamous carcinoma
80
Where do adenocarcinomas occur
more peripherally
| they are linked to smoking
81
What produce thyroid transcription factors
adenocarcinomas
82
Are bronchioalveolar tumours invasive
No they are adenocarcinoma in situ
The spread of well differentiated mucinous/non-mucionues cells on the alveolar wall
Mimics pneumonia
Uncommon to metastasis
83
What defeines large cell neuroendocrine tumours
more than 11 mitotitic figures per 2 sqmm
84
Are benign or malignant pleural tumours more rare
Malignant
| benign are rate
85
What is malignant mesothelioma associated with
Asbestos
86
histologically what does a malignant mesothleiuom look like
Mixed spindle cell and epithelial cells
87
Are metastases common in malignant mesotheliuom
No
88
How do we define an atypical carcinoid tumours
2-10 mitotic figures per 2 sqmm
Much more aggressive than typical carcinoid
70% metastasise
89
What cancer occurs almost exclusively in smokers
Small cell carcinomas
90
when do small cell carcinomas usually present
At a high stage with lots of metastasises
91
What is sigh of small cell carcinomas
Often release neurosecretory granules with peptide hormones e.g. ACTH
92
What are large cell carcinomas
Poorly differentiated epithelial tumours
| Can be neuroendocrine - express CD56 and neurosecretory granule proteins (synaptophysin and chromogramin)
93
Common epithelium in the respiratory ttract
mostly pseudo stratified ciliated columnar mucous secreting spithelium
94
What is respiratory failure
paO2 less than 8kPa
95
What is type 1 respiratory failure
Co2 less than 6.3kPA
| Hypoxic respiratory drive
96
What is type 2 respiratory failure
Co2 greater than 6.3kPa
| Hypercapnic respiratory drive
97
What causes stridor
Upper airway obstruction - inspiratory noise
98
What causes wheeze
distal airway obstruction - expiratory nose
99
What does asbestos cause
Mesothelioma, lung cancer and asbestosis (a pulmonary interstitial fibrosis)
100
What do primary lung tumours express
Cytokeratin and thyroid transcrption factor
101
What do colorectal secondary tumours express
cytokeratin 7 negative, cytokeratin 20 positive
102
what do upper GI tumours express
cytokeratin 7 and 20 positive
103
What is metaplastic change in the bronchi
Change from pseudo stratified columnar to stratified squamous type that may keratizine like the skin
104
What can cause metaplastic change in the bronchi
Irritants like smoke
105
What is thought to be precursors to neuroendocrine lung cancers
Carcinoid tumourlets
106
What type of carcinoid tumours are likely to metastasise
The atypical carcinoid tumours
| typical carcinoid tumours are not benign but distant metastases are rare
107
Differences between typical and atypical carcinoid tumrous
typical - grow centrally, organoid bland cells, no necrosis, less than 2 mitotic fiures, associated with multiple endocrine neoplasia syndrome type 1, not associated with smoking
atypical - necrosis, 2-10 mitotic figures per 2 sq., much more aggressive than typical carcinoids
108
How many mitotic figures in large cell neuroendocrine carcinomas
More than 11
109
5-hydroxyptamine comes from what type of tumours
Carcinoma
110
What is the epidermal growth factor receptor (EGFR) mutations
Sensitising mutations in 10% of small cell lung carcinomas
| More common in non-smoking and asian women
111
What can we do to treat EGFR
use EGFR-tyrosin kinase inhibitors
| E.g. Geftinib and Erlotinib
112
What is the analplastic lymphoma kinase gene rearrangement
Variable break point on short arm of chromsome 2
Fuses ALK and EML gene
Activates ALK tyrosine kinase
113
who is ALk gene rearrangements seen in
Seen in 10% of lung adenocarcinomas
| common in non-smoking asian and women
114
What is Crizotnib
An ATP analogue that inhibits the ALK gene rearrangement
115
What happens in mesotheliomas
Initial noduel and effusion
Later obliterates the pleural cavity growing around the lung - invades the chest wall and lung
But metastasis are loss common
116
How can we differentiate mesotheliomas from adenocarcinomas
Due to cellular antigen expressoin
117
what is typical of early malignant mesotheliomas
Small plaques on the parietal pleura - difficult to image and tipsy but may produce significant pleural effusion
118
Where do fibrous pleural plaques occur
ON lower thoracic wall and diaphragmatic parietal pleura
| Associated with low level asbestos exposure - not pre-malignant
119
What is a common cause of bronchopneumonia
Often secondary due to compromised defences
| often low virulence bacteria or occasionally fungi
120
What causes 90% of lobar pneumonia
Strep pneumonia
| Uncommon to get confluent segments, red then grey hepatisation, resolution without scarring
121
Who gets klebsiella penumonia
Elderly, diabetic and alcoholics
122
What are the TB granulomas like
Multinucleated langerhans cells and giant cells and caseous necrosis
123
What type of hypersensitivity reaction is the tuberculin skin test
Type IV cell mediated
124
What are the 3 types of emphysema
Centrilobular/acinar - due to coal dust and smoking
Panlovular
Paraseptal - upper lobe, sub pleural bullae adjacent to fibrosis, pneumothrax if rupture
125
What is common in the majority of pan lobular emphysemas
Anti-trypsin deficienct
126
Do interstitial lung disease increase or decrease lung compliance
decrease
127
Where is the cystic fibrosis mutation
Mutation in CFTR gene on chromosme 7
128
Cf in the lung
Bronchioles distended with mucous
Hyperplasia mucus secreting glands
Multiple repeated infections
Severe chronic bronchitis and bronchiectasis
129
CF in the pancreas
exocrine gland and ducts plugged by mucous
Atrophy and fibrosis of the gland
Impaired fat absorption, enzyme secretion, vitamin deficiincies
130
CF in the small bowel, liver, salivary glands and reproductive tract
Small bowel - meconium ileus
Liver - plugging of bile cannaliculi causing cirrhosis
Salivary glands - similar to pancreas - atrophy and fibrosis
95% of males infertile
131
How does CF present
Abnormallly visous mucus
failure to thrive
pancreatic insufficiency
recurrent intestinal obstruction
132
What is a LRTI
An infection below the larynx
133
What are the 4 types of pneumnia
Hospital acquired
Community acquired
Ventilator acquired
Aspiration
134
Is the LRTI sterile or non-sterile
Should be sterile
135
What can predisspose us to LRTI
Loss or supression of cough reflex/swallo
Ciliary defects
Mucuous disroders
Pulmonary oedema
Immunodeficiency
Macrophage function inhibition e.g. smoking
136
What is pneumonia
Infection of the lung parenchyma
137
How does acute bronchitis present
Cough - dry and retrosternal pain
Dyspnoea
Tachypnoea
138
When is acute bronchitis common
Most frequent in winter in children under 5
139
What are the common causes of acute bronchitis
Viral - most common, rhinovirus, influenza etc
| Bacterial - less common, h. influenza, pneumonia, pertussis
140
How do we treat acute bronchtiis
Supportive treatment if healthy
Oxygen and respiratory support if they have a severe diseae or co-morbidity
Antibiotics only if proven bacterial cause
141
How do we diagnose acute bronchitis
Diagnostic tests not usually done if mild
| If needs be do respiratory secretion to look for a specific cause
142
What is associated with chronic bronchitis
Smoking, pollution, allergens
| Most common in men and over 40s
143
mediators of chronic bronchitis
IInflammation and oedema of airways mediated by exogenous irritants rather than infective agents
Patients can have acute exacerbations mediated by the same infected pathogens
144
If you have obstructed airflow on spirometry and chronic bronchitis what does this mean
You have COPD
145
Who does bronchiolitis affect
Many childrn
Winter and early spring
Infatns 2-10months
146
What is bronchiolitis
Inflammation and oedema of the bronchioles
147
How does bronchiolitis present
Acute onset wheeze
Cough
Nasal discharge
Respiratoy distress (grunting, retractions, nasal flaring)
148
What is the most common cause of bronchiolits
RSV - 75% of cases
149
How do we diagnose bronchiolitis
Chest X-ray
| Microbiological diagnsosis - nasopharyngeal aspirate send for viral PCR
150
What is penumonia
Infection affecting the most distal airways and alveoli
151
What are the 2 anatomical patterns of pneumonia
1) bronchopneumoina - patchy dsitribution of pus centred on inflamed bronchioles and bronchi then subsequent spread to surrounding alveoli
2) Lobar - often affects a large part of entirety of the lobe, 905 due to S. pneumonia
Has a clear line of demarkation
152
Define hospital acquired pneumonia
Developed after 48 hours are hospital admissions
| If after 5 days think enterbacteriacaece and pseudomonas
153
What is ventilator acquired pneomonia
Develops after 48 hours after ET intubation and ventilation
154
Define aspiration pneumonia
Resulting from abnormal entry of fluids into the lower respiratory tract
Patient usually has impaired swallow mechanisms
155
Common cause of CAP
Person - person (s. pneumonia and h. influenza)
Environment (L. pneumophilia)
Animals (c. pistacci)
156
How can we split CAP
Into typical atypical
157
What is atypical CAP
Fail to respond to penicillin or sulpha drugs
| Mycoplasma pneumonia, legionella, chlamydia, coxiella
158
What is typical CAP
```
S. pneumonia
H, Influenza
Moraxella
Staph aureus
Klebsiella
```
159
Presentation of bacterial CAP
```
Rapid onset
Fever/chills
Productive cough, mucupurulent sputum
Pleurtic chest pain
General malaise
```
Signs: Tachypnoea, tachycardia, hypotension
Dull to percuss, reduced air entry, bronchial breathing
160
Presentation of Mycobacterium Pneumonia
Autumn epidemics
Common in children and young adults
Main symptom is cough
Diagnose with serology
161
Complications of mycobacterium pneumonia
Guillian Barre
| Peripheral neuropathy
162
Causes of legionella pneumophilia
Colonises water pipes
| Outbreaks associated with shoes, air conditioning units and de-humidifiers
163
Presentation of legionella pneumophilia
```
High fevers
rigors
dry cough
Dyspnoea
Vomiting, diarrhoea
Confusion
```
164
Blood results of legionella pneumophilia
Deranged LFTs
| SIADH (low sodium)
165
Presentation of chlamydophilia pneumonia
More common in elderly
| Causes mild penumonia or bronchitis in adolescents and young adults
166
What is chlarmudphilia psittaci associated with
Exposure to brds
Consider in those with pneumonia, splenomegaly and history of bird exposure
May also have rash, hepatitis, haemolytic anaemia and reactive arthritis
167
How does influenza present
Fever, headache, myalgia, dry cough, sore throat
| Convalescence can take 2-3 weeks
168
Who is primary viral prenumonia more common in
Those with existing cardiac and lung disorders
Cough, brethaless and cyanosis
secondary bacterial pneumonia may develop after initial period of improvement
169
How do we diagnose influenae
PCR
170
Investigations for CAP
Sputum gram stain and culture
Blood culture
Pneumococcal and regionally urinary antigen
PCR for viral pathoens, mycoplasma pneumonia and chlamydophilia
171
How to assess severity of CAP
CURB
C-confusion
U-Urea
Resp rate
Blood pressute
172
How to prevent LRTIS
Pneumococcal vaccinations - patients with chronic heart, lung and kidney disease, may repeat after 5 years
Influenza vaccine
173
Normal URTI flora
Strep Viridans
commensal neisseria
Diphterioids
Anaerobes
174
Is nesseiria meningitidis a commensal URTI flora
No but can be carried asymptomatically
175
What do get colonisation of in the URTI post antibitoics
Pseudomonas and candida
176
How are most URTI transmitte
Mainly droplets affecting v. young children and teenagers in winter/viral infections
177
Treatment of URTI
1) no treatment
2) delay prescribign
3) only prescribe if risk of complication
178
What causes common cold
rhinovirus
| also coronoviruses, RSV, enterovirus, parainfluenza, adenovbirus
179
Treatment of common cold
No treatment
180
What rhino-sinusitis
Post - viral ingection
| May also be allergy or non-infective
181
Symptoms of rhino-sinusitis
Facial pain
Nasal blockage
Smell Reduction
182
Causes of rhino-sinusitis
Secondary bacterial infection from strep pneumonia, ham influenza, strep milleri, anaerobes
183
What are the 3 main microbes causing URTI
Strep pneumonia, haem influenza, morexalla catarrhallis
184
What does chronic sinusitis cause
osteomyletis, meningitis, cerebral abscesses
185
How do we test for rhino-sinusitis
Ct/MRI/X-ray to check fluid level
186
Treatment of rhino-sinusitis
Sinus washout - relieves sympomts
| Only give antibiotics if proven bacterial
187
What are more the main causes of pharyngitis
Viral - RSV, influenza, adenovirus, EBV, HSV1
| Bacteria - Strep pyogenes, rarely gonorrhea
188
Symptoms of tonsilits
Red tonsils, dysphagia, fever, headache, uvula and exudate, lymphadenopathy
189
Common cause of tonsillitis in children
Group A strep infections
Complications of glomerulonephritis and rheumatic/scarlett faever
Supparative complicatinos e.g. ear infection
190
Treatment of tonsillitis in children
Penicillin to prevent
191
Symptoms of mono/glandular fever
fever and cervical lmphadenopathy
| complication: splenic reupture
192
Treatment to avoid in glandular fever
ampicillin - get mac-pac rash that is mistaken for allergy
193
diagnosis of mono
IgG serology
| Paul Brunell test/ PCR
194
What cause diphteria
Corynebacterium Diphterhia
195
Symptoms of diphtheria
malaris, fever, sore throat
196
Treatment of diphtheria
Treat complications with erythromycin/penicillin/antitoxin
197
When do we usually get candida tonsilitis
after antibiotics or steroids
198
Symptoms of eppiglotitis
```
Children 2 -4
Fever
Difficulty speaking (hot potato)
Droolig
Stridor, hoarse
```
199
Most common cause of epiglottitis
H. influenza type B
| Now rest bacteria and s. aurues
200
Diagnosis of epiglottitis
Lateral neck x-ray - enlarged epiglottis
| NOTE do not take swab/examine epiglottis unless intubated
201
Usual cause of acute laryngitis
Usually viral or one of the typical 3 bacteria
202
Symptoms of acute laryngitis
hoarse voice, globus pharyngitis, fever, myalgia, dysphagia
203
Non infective causes of laryngitsi
voice over use and malignancy
204
Cause of croup/acute laryngtracheobronchitis
Viral - parainfluenza type 2 and RSV
205
Symptoms of croup
Children
Inflammation of larynx and trachea after URTI
only treat symptoms
206
What causes whooping cough
Bordatella pertussis
| Gram I've coccobacillus
207
2 stages of whooping cough
1) catarrhal - runny nose, f ever, malaise
| 2) whooping - a week later with dry non productive cough on exhalation
208
Complications of whooping cough
otitis media, pneumonia (secondary or aspiration), convulsions or subconjunctival haemorrhage
209
Treatment of whooping cough
Erythromycin (give to household contacts too)
210
What is otitis externa
Infection of the external auditor canal
211
Symptoms of otitis eterna
Painful, itch, swelling, erythema, otorrhea
212
Causes of acute otitis externa
S. aurues or pseudomonas (likely after swimming)
213
Treatment of acute otitis externa
Toilet with saline treatment, wick insertion, topical drops
214
Cause of chronic otitis externa
Irritation from dram drainage from perforated tympanic membrane
215
Treatment of chronic otitis externa
Treat underling cause
| Avoid aminoglycosides!! if perforated can cause deafness
216
Cause of malignant otitis externa
Pseudomnas aeruginosa
Sever necrotizing, may invade bone/cartilage
Pain and pus
Elderly and immunocompromised more vulnerbale
217
Treatment of malignant otitis externa
4-6 weeks and ceftazidime and ciprofloxacin if pseudomonas is the cause
218
Symptoms of otitis media
```
Common in children
Fever
Pain
Impaired hearing
Red bulging tympanic membrane
```
219
Causes of otitis media
Usually viral or one of the 3 bacteria
220
Treatment of otitis media
Supportive or amoxicillin if one of the 3 bacteria
221
What is mastoiditis
Inflammation of the mastoid air cells after middle ear infection
Pus collect is cells - may lead to necrosis
222
Signs of mastoiditis
Same as acute otitis media BUT pain/swelling over mastoid bone
223
How do we assess mastoiditis
Bacteria samples and CT scan
224
How do we treat mastoidis
Prolonged antibitics if bone infection
| Co-amoxiclav first line treatment
225
What is vin cents angina
Deep fascial infections of the head and neck (ludwig and leemers also be aware of)
226
What is similar to concerts angina
Ginguvitis and periodontal infections - but we aren't dentists
227
What do we use to treat vincetn angina
penicillin and amocivillin
