Pneumonia

Question 1

Common upper respiratory tract conditions

Answer 1

Coryza, pharyngitis, sinusitis, epiglottis

Question 2

Common lower respiratory tract conditions

Answer 2

Acute bronchitis, acute exacerbations of chronic bronchitis, pneumonia, influenza

Question 3

What is Coryza

Answer 3

Common cold, acute inflammation of mucous membranes lining nasal cavity. Causes a runny nose, nasal congestion, often sore throat with fever. Viral cause such as Adenovirus, Rhinovirus, Respiratory Syncytial virus

Question 4

What is acute sinusitis

Answer 4

Acute infection or inflammation of membranes that line your sinuses preventing mucus drainage from nose. Preceded by common cold. Resolves in 10 days on its own, rarely requires antibiotics

Question 5

What is Quinsy

Answer 5

Potentially serious complication of tonsillitis. Abscess forms between tonsils and wall of throat. This is due to bacterial spread from infected tonsil to surrounding area

Question 6

What is Diptheria

Answer 6

Infection caused by Corynebacterium diptheriae. Toxin are produced which may be life threatening. Symptoms are sore throat, fever, characteristic barking cough and pseudomembrane formation which may block airway

Question 7

What is acute epiglottitis

Answer 7

Inflammation of epiglottis and tissues around that may lead to blockage of airway and impairing breathing process

Question 8

What is also known as chest cold

Answer 8

Acute bronchitis - Inflammation of bronchi

Question 9

Chest examination and x-ray of acute bronchitis

Answer 9

Normal. Is usually self limiting and antibiotics aren’t indication. Can lead to morbidity in patients with COPD

Question 10

What is acopia

Answer 10

Inability to cope with activites of daily living

Question 11

When should COPD patients be referred to hospital

Answer 11

If there’s evidence of respiratory failure or not coping at home

Question 12

What is red hepatisation

Answer 12

Consolidation due to pneumonia causing resemblance to live tissue rather than lung

Question 13

What are rigors

Answer 13

Sudden feeling of cold with shivering accompanied by a rise in temperature often with sweating

Question 14

Signs of pneumoniae

Answer 14

Fever, rigors, herpes labialis, tachypnoea, crackles, pleural rub, cyanosis, hypotension

Question 15

Investigating pneumoniae

Answer 15

Blood culture, serology, arterial gases, full blood count, urea, liver function test, chest x-ray

Question 16

What can be used to assess pneumoniae severity

Answer 16

CURB65

Question 17

How does CURB 65 work

Answer 17

C - New onset of confusion
U - Urea > 7
R - Respiratory rate > 30 / min
B - Blooc pressure systolic < 90 or diastolic < 61
65 - More than 65 years of age
1 points fore each
Increase in CURB65 score increases mortality

Question 18

What factor in CURB 65 rarely makes difference to management

Answer 18

Urea

Question 19

Markers for pneumoniae severity other than CURB65

Answer 19

Temperature < 35 or > 40
Cyanosis, PaO2 < 8 kPa
WBC < 4 or > 30
Multi lobar involvement

Question 20

Most common cause of pneumoniae (community and hospital)

Answer 20

Streptococcus pneumoniae
2nd most common for community acquired pneumoniae is Haemophilus influenzae and for hospital acquired is Mycoplasma pneumoniae

Question 21

Adult smoker presents with pneumoniae and chicken pox in primary care setting. Next step?

Answer 21

Admit to hospital as varicella pneumoniae can be fatal

Question 22

Bird keepers are bound to get what type of pneumoniae

Answer 22

Psittacosis - Known as parrot fever or ornithosis. Caused by bacteria known as Chlamydia psittaci. Contracted from birds such as parrots, macaws, pigeons, sparrows, ducks, hens etc

Question 23

Management of community acquired pneumoniae

Answer 23

Antibiotics, oxygen, fluids, bed rest, no smoking

Question 24

Complications of Pneumoniae

Answer 24

Respiratory failure, pleural effusion, empyema and death

Question 25

Extra steps in hospital acquired pneumoniae

Answer 25

Extended gram negative cover

Question 26

Extra steps in aspiration pneumonia

Answer 26

Anaerobic cover

Question 27

How can pneumonia be prevented

Answer 27

Giving an influenza and pneumococcal vaccine to - | > 65, immunocompromised, diabetics, chronic chest or cardiac disease, health care workers

Question 28

Clinical presentation of influenza

Answer 28

``` Fever - High, abrupt onset Malaise Myalgia Headache Cough Prostration - Extremely unwel ```

Question 29

Haemophilus influenzae and influenza

Answer 29

Not the primary cause of influenza but was believed to be. May be a secondary invader. Common cause is influenza A and B virus

Question 30

How in influenza transmitted

Answer 30

Droplets or direct contact with secretions of someone with infections

Question 31

Complications of flu

Answer 31

Primary influenzal pneumonia, secondary bacterial pneumonia, bronchitis, otitis media

Question 32

Influenza during pregnancy

Answer 32

Associated with perinatal mortality, prematurity, smaller neonatal size, lower birth weight

Question 33

Therapy for flu

Answer 33

Symptomatic - bed rest, fluids, paracetamol, antivirals such as Oseltamivir and Zanamivir, mostly during pandemics.

Question 34

Endemic vs epidemic vs pandemic

Answer 34

Endemic - Disease permanently affecting a particular region Epidemic - Outbreak of disease affecting one or many communities at the same time Pandemic - Epidemic spreads throughout the world

Question 35

What influenza virus causes pandemics

Answer 35

Influenza A due to antigenic shift, segmented genome and animal reservoir/mixing vessel

Question 36

What is antigenic drift

Answer 36

Minor mutation in surface proteins of virus

Question 37

Diagnosing influenza

Answer 37

PCR - Nasopharyngeal swab, throat swab in virus transport medium, other respiratory samples Antibody detection - Requires blood and takes a while for antibodies to be formed

Question 38

Prevention of flu

Answer 38

Vaccination - Killed: 2 different influenza A viruses and 1 influenza B Live attenuated: More effective than killed vaccine, administered intra-nasally

Question 39

What vaccine is given annually to adults at risk of complications, health care workers, children aged 6 months to 2 years

Answer 39

Killed vaccine

Question 40

What vaccine is given to children aged 2 to 17

Answer 40

Live attenuated

Question 41

Are antivirals used a prophylaxis

Answer 41

Rarely

Question 42

What bacteria cause atypical pneumonia

Answer 42

Mycoplasma pneumoniae, Coxiella burnetti and Chlamydohila psittaci

Question 43

Lab confirmation of atypical pneumonia

Answer 43

Serology and PCR

Question 44

Highest incidence of Mycoplasma pneumonia is in

Answer 44

Children and young adults, common CAP

Question 45

What causes pyrexia of unknown origin

Answer 45

Coxiella burnetti - Q fever From domestic animals such as sheep and goats Can cause culture negative endocarditis

Question 46

Cause of walking pneumoniae

Answer 46

Pneumonia that can spread from one lung to another, Mycoplasma pneumoniae

Question 47

Cardiology condition caused by pneumonia

Answer 47

Culture-negative endocarditis due to Q fever by Coxiella burnetti

Question 48

What pneumonia can be acquired from pet birds

Answer 48

Psittacosis by Chlamydophilia psittaci

Question 49

Cases presents in Dec to Jan with asthma like symptoms

Answer 49

Might be bronchiolitis

Question 50

What suspects you to bronchiolitis

Answer 50

Previous resp or cardiac disease

Question 51

Common cause of bronchiolitis

Answer 51

Human Respiratory Syncytial Virus

Question 52

Why isn't passive immunisation given for Respiratory Syncytial Virus

Answer 52

Due to poor efficacy and cost-effectiveness

Question 53

Major cause of lower respiratory tract infection in infancy and childhood

Answer 53

Human Respiratory Syncytial Virus

Question 54

Second most common cause of LRTI in young children

Answer 54

Metapneumovirus

Question 55

How are viral samples for PCR collected

Answer 55

Throat swab in viral transport medium, bronchoalveolar lavage (BAL) in which bronchoscope is passed through the mouth or nose into lungs and fluid is squirted into small part of the lungs and then collected for examination.

Question 56

STI that can cause infantile pneumonia

Answer 56

Chlamydia trachomatis, diagnosed by PCR on urine of mother or throat/pernasal swab of child

Question 57

What organism that causes mild pneumoniae may be picked up on the test for psittacosis

Answer 57

Chlamydophila pneumoniae

Question 58

Virus most prevalent in Saudi Arabia with a resovoir in dromedary camels known to cause pneumonia

Answer 58

Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

Question 59

Patient presents with pneumonia, confusion and diarrhoea after travel to Spain

Answer 59

Legionella pneumoniae

Question 60

Treatment for Legionella pneumonia

Answer 60

Levofloxacin IV - 14 days

Question 61

What Legionella causes epidemics

Answer 61

Legionella longbeachii

Question 62

Pathogen has no cell wall, possible antibiotics?

Answer 62

Macrolides - Azithromycin, Clarithromycin, Erythromycin | Quinolones - Levofloxacin, Ciprofloxacin

Question 63

How does Mycoplasma pneumonia show symptoms

Answer 63

Young patient with predominant cough for weeks. No effect from penicillins such as Amoxicillin. Use PCR to detect

Question 64

Common pathogen in younger patients with bronchiectasis and pneumonia

Answer 64

Haemophilus influenzae. Must rule out cystic fibrosis if bronchiectasis under 40

Question 65

Causes of cavitating pneumonia

Answer 65

Mycobacterium tuberculosis, Klebsiella, Enterobacteria

Question 66

Excess consumptions of what can cause reoccurence of TB in the elderly

Answer 66

Alcohol

Question 67

The fastest laboratory method for identifying Legionella

Answer 67

PCR (1-2 days), serology takes 1-2 weeks and routine sputum culture takes 10 days

Question 68

What colour is haemoptysis in pnuemococcal pneumoniae

Answer 68

Rusty coloured

Question 69

What is bronchial breathing

Answer 69

Louder and higher pitched in nature. Unlike normal vesicular breath sounds, there is an audible gap between inspiration and expiration. They are abnormal if heard in the chest and suggest consolidation or fibrosis

Question 70

What to give if allergic to penicillin

Answer 70

Doxycycline

Question 71

What CURB65 score indicates severe pnemonia

Answer 71

Score of 3 or more. Admit patient into hospital

Question 72

Treatment of severe pneumonia

Answer 72

IV Co-amoxiclav + Clarithromycin

Question 73

Mild pneumonia treatment

Answer 73

Oral amoxicillin (gram-positive and anaerobes) + Clarithromycin (non-culturable organisms)

Question 74

Mild pneumonia without admission

Answer 74

Oral Amoxicillin only, alternatives are Levofloxacin/Moxifloxacin

Question 75

Water lily sign on chest x-ray

Answer 75

Hydatid infection - Small tapeworm parasite

Question 76

Main organism causing chest abscess vs empyema

Answer 76

Chest abscess - Staphylococcus spp. | Empyema - Streptococcus spp.

Question 77

21 year old medical student with symptoms of pneumonia

Answer 77

Mycoplasma pneumonia

Question 78

Alcoholic with pneumonia symptoms

Answer 78

Unusual organism such as Klebsiella