Adult Respiratory Conditions

Question 1

What percentage of URTIs are caused by viral pathogens?

Answer 1

85-90% of URTIs are caused by viral pathogens.

Question 2

Name three URTIs that are treated with antimicrobials.

Answer 2

Acute bacterial rhinosinusitis, GAS pharyngitis, and pertussis.

Question 3

Describe the three clinical presentations that predict acute bacterial rhinosinusitis.

Answer 3

Persistent symptoms ≥10 days without improvement, severe symptoms (high fever, purulent nasal discharge, facial pain) for ≥3-4 consecutive days, and worsening symptoms following initial improvement (‘double sickening’).

Question 4

What is the drug of choice for bacterial rhinosinusitis and what is its recommended duration of therapy?

Answer 4

Amoxicillin-clavulanate; 5-7 days.

Question 5

Name the causative agent of pharyngitis that requires antimicrobial treatment.

Answer 5

Group A Streptococcus (GAS).

Question 6

List five physical findings in a patient with GAS pharyngitis.

Answer 6

Fever, tonsillopharyngeal erythema and exudates, palatal petechiae, tender and enlarged anterior cervical lymph nodes, absence of cough.

Question 7

Aside from penicillin, what are the four alternative drugs for GAS pharyngitis?

Answer 7

Cephalexin, cefadroxil, clindamycin, macrolides.

Question 8

Name the causative agent of pertussis and describe how it contributes to infection persistence.

Answer 8

Bordetella pertussis; produces pertussis toxin that suppresses the immune system.

Question 9

Enumerate the three phases of pertussis infection and their corresponding durations.

Answer 9

Catarrhal phase (1-2 weeks), Paroxysmal phase (2-3 months), Convalescent phase (1-2 weeks).

Question 10

What is the preferred macrolide treatment for pertussis in infants less than one month old?

Answer 10

Azithromycin.

Question 11

Differentiate the clinical presentation of the common cold from the flu.

Answer 11

Common Cold: Clear runny nose prominent at the outset. Flu: Higher and more persistent fever.

Question 12

Why are first-generation antihistamines preferred over second-generation ones for allergic rhinitis and UACS?

Answer 12

Due to their strong drying effect from anticholinergic properties.

Question 13

What is a possible adverse effect of prolonged use of intranasal corticosteroids for severe UACS and allergic rhinitis?

Answer 13

Rhinitis medicamentosa, a rebound congestion.

Question 14

What is the mechanism of action of proton pump inhibitors in treating GERD?

Answer 14

Block the final step in gastric acid production, reducing acidity.

Question 15

Name two conditions that present with reversible airflow obstruction.

Answer 15

Asthma and cough variant asthma.

Question 16

How do you differentiate cough variant asthma from classic asthma in terms of management?

Answer 16

Cough variant asthma is managed with bronchodilators and corticosteroids during attacks, while classic asthma requires maintenance therapy.

Question 17

What are the ‘3 Cs’ recommended to prevent the spread of flu?

Answer 17

Cover your cough, Clean your hands, Contain germs.

Question 18

Enumerate the ‘3 Cs’ that should be avoided to prevent COVID-19 infection.

Answer 18

Closed spaces, Crowded places, Close-contact settings.

Question 19

Differentiate acute from chronic bronchitis based on the duration of cough.

Answer 19

Acute bronchitis: 1-3 weeks; Chronic bronchitis: at least 3 months in a year for two consecutive years.

Question 20

Name three bacterial causes of acute bronchitis.

Answer 20

Bordetella pertussis, Chlamydia pneumoniae, Mycoplasma pneumoniae.

Question 21

Aside from clinical presentation, what diagnostic tool is used to confirm acute bronchitis?

Answer 21

Absence of clinical findings suggestive of pneumonia, asthma, COPD, or other causes of chronic cough.

Question 22

Name the common pathogens found in the dilated airways of patients with bronchiectasis.

Answer 22

Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pneumoniae.

Question 23

What are the radiographic findings associated with bronchiectasis?

Answer 23

Ring shadows, ‘tram-line’ opacities, tubular and branching opacities.

Question 24

Enumerate five underlying conditions that can lead to recurrent infections and bronchiectasis.

Answer 24

Immunodeficiency states, abnormal secretion clearance, cystic fibrosis, Young’s syndrome, alpha-1 antitrypsin deficiency.

Question 25

What are the three goals in treating bronchiectasis?

Answer 25

Treat underlying conditions and lung infections, remove mucus from the lungs, prevent complications.

Question 26

Aside from pharmacologic treatment, what are two non-pharmacologic interventions for managing bronchiectasis?

Answer 26

Chest physiotherapy, postural drainage.

Question 27

In cases of life-threatening, severe bleeding in bronchiectasis, what are the two treatment options?

Answer 27

Arteriographic embolization, open reduction of bleeders.

Question 28

What are the four stages of typical community-acquired pneumonia (CAP)?

Answer 28

Congestion, red hepatization, grey hepatization, resolution.

Question 29

What type of sputum is indicative of progression from the stage of congestion to red hepatization in CAP?

Answer 29

Rust-colored sputum.

Question 30

What does each letter in the CURB-65 mnemonic for CAP assessment represent?

Answer 30

Confusion, Urea > 7 mmol/L, Respiratory rate ≥ 30, Blood pressure ≤90/≤60 mmHg, Age ≥ 65.

Question 31

A patient presents with confusion, urea > 7 mmol/L, and a respiratory rate ≥ 30. What is their CURB-65 score and corresponding risk classification?

Answer 31

Score: 3; High-risk pneumonia.

Question 32

What are the first-line antimicrobial choices for low-risk CAP in patients without comorbidities?

Answer 32

Amoxicillin or macrolides (e.g., clarithromycin, azithromycin).

Question 33

When would you add a macrolide or tetracycline to the treatment regimen of low-risk CAP in a patient with stable comorbidities?

Answer 33

When there are symptoms and signs of possible atypical infections.

Question 34

What is the recommended antimicrobial treatment for moderate-risk CAP without MDRO infection?

Answer 34

Extended-spectrum beta-lactam (e.g., ampicillin-sulbactam) or third-gen cephalosporin PLUS a macrolide.

Question 35

Differentiate the first-line therapy from the alternative therapy for high-risk CAP without risk for MDRO.

Answer 35

First-line: β-lactam + macrolide. Alternative: β-lactam + respiratory fluoroquinolone.

Question 36

Enumerate the patient risk factors for MRSA infection.

Answer 36

Prior MRSA colonization/infection, IV antibiotic therapy within 90 days.

Question 37

What antimicrobial should be added to the regimen of high-risk CAP patients with risk for MRSA infection? Provide three options.

Answer 37

Vancomycin, linezolid, clindamycin.

Question 38

What are the three criteria for clinical stability used to guide the duration of CAP treatment?

Answer 38

Resolution of vital sign abnormalities, ability to eat, normal mentation.

Question 39

Name three bacterial causes of atypical pneumonia.

Answer 39

Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila.

Question 40

What diagnostic tool is used to confirm atypical pneumonia, particularly in severe cases?

Answer 40

PCR.

Question 41

Describe the common radiographic findings for Chlamydia pneumoniae.

Answer 41

Patchy or reticulonodular opacities, often perihilar, may extend to interlobar septa and pulmonary interstitium.

Question 42

Name three possible complications of Chlamydia pneumoniae infection.

Answer 42

Encephalitis, myocarditis, chronic infection.

Question 43

What are the two surface proteins that help distinguish influenza A subtypes from the common cold?

Answer 43

Hemagglutinin (H) and Neuraminidase (N)

Question 44

Which influenza A subtype is responsible for the Spanish Flu pandemic of 1918 and the Swine Flu outbreak of 2009?

Answer 44

H1N1

Question 45

Aside from H1N1, what other Influenza A subtype is currently circulating among humans?

Answer 45

H3N2

Question 46

What is the mechanism of action of oseltamivir/zanamivir in treating influenza?

Answer 46

Neuraminidase inhibitors that prevent the release of virions from infected cells

Question 47

What is the maximum time frame after the onset of influenza symptoms within which oseltamivir/zanamivir must be taken to be most effective?

Answer 47

Within 2 days of symptom onset

Question 48

What are the “3 Cs” recommended by the World Health Organization (WHO) to prevent aerosol transmission of the flu?

Answer 48

Cover your mouth, clean your hands, contain your germs

Question 49

What are the 'new 3 Cs' to avoid in the context of COVID-19?

Answer 49

Confined spaces, crowded places, close-contact settings

Question 50

What diagnostic tool is used to confirm Streptococcus pyogenes as the cause of pharyngitis?

Answer 50

Rapid antigen detection test (RADT)

Question 51

What is the drug of choice for GAS pharyngitis?

Answer 51

Penicillin G/Penicillin V/Amoxicillin

Question 52

What condition should be suspected if a patient's common cold symptoms worsen after an initial improvement, with fever, headache, and increased nasal discharge?

Answer 52

'Double-sickening,' suggestive of bacterial rhinosinusitis

Question 53

What are the three criteria that predict a bacterial etiology for rhinosinusitis?

Answer 53

1. Persistent symptoms lasting ≥ 10 days with no improvement; 2. Severe symptoms with high fever and purulent discharge or facial pain for ≥ 3-4 days; 3. Worsening symptoms after initial improvement from a viral URTI that lasted 5-6 days ('double sickening')

Question 54

For how long should a patient with bacterial rhinosinusitis be treated with amoxicillin-clavulanate empirically?

Answer 54

5-7 days

Question 55

What bacterial agent should be targeted when choosing empiric therapy for rhinosinusitis?

Answer 55

Haemophilus influenzae

Question 56

What virulence factor of Bordetella pertussis is responsible for suppressing the immune system and contributing to the persistence of infection?

Answer 56

Pertussis toxin

Question 57

Which phase of pertussis is characterized by the hallmark 'whooping cough'?

Answer 57

Paroxysmal phase

Question 58

What is the recommended treatment for pertussis?

Answer 58

Macrolides (e.g., erythromycin, azithromycin, clarithromycin)

Question 59

What condition is characterized by reversible airflow obstruction and uncontrollable cough spasms, often with a history of hypersensitivity or a family history of asthma?

Answer 59

Cough variant asthma

Question 60

What are the radiographic findings associated with bronchiectasis?

Answer 60

Ring shadows and 'tram-line' opacities

Question 61

What is the CURB-65 score used for?

Answer 61

Assessing the severity and risk of community-acquired pneumonia (CAP)

Question 62

List the components of the CURB-65 score.

Answer 62

Confusion, Urea > 7 mmol/L, Respiratory Rate ≥ 30, Blood pressure ≤ 90/80 mmHg, Age > 65 years