A2- Lower respiratory infection

Question 1

What is the most common new symptomatic presentation with a patient with HIV?

Answer 1

Pneumoncystis pneumonia (pneumocystis jirovecii)

Question 2

Certain medication can increase the chance of LTRI.
What is this medication?

Answer 2

Seretide accuinhaler- used for COPD and Chronic disease. Contains Inhaled corticosteriod. Can develop pneumonia

Question 3

What is the CXR showing?

Answer 3

Consolidation in the right middle lobe - suggestive of pneumonia

Question 4

What does this show

Answer 4

Apical cavity (hole) in the right lung (apex)
Circular lesion- white line around a dark hole
Classic presentation in pulmonary tuberculosis.

Question 5

What does this CXR show?

Answer 5

Large area of increased opacification in the right hemithorax. Very dense.
Has a lense shape pattern.
Suggestive of pleural lesion
This patient has fluid in their peripheral pleura.
Empyema

Question 6

What does this CXR show?

Answer 6

Large area of increased opacification in the right hemithorax. Very dense.
Has a lense shape pattern.
Suggestive of pleural lesion
This patient has fluid in their peripheral pleura.
Empyema

Question 7

What does this CXR show?

Answer 7

Large area of increased opacification in the right hemithorax. Very dense.
Has a lense shape pattern.
Suggestive of pleural lesion
This patient has fluid in their peripheral pleura.
Empyema

Question 8

What does this CXR show?

Answer 8

Consolidation in the mid lobe.
Bat wing presentation.
Classic presentation of people that present with pneumoncytic pneumonia

Question 9

What does the CXR show?

Answer 9

Generally whitening on the outside (peripheries).
Classic widespread peripheral ground glass consolidation that is seen in covid pneumonia

Question 10

WHat can you see in this CT?

Answer 10

Consolidation in the back of the lung standard for pnuemonia.

Question 11

What is this CT showing?

Answer 11

Ground glass appearance
classic in viral pnuenmonia
Multifocal

Question 12

Ix for respiratory tract infections?

Answer 12

FBC
CRP
U+E
Albumin
HIV

Question 13

How do you establish the cause fo the respiratory tract infection
Tests?

Answer 13

Nose and throat swabs
Noso and oropharyngeal asoirates
SPutum
Induced sputum
Brocnhoalveolar lavage
Pleural aspirates (pH)
Lung aspirates
Node Biopsies
Blood culture

Question 14

What do you use to diagnose/classify CAP?

Answer 14

C - confusion
U - urea >7mmol/L
R - respiartory rate >30/min
B - blood pressure <90 mmHg systolic and/or <60 mmHg diastolic
65- over 65

Question 15

The score you get from CURB 65 suggests?

Answer 15

Suggest the percentage for 30 day mortality

Question 16

Outline the CAP therapeutics in relation to the patients CURB score?

Answer 16

BC- blood culture

LA- legionella antigen test

Question 17

What is the standard treatment for TB?

Answer 17

4 drugs for 2 months and then you give 2 drugs for 4 months

Adherence-

SE- Liver toxicity

Efficacy- improvement in radiology, symptoms. Are the patient gaining weight?

Question 18

How are non tuberculous mycobacteria transmitted?

Answer 18

Environmental organisms- water and soil

Question 19

How are non tuberculous mycobacteria transmitted?

Answer 19

Environmental organisms- water and soil

Question 20

Common Viral respiratory tract infections?

Answer 20

COVID

Influenza

Question 21

Pathology of COVID -19

Answer 21

Pathogen binds to the ACE2 sites which is the lung, heart oesophagus, kidneys, bladder and ileum.

it is driven by lung neutophil infiltrate plus micro + macrovascular thrombus

Question 22

Tx for COVID-19

Answer 22

oxygen (nasal prongs, mask with venture, non rebreather, CPAP, Invasive ventillation

Anticoagulation (daltaparin 5000u OD or BD

Dexamethasone (6mg OD for 10 days)

Remdesivir (100mg OD infusion)