Lower respiratory tract infection

Question 1

Name 6 lower respiratory tract infections

Answer 1

acute bronchitis
exacerbation of COPD
Pneumonia 
empyema 
lung abscess 
bronchiectasis

Question 2

List some symptoms of pneumonia

Answer 2

malaise, fever, purulent sputum, pleuritic chest pain, cough, dyspnoea

Question 3

List some signs of pneumonia

Answer 3

pyrexia, tachpnoea, central cyanosis, dullness on percussion, bronchial breathing, increased resonance

Question 4

Name the investigations for pneumonia

Answer 4

serum biochemistry and full blood count
chest xray
blood cultures 
throat swab
sputum

Question 5

What mostly causes pneumonia?

Answer 5

streptococcus pneumoniae

Question 6

What is the second leading cause of pneumonia?

Answer 6

H.influenzae

Question 7

What does CURB65 stand for in the severity scoring of pneumonia?

Answer 7

confusion
urea>7
respiratory rate>30
blood pressure<60
over 65

Question 8

List the usual treatment plan for pneumonia

Answer 8

iv fluids
oxygen
antibiotics
CPAP

Question 9

List some possible complications of pneumonia

Answer 9

septicaemia, empyema, ARDS, kidney failure

Question 10

What are the 2 main thins that can follow pneumonia?

Answer 10

empyema and lung abscess

Question 11

Is there a cough with empyema?

Answer 11

No

Question 12

How is empyema diagnosed?

Answer 12

chest drain with pH<7.2

Question 13

What is bronchiectasis?

Answer 13

dilated and damaged bronchi

Question 14

What are some causes of bronchiectasis?

Answer 14

idiopathic
immotile cilia syndrome
CF

Question 15

Why would dysfunctional cilia cause bronchiectasis?

Answer 15

Cannot get rid of the mucus and therefore collects and causes inflammation

Question 16

What is the main sign of bronchiectasis?

Answer 16

finger clubbing

Question 17

What is an unusual specific investigation of bronchiectasis?

Answer 17

CF genotyping

Question 18

Name some treatment for bronchiectasis

Answer 18

chest physiotherapy
antibiotics
beta 2 agonist and inhaled corticosteroids

Question 19

Name some organisms likely to result in cavitating pneumonia

Answer 19

staph aureus, pseudomonas and anaerobes

Question 20

Name the 4 diagnostic techniques for microbiological diagnosis

Answer 20

sputum and blood
antigen detection
PCR
serology

Question 21

What does PCR amplify?

Answer 21

Nucleic acids

Question 22

What does serology measure?

Answer 22

antibodies

Question 23

What does IgM indicate?

Answer 23

current infection

Question 24

What does IgG indicate?

Answer 24

previous infection

positive for life

Question 25

What 2 things are you looking for with gram stain?

Answer 25

organisms and pus cells

Question 26

Why is gram stain of limited value?

Answer 26

only tell you if it is gram positive or negative and not the specific organism

Question 27

Name the 3 major respiratory pathogens cultured overnight *must know*

Answer 27

strep pneumonia H influenza Moraxella catarrhalis

Question 28

What is a usual upper respiratory organism?

Answer 28

viridans strep

Question 29

Why are URT organisms found in LRT not usually significant?

Answer 29

Due to nasopharyngeal contamination

Question 30

What stain is used for TB?

Answer 30

ZN

Question 31

What are you looking for In TB?

Answer 31

AAFB

Question 32

What is a main thing to consider in the history for TB?

Answer 32

travel history

Question 33

In TB what is there an extended culture for?

Answer 33

mycobacteria

Question 34

what is bronchio-alveolar lavage?

Answer 34

Lower airway sample collected at bronchoscopy

Question 35

What can you measure with BAL?

Answer 35

quantitatively colony formation

Question 36

What is BAL used to diagnose?

Answer 36

ventilator associated pneumonia

Question 37

What severity of diseases are blood cultures used for?

Answer 37

Severe

Question 38

What is bacteraemia

Answer 38

viable bacteria in the blood

Question 39

Name the 4 organisms not easy to culture

Answer 39

legionella pneumophilia mycoplasma pneumonia chlamydia psittaci coxiella burnetti

Question 40

Where does chlamydia psittaci come from?

Answer 40

birds

Question 41

What is the causative agent of Q fever?

Answer 41

coxiella burnetti

Question 42

What samples can viruses be detected in?

Answer 42

nasopharyngeal

Question 43

What is agglutination?

Answer 43

clumping

Question 44

What is latex agglutination?

Answer 44

latex particles and monoclonal antibodies

Question 45

What is the main feature of ELISA to indicate presence?

Answer 45

colour change due to enzyme

Question 46

Why are false positives common in PCR?

Answer 46

If there is contamination, especially early on, it will be amplified

Question 47

What is "real time" PCR?

Answer 47

Enables the product of reaction to be measured as the reaction progresses

Question 48

What is routinely screened for with PCR?

Answer 48

mycoplasma pneumoniae

Question 49

Name some respiratory viruses

Answer 49

influenza A/B adenovirus rhinovirus parainfluenza

Question 50

What is rising titre?

Answer 50

When total antibody is measured there must be a significant increase in levels during the course of illness

Question 51

What 2 organisms are antigen tested in urine?

Answer 51

legionella | pneumococcal