LUNG

Question 1

CAP scoring

Answer 1

CURB65
confusion
urea >7
RR >30
SBP <90 or DBP<60
age >65

Question 2

CAP of 0-2 (mild/mod)

Answer 2

amox 1g tds IV/PO (5 days)
if pen allergic doxy PO 200mg on day 1 then 100mg od or IV clarithromycin

Question 3

CAP of 3-5 (severe)

Answer 3

co-amox IV 1.2g tds + doxycycline PO 100mg bd
if pen allergic IV levofloxacin 500mg bd monotherapy

Question 4

CAP 3-5 and ICU/HDU

Answer 4

co-amox IV 1.2g tds + clarithromycin IV 500mg bd
if pen allergic IV levofloxacin 500mg bd monotherapy

Question 5

step down for CAP 3-5

Answer 5

doxy 100mg bd

Question 6

non-severe HAP

Answer 6

total PO/IV 5 days
PO amox + met
if pen allergic PO doxycycline 100mg bd + met

Question 7

severe HAP

Answer 7

total IV/po 7 days
IV amox + gentamicin
if pen allergic IV co-trimoxazole +gentamicin

Question 8

step down severe HAP

Answer 8

po co-trimoxazole

Question 9

acute exacerbation of COPD

Answer 9

abx if sputum purulence
no sputum purulence -> no abx unless consolidation on CXR or signs of pneumonia
1STLINE Amoxicillin 500mg tds
2ND LINE Doxycycline 200mg on day 1 then 100mg od (5days)

Question 10

acute cough/acute bronchitis

Answer 10

abx give no significant benefit in clinical improvement but may be considered in the frail elderly
1ST LINE Amoxicillin 500mg tds 2ND LINE Doxycycline 200mg on day 1 then 100mg od (5 days)