Infectious Diseases

Question 1

Clinically distinguish between CMV and EBV infections

Answer 1

EBV

• Less protracted fevers
• Cervical lymphadenopathy and exudative tonsillopharyngitis is common
• Splenomegaly is common

CMV

• Protracted fevers
• Less lymphadenopathy, splenomegaly
• Exudative tonsillopharyngitis is less common

Question 2

Risk factors for legionella disease

Answer 2

1. Chronic lung disease
2. Smoking
3. Diabetes
4. ESKD
5. Malignancy
6. Immune compromise including chronic steroid disease

Question 3

Why is amoxycillin monotherapy at 1g TDS preferred over augmentin for treatment of CAP?

Answer 3

1. Less selective for resistance
2. Fewer adverse effects
3. At dosage recommended for CAP (1g TDS), achieves significantly higher concentration of amoxycillin

Question 4

Treatment of high severity CAP

Answer 4

IV ceftriaxone or IV cefotaxime plus IV azithromycin

Alternative is benpen, gent and azithromycin

If immediate severe or delayed severe hypersensitivity to penicillin, use moxifloxacin 400mg IV OD

Add vancomycin at 25-30mg/kg loading dose if staph aureus CAP is suspected

Question 5

What is the main difference between aspiration pneumonitis and aspiration pneumonia?

Answer 5

Aspiration pneumonitis is an acute chemical injury to the lung parenchyma after aspiration of acidic stomach content. Symptom onset is rapid (usually within hours). Symptoms can range from mild to severe, but in most patients symptoms improve quickly within 1-2 days and antibiotic is not required.

In aspiration pneumonia, bacterial infection occurs following aspiration, and symptom onset is delayed.

Could start antibiotic therapy, but cease after 24-48 hours if symptoms are resolving quickly.