Infections Flashcards
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%
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%
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
C Moraxella catarrhalis
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
D Co-trimoxazole
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
C Pseudomonas aerguinosa
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
C Coxiella burnetti
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 Haemophilus influenzae
B Moraxella catarrhalis
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
E Strep pneumoniae
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
E Strep pneumoniae
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
E Mycoplasma pneumoniae
Causing typical features inc. a GBS picture.
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
C Serum PCR
Signs and symptoms are consistent with infetion and bloods show anaemia, thrombocytopaenia and hyponatraemia which are all features of Mycoplasma infection.
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
E Mycoplasma pneumoniae
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
D Legionella pneumophila
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
D Legionella pneumophila
Investigations for Legionella
Sodium: low
LFTs: deranged
CK: raised
Specific: urinary antigen highly specific and sensitive
Culture must be sent if urinary antigen positive
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 Chlamydia psittaci
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 Chlamydia psittaci
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
C Ciprofloxacin
He likely has Legionella pneumonia and it is appropriate to treat him with a fluoroquinolone e.g. ciprofloxacin
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
C Clarithromycin
She likely has Mycoplasma pneumonia with erythema multiforme and clarithromycin is the most appropriate treatment.
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
D Legionella pneumophila
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
B Coxiella burnetti (Q fever)
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
D Doxycycline
This patient likely has Coxiella burnetti (Q fever) and doxycycline is the most appropriate treatment.
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
C Klebsiella pneumoniae
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
E Linezolid and rfampicin
History and investigations are suggestive of PVL Staph aureus. Treatment may be with either:
Clindamycin
OR
Linezolid and rifampicin
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
B Cytomegalovirus pneumonia
