31. Lower RTIs

Question 1

What are the risk factors for pneumonia?

Answer 1

Age
Chronic lung disease
Smoking and alcohol
Winter
Co-morbidities

Question 2

What pathogens cause community acquired pneumonia?

Answer 2

Strep pneumoniae
Mycoplasma pneumoniae
Haemophilus influenzae
Legionella pneumophilia
Staph aureus
Chlamydia, coxiella and gram negatives

Question 3

What micro investigations can be done in suspected pneumonia?

Answer 3

Blood, sputum and BAL for culture
Urinary antigen for legionella or pneumococcus
Nose/throat swab for influenza PCR

Question 4

What blood test results are indicative of pneumonia?

Answer 4

High WCC
Inflammatory markers
Renal function tests used to calculate severity

Question 5

How is community acquired pneumonia empirically treated?

Answer 5

Benzylpenicillin

Question 6

What pathogens cause atypical pneumonia?

Answer 6

Mycoplasma, legionella, chlamydia, coxiella

Question 7

How is atypical pneumonia treated?

Answer 7

Macrolides
Tetracyclines
Fluoroquinones

Question 8

What population group is most commonly infected with mycoplasma?

Answer 8

Children and young adults

Question 9

How does mycoplasma spread?

Answer 9

Droplet

Question 10

What complications are associated with mycoplasma?

Answer 10

Carditis and encephalitis

Question 11

How is mycoplasma detected?

Answer 11

Serology and NAAT

Question 12

What is the treatment for mycoplasma?

Answer 12

Macrolides or tetracycline

Question 13

How is legionella detected?

Answer 13

Urinary antigen

Sputum culture

Question 14

How is legionella treated?

Answer 14

Macrolide or fluoroquinone

Question 15

Which chlamydia subspecies cause pneumonia?

Answer 15

Psittaci

pneumoniae

Question 16

Compare the method of spread of chlamydia psittaci and pneumoniae

Answer 16

Psittaci: airborne
Pneumoniae: Droplet

Question 17

Compare the incubation periods of chlamydia psittaci and pneumoniae

Answer 17

Psittaci: 1-3 weeks
Pneumoniae: 3-4 weeks

Question 18

How is chlamydia pneumonia diagnosed?

Answer 18

NAAT

Serology for specific IgG

Question 19

What is the treatment for chlamydia?

Answer 19

Tetracycline or macrolides

Question 20

What is the treatment of coxiella?

Answer 20

Doxycycline

Question 21

What kind of pneumonia is caused by staph aureus?

Answer 21

Severe necrotising pneumonia due to the production of PVL toxin
Causes abscess formation

Question 22

What patient group is associated with klebsiella pneumonia?

Answer 22

Alcoholics

Question 23

What kind of pneumonia is associated with klebsiella?

Answer 23

Cavitating pneumonia
Redcurrant jelly sputum
Abscess formation

Question 24

What are the viral causes of pneumonia?

Answer 24

Influenza
RSV in children
Complication of chicken pox, measles and CMV

Question 25

What pathogens are associated with hospital acquired pneumonia?

Answer 25

Gram - bacilli MRSA Legionella Viruses

Question 26

What score is used to predict the mortality of community acquired pneumonia?

Answer 26

CURB-65 | Used to decide treatment

Question 27

What does CURB-65 stand for?

Answer 27

``` Confusion Urea Respiratory rate BP >65 ```

Question 28

What is the treatment for a CURB-65 score of 0-1?

Answer 28

PO: Amoxicillin Clarithromycin Doxycycline

Question 29

What is the treatment for a CURB-65 score of 2?

Answer 29

IV amoxicillin and PO clarithromycin

Question 30

What is the treatment for a CURB-65 score of 3-5?

Answer 30

IV co-amoxiclav and PO clarithromycin

Question 31

What are the risk factors for lung abscesses?

Answer 31

``` Aspiration Periodontal disease Bronchiectasis Bronchial carcinoma Bacteraemia ```

Question 32

What fungi are opportunistic causes of pneumonia?

Answer 32

PCP Aspergillus Cryptococcus neoformans

Question 33

Which bacteria cause lung abscesses?

Answer 33

Staph aureus Klebsiella Strep pyogenes

Question 34

Why do patients with CF have an increased risk of lung infections?

Answer 34

``` Reduced microbial clearance Inactivated defensins and impaired killing by neutrophils in airways Receptor for pseudomonas Reduced NO Airways are hyperinflammatory ```