5. Respiratory Tract Infections

Question 1

URTI infections (3)

Answer 1

Sinusitis (rhinosinusitis)
Tonsillitis
Pharyngitis

Question 2

Causes of viral URTIs (5)

Answer 2

Rhinovirus
Adenovirus
Parainfluenza viruses
Influenza viruses
Epstein Barr virus (glandular fever)

Question 3

Main cause of bacterial URTIs

Answer 3

S. pyogenes

Question 4

Rhinovirus transmission (2)

Answer 4

Direct contact

Brief exposure

Question 5

Cause of strep sore throat

Answer 5

Group A S. progenies (25% of all cases)

Question 6

Group A strep virulence factors (4)

Answer 6

Pyrogenic exotoxins
Streptolysins
Hyaluronidase
M protein

Question 7

Complications of strep sore throat (5)

Answer 7

Otitis media or sinusitis 
Scarlet fever
Rheumatic fever
Rheumatic heart disease
Acute glomerulonephritis

Question 8

Definition of bronchitis

Answer 8

Inflammation of tracheobronchial tree

Question 9

Types of bronchitis

Answer 9

Acute - usually during winter months, viral

Chronic - viral/bacterial, affects 10-25% of population

Question 10

Definition of chronic bronchitis

Answer 10

Productive cough on most days during at least three months in each of two successive years

Question 11

Predisposing factors to chronic bronchitis (4)

Answer 11

Smoking
Infection
Air pollution
Allergies

Question 12

Causes of bronchitis (2)

Answer 12

90% - viral

10% - bacterial

Question 13

Bronchitis treatment (3)

Answer 13

Decongestants
NSAIDS
Antibiotics (where appropriate)

Question 14

Complications of untreated viral infections

Answer 14

Secondary bacterial infections

Question 15

TB mechanisms (3)

Answer 15

Microbiological
Infectivity
Oro-facial implications

Question 16

Microbiological TB features (3)

Answer 16

Acid fast, aerobic, non-motile, non-encapsulated bacilli
Lipid wall component
Resistant to phagocytosis destruction

Question 17

TB infectivity features (2)

Answer 17

Spread by droplet nuclei

Ingestion/skin contact rare

Question 18

TB oro-facial implications (4)

Answer 18

Chronic painless ulcer
Primary oral lesions
Cervical lymphadenitis
Primary jaw TB

Question 19

TB treatment (2)

Answer 19

Triple therapy

Streptomycin, para-aminosalicylic acid and isoniazid

Question 20

Long-term TB treatment and benefits (2)

Answer 20

DOTS (direct observed treatment short course)
95% cure rate
Prevents transmission

Question 21

Pneumonia definition

Answer 21

Inflammatory condition of the lung, especially alveoli

Question 22

Causes of pneumonia (2)

Answer 22

Typically infection but multifactorial

S. pneumoniae (community-acquired), S. aureus (hospital-acquired)

Question 23

Features of pneumonia (9)

Answer 23

Sudden/insidious onset
Fevers
Rigours
Malaise
SoB
Rapid, shallow breathing
Cyanosis
Cough producing purulent sputum
Consolidation of lungs clinically and radiographically

Question 24

Function of pneumolysin (2)

Answer 24

Inhibits activity of ciliated cells

Cytotocic for alveolar and endothelial cells

Question 25

Action of pneumolysin (3)

Answer 25

Activates classical complement binding pathway (by binding to Fc of an antibody)
Causes inflammation in lungs, decreases effectiveness of PMNs
Stimulates monocytes to produce cytokines

Question 26

Clinical management of pneumonia (2)

Answer 26

IV antibiotics and hospitalisation

Vaccination

Question 27

IV antibiotics and hospitalisation management of pneumonia (3)

Answer 27

Beta-lactams
Erythromycin
Quinolones

Question 28

Most common type of pneumonia

Answer 28

Legionnaire’s disease

Question 29

Legionnaire’s transmission (2)

Answer 29

Inhalation of aerosols (contaminated water)

Aspiration of oropharyngeal colonised bacteria

Question 30

Legionnaire’s symptoms (5)

Answer 30

Flu-like symptoms
Progression to severe pneumonia symptoms
Mental confusion
Renal failure
GI symptoms

Question 31

Legionnaire’s diagnosis (3)

Answer 31

Micro culture
CXR
Antibody level measurements

Question 32

Legionnaire’s treatment (2)

Answer 32

Erythromycin

Unresponsive to penicillin