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Respiratory SCE > Infections > Flashcards

Infections Flashcards

1
Q

A 68-year-old patient presents with pneumonia. Her respiratory rate is 28, BP 105/74, HR 98. Urea is 5mmol. She is not confused.

What is her estimated mortality rate?

A 1%
B 3%
C 7%
D 9%
E 15%

A

D 9%

Higher CURB 65 scores are associated with worsening mortality. She has CURB 2 pneumonia. As a guide:

Score 0-1 <3%
Score 2: 9%
Score 3-5: 15-40%

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2
Q

A patient is admitted with suspected pneumonia and commenced on amoxicillin.

Which of the following organisms will not be covered by this antibiotic?

A Enterococcus faecalis
B Haemophilus influenzae
C Moraxella cararrhalis
D Streptococcus pneumoniae
E Streptococcus pyogenes

A

C Moraxella catarrhalis

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3
Q

A patient in hospital develops pneumonia. They have had a previous syetsmic reaction to penicillin.

Which of the following antibiotics is most appropriate?

A Ceftazidime
B Clarithromycin
C Co-amoxiclav
D Co-trimoxazole
E Vancomycin

A

D Co-trimoxazole

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4
Q

A patient in ICU develops a fever and increased sputum after 72 hours of being on a ventilator.

Which of the following organisms is most likely to be responsible?

A Moraxella catarrhalis
B Nocardia asteroides
C Pseudomonas aerguinosa
D Staphylococcal epidermidis
E Streptococcus pyogenes

A

C Pseudomonas aerguinosa

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5
Q

Which of the following organisms is not associated with cavitating pneumonia?

A Actinomyces israelii
B Coxiella burnetti
C Haemophilus inflenzae
D Klebsiella pneumoniae
E Legionella pneumophila

A

C Coxiella burnetti

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6
Q

What are the most common causes of pneumonia in COPD patients? TWO answers.

A Haemophilus influenzae
B Moraxella catarrhalis
C Mycoplasma pneumonia
D Staphylococcus aureus
E Streptococcus pneumoniae

A

A Haemophilus influenzae
B Moraxella catarrhalis

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7
Q

What is the most common cause of bacterial pneumonia in diabetics?

A Haemophilus influenzae
B Moraxella catarrhalis
C Mycoplasma pneumonia
D Staphylococcus aureus
E Streptococcus pneumoniae

A

E Strep pneumoniae

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8
Q

What is the most common cause of bacterial pneumonia in the elderly?

A Haemophilus influenzae
B Moraxella catarrhalis
C Mycoplasma pneumonia
D Staphylococcus aureus
E Streptococcus pneumoniae

A

E Strep pneumoniae

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9
Q

A 42-year-old presents with a week of flu-like symptoms. She now has low platelets, rash, new haemolytic anaemia with progressive ascending weakness and sensory loss

A Chlamydia psittaci
B Coxiella burnetti
C Haemophilus influenzae
D Legionella pneumophila
E Mycoplasma pneumonia

A

E Mycoplasma pneumoniae

Causing typical features inc. a GBS picture.

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10
Q

A 53 year old smoker presents with a three week history of persistent dry cough and fever. A chest x-ray reveals right patchy opacification. Blood test results are as follows:
Hb 113
Plt 105
Na 131
K 4.2

Which would be the next most appropriate investigation?

A Bronchoalveolar lavage
B Intergeron gamma release assay
C Serum PCR
D Sputum acid fast bacilli
E Sputum cytology

A

C Serum PCR

Signs and symptoms are consistent with infetion and bloods show anaemia, thrombocytopaenia and hyponatraemia which are all features of Mycoplasma infection.

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11
Q

A 25-year-old presents with flu-like illness and rash with non-pruritic, maculopapular rash with dark centre and pale rings that appear like target lesions.

What is the most likely organism?

A Chlamydia psittaci
B Coxiella burnetti
C Haemophilus influenzae
D Legionella pneumophila
E Mycoplasma pneumonia

A

E Mycoplasma pneumoniae

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12
Q

A 45-year-old businessman, previously fit and well returned from overseas with a cough. Blood show hyponatraemia and deranged LFTs.

What is the most likely organism causing his illness?

A Chlamydia psittaci
B Coxiella burnetti
C Haemophilus influenzae
D Legionella pneumophila
E Mycoplasma pneumonia

A

D Legionella pneumophila

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13
Q

A 70-year-old man returns from a cruise around Norway with severe respiratory symptoms. He has no underlying risk factors. He has new confusion and diarrhoea.

Blood show deranged LFTs, raised CK and low sodium.

What is the most likely causative organism?

A Chlamydia psittaci
B Coxiella burnetti
C Haemophilus influenzae
D Legionella pneumophila
E Mycoplasma pneumonia

A

D Legionella pneumophila

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14
Q

Investigations for Legionella

A

Sodium: low
LFTs: deranged
CK: raised

Specific: urinary antigen highly specific and sensitive

Culture must be sent if urinary antigen positive

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15
Q

A middle-aged man who keeps birds develops a few weeks of respiratory symptoms, headache and mild jaundice with upper abdominal pain.

What is the most likely organism responsible?

A Chlamydia psittaci
B Coxiella burnetti
C Haemophilus influenzae
D Legionella pneumophila
E Mycoplasma pneumonia

A

A Chlamydia psittaci

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16
Q

A 58-year-old presents with two weeks of cough, new rash and a headache. She lives on a farm and her husband keeps pigeons. She recently travelled to the Mediterranean.

Further investigations reveal:

Bili 28
ALT 65
ALP 159
Urea 9.0
Creat 140

What is the most likely causative organism?

A Chlamydia psittaci
B Coxiella burnetti
C Haemophilus influenzae
D Legionella pneumophila
E Mycoplasma pneumonia

A

A Chlamydia psittaci

17
Q

A 45-year-old presents with fever, cough and breathlessness after a business trip to Spain. His bloods show mildly deranged LFTs.

What is the most appropriate antibiotic?

A Amoxicillin
B Benzylpenicillin
C Ciprofloxacin
D Clarithromycin
E Doxycycline

A

C Ciprofloxacin

He likely has Legionella pneumonia and it is appropriate to treat him with a fluoroquinolone e.g. ciprofloxacin

18
Q

A 23-year-old presents with cough, fever, myalgia and a new maculopapular rash with prominent red rings around it.

What is the most appropriate antibiotic?

A Amoxicillin
B Benzylpenicillin
C Clarithromycin
D Doxycycline
E Levofloxacin

A

C Clarithromycin

She likely has Mycoplasma pneumonia with erythema multiforme and clarithromycin is the most appropriate treatment.

19
Q

Which of the following infections is notifiable to the HPA?

A Chlamydia pneumoniae
B Coxiella burnetti
C Haemophilus influenzae
D Legionella pneumophila
E Mycoplasma pneumonia

A

D Legionella pneumophila

20
Q

A 58-year-old farmer presents with dry cough and a fever of 39.1.

What is the most likely causative agent?

A Chlamydia pneumoniae
B Coxiella burnetti
C Haemophilus influenzae
D Legionella pneumophilia
E Mycoplasma pneumonia

A

B Coxiella burnetti (Q fever)

21
Q

A 58-year-old farmer presents with dry cough, headache and a fever of 39.1. On further direct questioning you find out he keeps sheep.

What is the most appropriate antibiotic?

A Amoxicillin
B Benzylpenicillin
C Clarithromycin
D Doxycycline
E Levofloxacin

A

D Doxycycline

This patient likely has Coxiella burnetti (Q fever) and doxycycline is the most appropriate treatment.

22
Q

A 45-year-old alcoholic patient presents with a productive cough and redcurrant jelly sputum. Bloods show low platelets and leucopenia.

What is the most likely causative agent?

A Chlamydia pneumonia
B Haemophilus influenza
C Klebsiella pneumoniae
D Legionella pneumophilia
E Mycoplasma pneumonia

A

C Klebsiella pneumoniae

23
Q

A young patient is hospitalised for severe pneumonia having previously been fit and well. CT shows extensive consolidation, with cavitation and necrosis.

Initial gram stain shows a Gram-positive coccus in sputum.

What antibiotics are appropriate?

A Amoxicillin
B Co-amoxiclav
C Doxycycline
D Flucloxacillin
E Linezolid and rifampicin

A

E Linezolid and rfampicin

History and investigations are suggestive of PVL Staph aureus. Treatment may be with either:

Clindamycin

OR

Linezolid and rifampicin

24
Q

A 24-year-old with AML presents 3 months post-BMT with dry cough and fever. CXR shows hazy bilateral infiltrates.

What is the most likely causative agent?

A Chlamydia pneumoniae
B Cytomegalovirus pneumonia
C Haemophilus influenzae
D Legionella pneumophilia
E Mycoplasma pneumonia

A

B Cytomegalovirus pneumonia

25
Q

A 28 year old is referred to oyur service with difficult to control asthma. They report fevers and worsening breathlessness over the last 6 -8 weeks. Chest x-ray shows flitting infiltrates and proximal bronchiectasis.

What is the next most useful investigation?

A Aspergillus specific IgE
B Bronchoalveolar lavage
C Interferon gamma release assay
D Sputum microscopy
E Total IgE

A

A Aspergillus specific IgE

This is ABPA. A specific IgE will be most helpful in confirming the diagnosis.

26
Q

A 40 year old patient with recently diagnosed HIV is referred to the medical take from the infectious diseases clinic due to breathlessness and weight loss.

Their viral load is 1.65 copies/million and CD4 count is 40. Their CT chest shows upper lobe fibrosis and cavitation.

What is the most likely pathogen?

A Histoplasma capsulatum
B Klebsiella pneumoniae
C Mycobacterium avium-intracellulare
D Staphylococcus aureus
E Streptococcus pneumoniae

A

Mycobacterium avium-intracellulare

27
Q

A 40 year old patient with recently diagnosed HIV is referred to the medical take from the infectious diseases clinic due to breathlessness and weight loss.

Their viral load is 1.81 copies/million and CD4 count is 30. Their initial CXR shows CXR shows ill-defined, perihilar nodules and pleural effusion. CT chest shows nodular opacities, interlobular septal thickening, and lymphadenopathy, as well as a small pleural effusion.

What is the most likely pathogen?

Case study:

HIV positive patient
CD4 30

CT goes on to show nodular opacities, interlobular septal thickening, and lymphadenopathy, as well as a small pleural effusion

What is the most likely organism?

A

HSV8 causing pulmonary Kaposi’s sarcoma

28
Q

A 45-year-old patient presents to his GP with pneumonia. His respiratory rate is 19, BP 105/74, HR 98. Urea is 4mmol. He is not confused.

What is his estimated mortality rate?

A 2%
B 4%
C 7%
D 9%
E 15%

A

A 2%

Higher CURB 65 scores are associated with worsening mortality. He has CURB 0 pneumonia and can safely be managed in the community. As a guide:

Score 0-1 <3%
Score 2: 9%
Score 3-5: 15-40%

29
Q

A 25 year old man presents to hospital with headache, cough, and chest pain for 4 days. He also describes joint pain and stiffness for 2 days before admission and has noticed a rash over his abdomen and legs.

His examination reveals occasional crackles at the right base. His oxygen saturations are 90 %on room air. Chest X-ray (CXR) shows bilateral patchy infiltrates. Blood tests show mild anaemia, hyponatraemia and thrombocytopenia.

What is the most likely pathogen?

A Chlamydia psittaci
B Klebsiella pneumoniae
C Leigonella pneumophila
D Mycoplasma pneumoniae
E Streptococcus pneumoniae

A

D Mycoplasma pneumoniae

30
Q

Which drug is used in the treatment of tuberculosis and may cause red tears / sweat / saliva?

A Isoniazid
B Rifampicin
C Ethambutol
D Rocephin
E Pyrazinamide

A

B Rifampicin

Rifampicin can cause red secretions (tears, sweat etc.). Isoniazid can cause fever, jaundice and nausea.
Pyrazinamide can cause hyperuricaemia (and gout), and hepatotoxicity. Ethambutol can cause optic
neuritis / eye symptoms such as colour-blindness.

31
Q

Peter is a 64 year old man. He has become unwell over the past couple of days, he feels very under the weather, tired, feverish and has a productive cough of green sputum. He ignored this for a couple of days as he often has a smokers cough. He has a 100 pack year history and has continued to smoke despite recent increased shortness of breath on exercise. He has seen his GP recently and he has referred him to hospital for further investigations. His wife became very concerned about him and has brought him to A&E.

What is the most appropriate first line investigation for this gentleman?

A Sputum culture
B Chest x-ray
C Spirometry
D Peak flow
E C-Reactive protein

A

B Chest x-ray

Respiratory SCE (8 decks)

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