Clinical: General Medicine

Question 1

What is the most common causative agent in Community Acquired Pneumonia (CAP)?

Answer 1

Streptococcus pneumonia

Question 2

Streptococcus pneumonia is the most common causative agent in Community Acquired Pneumonia (CAP)? List four other common causative agents.

Answer 2

1. Haemophilus influenza
2. Klebsiella pneumonia
3. Mycoplasma (Atypical)
4. Chlamydia

Question 3

What empirical antibiotics are used for low severity Community Acquired Pneumonia (CAP)>

Answer 3

Amoxicillin 1g TDS or 500mg Clarithromycin BD

Question 4

What empirical antibiotics are used for mod-high severity Community Acquired Pneumonia (CAP)?

Answer 4

Benzylpenicillin 1.2g IV QID
OR
Doxycycline 100mg PO BD / Clarithromycin 500mg PO BD

Question 5

What empirical antibiotics are used for high severity Community Acquired Antibiotics?

Answer 5

Ceftriaxone 2g IV daily
OR (in septic shock)
Ceftriaxone 1g IV BD

Question 6

What is the most common causative agent in uncomplicated Urinary Tract infection (UTI)?

Answer 6

E. Coli in 70-95% of cases.
Less common Staphylococcus saprophticus.

Question 7

What is the most common causative agent in complicated Urinary Tract infection (UTI)?

Answer 7

E. coli 20-50% of cases
Less common: Klebsiella, Proteus, Pseudomonas and Candidiasis.

Question 8

In uncomplicated UTI antibiotics are not always needed (paracetamol + NSAIDS). However when required what is the empirical antibiotics for uncomplicated UTI?

Answer 8

Women: Trimethoprim 300mg OP OD - 3 days OR
Nitrofurantoin 100mg OP QID.

Men: Trimethoprim 300mg OP OD - 7 days OR
Nitrofurantoin 100mg QID 7 days.

Question 9

What is the empirical antibiotic used in the treatment of Candidiasis?

Answer 9

Fluconazole.

Question 10

What is the most common causative agent in cellulitis?

Answer 10

Streptococcus pyogenes (group A)
*Non-purulent rapidly spreading cellulitis.

Question 11

List less common causes of cellulitis including:
1. Salt water exposure species
2. Fresh water exposure species
3. Deep / penetrating wound species.

Answer 11

1. Vibrio (salt water exposure).
2. Aeromonas (fresh water exposure).
3. Staph aureus (purulent cellulitis).

Question 12

What are the two red flag not to be missed features associated with cellulitis?

Answer 12

1. Systemic infection - bacteremia.
2. Necrotising fasciitis / myonecrosis.

Question 13

Empirical antibiotics for management of cellulitis plus only 1 systemic feature of infection.

Answer 13

Not always for Ab’s.

Question 14

Empirical antibiotics for the management of cellulitis plus < 1 of the following systemic features of infection:
Temperature >38
Heart rate >90bpm
Respiratory rate >20breaths / min
WCC >12

1. If Strep pyogenes is suspected (rapid + non-purulent)
2. If Staph aureus (purulent)

Answer 14

1. S. pyogenes
   Phenoxymethylpenicillin 500mg PO QID - 5 days
   OR
   Procainbenzylpenicillin 1.5g IM OD - 3 days
   WITH PENICILLIN ALLERGY
   Cefalexin 500mg PO QID - 5 days.
2. S. aureus
   Dicloxacillin 500mg PO QID - 5 days
   OR
   Flucloxacillin 500mg PO QID - 5 days.

MRSA risk:
Trimethoprim + sulfamethoxazole 160+800mg PO BD.
OR
Clindamycin 450mg PO TDS - 5 days

Question 15

Empirical antibiotics for cellulitis with systemic features includes:
1. If strep suspected (rapid + non-purulent).
2. If Staph suspected (purulent).
3. If Staph suspected with risk of MRSA species.

Answer 15

1. Benzylpenicillin 1.2g IV QID
2. Flucloxacillin 2g IV QID
3. Vanocmycin IV OR Clindamycin 600mg IV TDS.

*Cefazolin 2g IV OD - in penicillin allergy.

Question 16

What does Atrial Fibrilation look like on an ECG?

Answer 16

• Irregularly irregular rhythm
• Indiscernible P waves

Question 17

What is the typical HR in a person with Atrial Flutter?

Answer 17

Regular 150bpm

Question 18

How does Atrial Flutter present on an ECG?

Answer 18

• Saw tooth P waves
• Regular rhythm

Question 19

What are the four key aspects of the managment of Atrial Fibriliation (Atrial Flutter is similar).

Answer 19

1. Anticoagulation to prevent emolism from L atrium - DOAC (rivaroxiban, epixaban, apixaban / warfarin in mechanical valve AF).
2. Rate control (B.Blockers ‘olol’, Calcium channel blockers (verapamil), Digoxin. Aim <110bpm.
3. Rhythm control (Amiodarone > Cardioversion > Ablation).
4. Manage risk factors (OSA, HTN, Alcohol, Tobacco, Simpathomimetic drugs).

Question 20

What is the QRS form in ventricular tachycardia?

Answer 20

All ventricular tachycardia’s have a wide QRS complex.