Diseases of the Respiratory System Flashcards Preview

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Flashcards in Diseases of the Respiratory System Deck (227):
1

what causes tb

Mycobacterium TB

2

What happens in primary TB

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

Where is the most common site for TB to activate

The periphery of the mid zone of the lung

4

What is the bodies immune response to TB

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

What are the primary symptoms of TB

Influenza like - absent/mild

Do a CXR and tuberculin skin test

6

How many does TB reactivate in

10%

7

What is TB called when its read to the hilar lymph nodes

Ghon focus

8

How do we histologically diagnose TB

Look for granulomas and ZN test

9

What other tests can we do for TB

Skin testing
IFN-gamma release test

But these don't really look for the active disease

10

What type of tissue samples do we need to test for TB

Fresh tissue samples
NOT formalin fixed

11

What can cause reactivation of Tb

Immunosuppression
Alcohol
Malnutrition
Western countries - men over 50
HIV
Silicosis, CRF, gastrectomy
Anti-TNF alpha drugs e.g. infliximab

12

What is tense to keep the tomb walls strong i TB

TNF alpha

13

Pathogenesis of TB

Coalescing tubercles - central caseous necrosis
Cavitation

14

Where does TB typically reactivate

In the apexes of the lungdue to highest oxygen tensions

15

Symptoms of secondary TB

Chornic productive cough - haemoptysis
Weight loss, fever, night sweats

16

How do we treat TB

2 months: Isonizaid, rifampicin, pyrazinamide, ethambutol/streptomycin
4 months: Izonizaid, rifampicin

Drug combination reduces risk of resistance

17

What are some extra-pulmonary sites of TB

Pleura
Lymph nodes - enlalrged in chest and neck
Bone - spine
Kidneys
Epididymins
Bran/meninges
Intestine
Pericardium

18

How can we get intestinal TB

Can swallow respiratory pathogens
Or
From unpasterusied milk due to M. Bovis

19

What is atypical TB

Non tuberculous mycobacteria
Environmental organism
Lack of person-person complex

20

Describe the effects of mycobacterium avium complex in HIV infected

Disseinated disease

21

Descrive the effects of non-HIV infected mycobacterium avid complex

Pulmonary TB like
Young children - cervical lymphadentitis

22

Describe what happens in TB meningitis

Inisidious onset
personality change
focal neurological deficit
mild headache/meningism (although the typical fever, night sweats, anorexia and weight loss may be absent)

23

Where does TB multiple in TB meningitis

Multiplies at the base of the brain asking basilar inflammation

24

What does the BCG vaccine contain

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