Lower Respiratory Tract Infections

Question 1

Symptoms of Pneumonia (7)

Answer 1

Malaise
Myalgia
Fever
Chest pain (pleuritic)
Purulent sputum
Maybe be rusty sputum (haemoptysis)
Dyspnoea

Question 2

Signs of Pneumonia (7)

Answer 2

Pyrexia
Tachypnoea
Central cyanosis
Dullness on percussion of affected lobe
Bronchial breath sounds
Inspiratory crepitations
Increased vocal resonance

Question 3

Investigations for Pneumonia (7)

Answer 3

Serum biochemistry, CRP (produced by liver in response to inflammation) and FBC
CXR
Blood cultures
Throat swab (atypical pathogens)
Urinary legionella antigen
Sputum microscopy and culture
HIV test

Question 4

Microbiology of Pneumonia (9)

Answer 4

Strep. Pneumoniae- CAP
H. influenzae
Legionella
S. Aureus- HAP (MRSA)
Moraxella Catarrhalis
Mycoplasma pneumoniae
Chlamydophyla pneumoniae 
Chlamydophyla psittaci
Coxiella burnetii

Question 5

Pneumonia Severity Scoring

Answer 5

CURB 65

Question 6

C (CURB)

Answer 6

Confusion

Question 7

U (CURB)

Answer 7

Blood urea >7

Question 8

R (CURB)

Answer 8

Respiratory rate >30

Question 9

B (CURB)

Answer 9

diastolic blood pressure <60

Question 10

65 (CURB)

Answer 10

age>65

Question 11

A score of 0 (CURB)

Answer 11

low risk and could be treated in the community

Question 12

A score or 1-2 (CURB)

Answer 12

hospital treatment usually required

Question 13

A score of 3-5 (CURB)

Answer 13

High risk of death and need for ITU

Question 14

Treatment for (CURB) 0-1

Answer 14

Amoxycillin or Clarithromycin/doxycycline

Question 15

Treatment for (CURB) 2

Answer 15

Amoxycillin and Clarithromycin or levofloxacin

Question 16

Treatment for (CURB) 3-5

Answer 16

Co-amoxiclav and Clarithromycin or Levofloxacin (if penicillin allergic)

Question 17

Treatment for aspiration pneumonia and why

Answer 17

Anaerobes likely

Metronidazole and amoxycillin

Question 18

Haematological malignancy/neutropenia treatment

Answer 18

Broad spectrum antibiotics, consider anti-fungals if immunosuppressed

Question 19

Legionnaires disease treatment

Answer 19

Consider involvement with public health to check water systems

Question 20

MRSA pneumonia treatment

Answer 20

Vancomycin or linezolid

Question 21

What type of pneumonia would be seen in HIV (immunosuppressed)

Answer 21

Pneumocystis jiroveci pneumonia

Question 22

General treatment for pneumonia (4)

Answer 22

Oxygen- hypoxic
IV fluids- AKI/ dehydration
Continuous positive airway pressure- for type 1 respiratory failure
Intubation and ventilation

Question 23

Complications of pneumonia (6)

Answer 23

Septicaemia
AKI- dehydration
Empyema
Lung abscess
Metastatic infection
Acute Respiratory Distress Disorder

Question 24

Differential diagnosis for pneumonia (5)

Answer 24

TB
Lung cancer
Pulmonary embolism
Pulmonary Oedema
Pulmonary vasculitis (Wegner's granulomatosis)

Question 25

Cause of Empyema (3)

Answer 25

Streptococcus S. aureus Anaerobes

Question 26

Investigation of Empyema

Answer 26

High swinging fever CT thorax Pleural ultrasound Pleural aspiration (pH<7.2)

Question 27

Treatment of Empyema (2)

Answer 27

Chest drain and IV antibiotics | Intrapleural t-PA/DNase required to breakdown thick fluid if it wont drain

Question 28

Features of Lung Abscess (3)

Answer 28

Similar to empyema May or may not follow pneumonia S.aures, Pseudomonas may lead to cavitating pneumonia

Question 29

Symptoms of Lung Abscess (3)

Answer 29

Lethargy Weight loss High swinging fever

Question 30

Investigation for lung abscess (3)

Answer 30

CT thorax Sputum culture CXR

Question 31

Treatment of Lung abscess (2)

Answer 31

Prolonged antibiotics | Drainage via bronchial tree

Question 32

What is Bronchiectasis

Answer 32

Widening of bronchi which leads to accumulation of mucous

Question 33

Causes of Bronchiectasis (6)

Answer 33

``` Idiopathic Immotile Cilia Syndrome Cystic fibrosis Childhood infections (measles, whooping cough) Hypogammaglobulinemia Allergic bronchopulmonary aspergillosis ```

Question 34

Symptoms of Bronchiectasis (7)

Answer 34

``` Chronic cough Daily sputum Wheeze Dyspnoea Tiredness Fitting chest pains Haemoptysis ```

Question 35

Signs of Bronchiectasis (2)

Answer 35

Finger clubbing | Coarse inspiratory crepitations

Question 36

Investigations for Bronchiectasis (5)

Answer 36

``` High resonance CT of the thorax Sputum culture: S. aureus, P. aeruginosa, H. Influenzae Serum immunoglobulins Total IgE and aspergillus precipitins CF genotyping ```

Question 37

Treatment for Bronchiectasis

Answer 37

Chest physiotherapy to clear the sputum Appropriate antibiotics Inhaled beta 2 agonists and inhaled corticosteroids