L5- Fever and Cough

Question 1

4 main risk factors for respiratory tract infections?

Answer 1

young (<2) or old age (>65)
- mechanical impairment
- comorbid conditions
- hopital exposure
chronic lung disease
smoking
immune dysfunction

Question 2

streptococcus pneumoniae- clasification, where does it colonise and prevalence demographics

what other diseases can it cause?

Answer 2

alpha haemolytic (gram postive) streptococcus

• colonises the nasopharynx
• more common in children, and increases in winter

bacteraemia, septic arthritis and meningitis

Question 3

what are the 5 pneumococcal virulence factors?

Answer 3

pneumococcal surface protein A- binds to epithelial cells and prevents deposition

polysaccharide capsule prevents phagocytosiss and complement activation

choline binding protein binds to Ig receptor on epithelial cells - allows transport into cell

Question 4

what are the investigations for pneumonia?

Answer 4

CXR- if normal, no antibiotics requried

sputum culture
nasopharyngeal swabs

Question 5

what treatment should be given for pneumonia? why?

Answer 5

antibiotics- required

- reduces the duration of illness and risk of death

Question 6

uses of microlides

Answer 6

braod spectrum antibiotic

• active against most causes of pneumonia
• treatment of chlamydia

Question 7

3 examples of macrolides?

Answer 7

erythromycin
clarithromycin
azithromycin

Question 8

3 adverse effects of macrolide antimicrobials

Answer 8

GIT upset
sudden death
drug-drug interactions

Question 9

what does the treatment of pneumonia depend on?

Answer 9

based on the severity and the setting (community vs. hospital) of pneumonia

Question 10

treatment for mild pneumonia? (good enough to stay at home)

Answer 10

amoxycillin 500mg

Question 11

moderate pneumonia treatment?

Answer 11

amoxicillin 1g oral and roxithromycin 300mg daily

Question 12

treatment for very sick pneumonia patients

Answer 12

needs intensive care

amoxycillin 1.2gm IV, erythromycin 1 g IV

Question 13

what is cefuroxime (effects and advantages)

Answer 13

should be used for healthcare assocaited pneumonia

- useful against gram positive and negative (also B lactamase resistant)

Question 14

differnce in definition between pnemonia and brnchitis? differnce in treatment?

Answer 14

pneumonia - infection in alveolar spaces and bronchioles (requires treatment)

bronchitis - infection of the conducting airways (does not require treatment)

Question 15

what does the colour of sputum indicate? is this indicative of pneumonia?

Answer 15

indicates inflammatory cells and debris

- NOT pneumonia

Question 16

what are the main 5 possible signs of pneumonia in the elderly

Answer 16

increased RR

crackles

consolidation (dullness to percussion)

fever and chills

confusion and delirium

Question 17

CXR results for bronchitis?

Answer 17

usually normal- potenitlaly some bronchial wall thickening

Question 18

which 3 respiratory tract infections are entirely bacterial?

Answer 18

mastoiditis
epiglottitis- life threatening
pneumonia

Question 19

2 respiratory infections that are entirely viral?

Answer 19

tracheolaryngitis (croup)

bronchitis

Question 20

4 most common mcirobial agents that cause community acquired pneumonia?

Answer 20

strep. pneumonia
haemophillus influenzae
klebiella pneumonia
influenza and viruses

Question 21

when are the gram -ive gut bacteria cause pneumonia?

- microbial examples?

Answer 21

in the hospital setting

• e. coli
• k. pneumoniae