Bronchial Sepsis/ Pnuemonia

Question 1

describe the presentation of pharyngitis

Answer 1

reddening of the oropharynx and soft palate

Inflammation of the tonsils (lymph nodes swell in 1-2 days)

Question 2

What are the 4 D’s of epiglottitis

Answer 2

Drooling
Drawn
Dysphonia
Dysphagia

Question 3

Is epiglottitis a medical emergency

Answer 3

YES! can loose airway so must be secured ASAP. Pts also should be given IV cefuroxime.

Question 4

What is the most common causative agent of epiglottitis

Answer 4

H. influenzae

Question 5

which structure marks the boundary between an URTI and a LRTI

Answer 5

the epiglottis

Question 6

name a viral cause of pharyngitis

Answer 6

EBV
Adenovirus
Enterovirus
HSV

Question 7

name two bacterial causes of pharyngitis

Answer 7

Group A streptococci –> penicillin/amoxicillin

Corynebacterium dipthreiae–> MEDICAL EMERGENCY –> slow asphyxiation (reqs antitoxin treatment)

Question 8

Most likely diagnosis of:
Rust coloured sputum
Peri oral HSV
Abrupt onset

Answer 8

CAP –> streptococcus pneumoniae
Treat with amoxicillin and clarithromycin
Medical emergency

Question 9

Most likely diagnosis of
Young adult in closed population
Long prodrome
WCC normal
Extra pulmonary complications (rash, myocarditis, percarditis, haemolytic anaemia, myalgia, neurological abnormalities, abnormal LFTs, diarrhoea)

Answer 9

atypical CAP

Mycoplasma pneumoniae

Question 10

most likely diagnosis of:
lung abscesses/empyema
following untie
cavitation
IV drug user/ recently ill children

Answer 10

staph aureus
CAP&HAP
treat with fluclox (unless MRSA–> vancomycin)

Question 11

most likely diagnosis of:
preexisting lung disease
weak grumbly illness
small pleural effusions

Answer 11

H. influenza

Question 12

most likely diagnosis of 
underlying lung disease
jaundice
SIADH
institutional outbreak

Answer 12

legionella

atypical CAP

Question 13

most likely diagnosis of 
contact with birds
bilateral lung inlfammation
fever
myalgia
macular rash
splenomegaly
severe cough
dyspnoea
depression

Answer 13

Chlamydia psittacci

Question 14

most likely diagnosis of 
abattoir worker
multiple lesion on X-ray
dry cough
high fever
young men

Answer 14

CAP

coxiella burnetti

Question 15

most likely diagnosis of 
aspiration risk
haemoptysis
male
alcohol abuse
poor dental hygeine

Answer 15

HAP klebsiella spp

IV cefuroxime and metranidazole

Question 16

aspiration pneumonia in chronically ill pt with other comorbidities

Answer 16

E. coli

most common HAP

Question 17

pneumonia in pt with lung disease (COPD, CF, bronchiectasis)
gradual onset
Green sputum
cavitation and abscess formation

Answer 17

HAP
Pseudomonas aeruginos

3rd gen cephalosporin and metronidazole

Question 18

pneumonia in a patient with:
recent travel
miliary appearance
gradual onset
fever
chest pain
haemoptysis
weight loss

Answer 18

think TB

notifiable

Question 19

pneumonia in a pt with:
immune comprimise
dry cough
fever
breathlessness
minimal change on CXR

Answer 19

pneumocystis carnii

co-trimoxazole

Question 20

pneumonia in a pt with:
immunocomprimise
haemoptysis
cavitation
wt loss

Answer 20

fungal
aspergillosis fumigatus
poor prognosis

Question 21

which pneumoniae are hospital acquired

Answer 21

Klebsiella
Staph aureus
E Coli
Pseudomonas aeruginosa

Question 22

features of lobar pneumonia on CXR

Answer 22

infection confined to one lobe

can be identified by the silhouette sign (loss of borders)

Question 23

features of bronchial pneumonia on CXR

Answer 23

patches throughout lungs

Question 24

poor prognostic features in pneumonia

Answer 24

coexisting disease
albumin 20
multi-lobar involvement
hypoxia
positive blood culture

Question 25

complications following pneumonia

Answer 25

lung abscess
empyema
ARD
bronchiectasis
PE