CSIM 1.32 Case 42 Launch - A Tale of Two Sisters

Question 1

What are the interpretations of the following bloods results:

1) High urea, normal creatinine
2) Neutrophil leucocytosis
3) Increased C-reactive protein

Answer 1

1) Dehydration
2) Acute bacterial infection
3) Active inflammation

Question 2

What is the treatment for pneumonia?

Answer 2

Combination of:
• IV cephalosporin
• Oral macrolide

Question 3

What is the mortality rate of community-acquired pneumonia?

Answer 3

5-10%

Question 4

What are the types of pneumonia?

Answer 4

• Lobar pneumonia
  
  • Bronchial pneumonia
  • Nosocomial pneumonia (Hospital-acquired)
  • Community-acquired pneumonia

Question 5

What is the difference between LRTIs and pneumonia?

Answer 5

Lower respiratory tract infection - an infection of the lower respiratory tract without radiological change.

Pneumonia - an infection of the lower respiratory tract with radiological change.

Question 6

What is the commonest causative agent of pneumonia in CAP and nosocomial pneumonia?

Answer 6

CAP:
• S. pneumoniae

Nosocomial pneumonia
• Gram negative pneumonia

Question 7

How is pneumonia severity scored?

Answer 7

CURB-65 score:
  •  Confusion?
  •  Blood urea nitrogen >7 mmol/L
  •  Resp rate >30/min
  •  BP sBP 65

Score given out of five

Question 8

What is ‘typical’ pneumonia? Describe the features of this kind of pneumonia.

Answer 8

Pneumonia resulting from Streptococcus pneumoniae, Haemophilus influenzae or S pyrogenes 
  •  Abrupt onset
  •  Classic X-ray
  •  Raised white cell count
  •  Pyrexia with rigors

Question 9

What are the features of “atypical” pneumonia?

Answer 9

• Cough with no sputum
  
  • Interstitial infiltrates
  • Myalgia
  • Pyrexia, no rigors

Question 10

Which ABX are used in CAP?

Answer 10

Mild
• Amoxicillin
• Erythromycin

Severe
• Co-amoxiclav

Question 11

Which ABX are used in HAP?

Answer 11

Mild
• Co-amoxiclav
• Ciprofloxacin

Severe
• Gentamicin
• Vancomicin

Question 12

What is co-amoxiclav?

Answer 12

Combination of
• Amoxicillin
• Clavulanate (β-lactamase inhibitor)

Question 13

Describe Type II respiratory failure

Answer 13

Low oxygen WITH high CO2 (as opposed to Type 1 = normal CO2)

Respiratory failure reliant on hypoxic drive (giving oxygen will kill the patient)
• Hypercapnia
• Hypoxia

Happens when there is reduced surface area (COPD) so there is less CO2 being blown off. This causes chronic acidaemia, resulting in the chemoreceptors getting ‘used’ to this pH

Question 14

How is Type II respiratory failure (acute exacerbation of COPD) treated?

Answer 14

• Non-invasive ventilation
  
  • Nebulised bronchodilators
  • Oral steroids
  • Oral amoxicillin

(also X-ray to check there is no pneumonia)

Question 15

What are the Haemophilus influenzae bacteria?

Answer 15

Gram negative bacteria

Can be encapsulated
• Types a to f (e.g. HiB)

Or can be unencapsulated

Question 16

When is the HiB vaccine given

Answer 16

As baby, 3 doses:
• 2 months of age
• 3 months of age
• 4 months of age

Question 17

Which type of haemophilus most frequently causes respiratory disease?

Answer 17

Nontypeable haemophilus (unencapsulated)