LRTIs

Question 1

Normal sats

Sats for COPD pt

Answer 1

> 94%

COPD: 88-92%

Question 2

What is the CURB65 score and what is it for

Answer 2

Confusion
Urea >7
RR >30
BP systolic <90, diastolic <60
Age >65

0-1 home tx
2 hospital admission
3-4 assess for ITU admission

Sepsis

Question 3

Tests to order for suspected CAP

Answer 3

Bloods- FBC, CRP, U&E, LFT
ABG
HIV
Sputum MCS
Blood culture
CXR
Lactate- indicator of underperfusion (>2= abnormal)
?Urine- pneumococcal and leigonaires disease is tested in the urine

Question 4

Key tx for CAP

Answer 4

Abx
fluids
oxygen

Question 5

Main causes of CAP

Answer 5

S. pneumoniae
H influenzae
Legionella
S aureus

Question 6

what can’t we grow on sputum culture

Answer 6

viruses
mycoplasma
chlamydia

Question 7

what can we grow in sputum culture

Answer 7

pneumococcus
staph A
coliforms
Haemophilus

Question 8

what can be detected in urine antigens tests

Answer 8

legionella

strep pneumonia

Question 9

what abx is pneumococcus susceptible to?

Answer 9

Penicillin
Erythromycin
Tetracycline
Cephalosporins

Question 10

RFs for hospital acquired pneumonia

Answer 10

Elderly, post-surgical patients, ventilated patients, those with neurological disease or decreased consciousness

Question 11

common pathogens causing hospital acquired pneumonia

Answer 11

Gram-Negatives: E.coli, Pseudomonas (esp if ventilated), Proteus, Klebsiella

strep pneumoniae

Question 12

abx for hospital acquired pneumonia

Answer 12

Need cover for gram-negatives, pneumococcus

Oral Co-amoxiclav
IV Penicillin & Gent
If ventilated, consider cover for Pseudomonas: eg Piperacillin-Tazobactam

Question 13

basic causes of exacerbation of COPD

Answer 13

bacterial infection
viral infection e.g. RSV, flu
non-infective e.g. allergens, cold

Question 14

problem investigating COPD exacerbations

Answer 14

Chronic sputum prod
Chronic colonisation with bacteria: Pneumococcus, Haemophilus influenzae and Moraxella catharralis

These may also be the cause

Question 15

tx for moraxella infection

Answer 15

co-amox

Question 16

mx of COPD exacerbation

Answer 16

Maintain oxygenation
Treat underlying cause
Infection – amoxicillin 500mg tds
Treat airways obstruction:
bronchodilators, corticosteroids
Hydration/nutrition

Question 17

what pathogen should always be considered when people return from holiday with chest infection?

Answer 17

legionella

Question 18

what do atypical pneumonia pathogens usually respond to

Answer 18

macrolides- clarithromycin