Biochemistry

Question 1

What is the CURB65 score?

Answer 1

Confusion
Urea >7mmol/l
RR >30breaths
BP (systolic <90mmHg or diastolic <60mmHg)
Age 65 or greater

0-1 = low severity
2 = moderate severity
3-5 = high severity

Question 2

What is the NEWS2 score?

Answer 2

1. RR
2. O2 sats
3. Systolic BP
4. Pulse rate
5. Level of consciousness or new confusion
6. Temperature

The score can be increased by 2 for people requiring supplemental oxygen to maintain their recommended O2 sat.

Question 3

What are URTIs?

Answer 3

• Common cold
• Sinusitis
• Pharyngitis
• Laryngitis

Question 4

What are LRTIs?

Answer 4

• Acute bronchitis (COPD exacerbation)
• Exacerbation of bronchiectasis
• Pneumonia (lung abscess and empyema)
• TB
• Influenza

Question 5

What is the most common causes of CAP?

Answer 5

Streptococcus pneumoniae

Less common - mycoplasma pneumoniae, haemophilius influenzae

Question 6

What are the viral causes of pneumonia?

Answer 6

Influenza A+B, adenovirus, coronavirus - diagnosis with PCR

Question 7

What is the most common fungal cause of pneumonia?

Answer 7

Pneumocystic jiroveci

Question 8

What are the complications of CAP?

Answer 8

• Pleural effusion
• Infectious complications - empyema, lung abscess, metastatic infection, pericarditis
• VTE
• Hypotension
• Worsening of comorbidities (AF, heart failure etc)
• Side effects of antibiotics (C.difficile, future resistance)
• Sepsis

Question 9

What is HAP defined as?

Answer 9

New onset of symptoms along with compatible x-ray developing more than 48 hours after the patient’s admission to hospital.

Question 10

What are the risk factors for HAP?

Answer 10

• ICU stay, mechanical ventilation
• Prolonged hospital or ICU stay (with increased risk of multi-drug resistant organisms)
• Severe underlying illness, multiple co-morbidities
• Underlying respiratory disease e.g. COPD, asthma
• Abdominal surgery, vomiting/aspiration

Question 11

What are the causes of HAP?

Answer 11

• Enterobacteria (e.coli, klebsiella sp.)
• Staph aureus
• Psuedomonas sp.

Question 12

How is TB transmitted?

Answer 12

• Inhalation of infected droplets
• Droplets generated by cough/sneeze
• Prolonged close contact usually required
• Only sputum smear-positive are infectious
• Occasional transmission from: infected milk, tuberculous abscess, post mortem

Question 13

What is the primary infection of TB?

Answer 13

• Latent TB
• No specific immunity
• Small lung lesion
• Regional lymph node involvement
• Haematogenous spread
• Asymptomatic in 90%

Question 14

What is the post-primary disease (active) of TB?

Answer 14

• Reactivation of persisting mycobacteria
• Much greater immune response
• Usually symptomatic