Pneumonia and Respiratory Tract infections

Question 1

Antibiotics for mild CAP

Answer 1

amoxicillin PO 7 days (doxycycline if allergic)

Question 2

Antibiotics for severe CAP

Answer 2

IV amoxicillin and clarithromycin 10 days (doxycycline PO if allergic)

Question 3

Antibiotics for severe HAP

Answer 3

IV amoxicillin, metronidazole and gentamycin then step down to co-amox - total = 7-10 days

Question 4

Antibiotics for non-severe HAP

Answer 4

amoxicillin and metronidazole 7 days

Question 5

Buzzword: Rusty coloured sputum

Answer 5

Pneumoococcal pneumoniae

Question 6

Buzzword: Red Jelly sputum

Answer 6

Klebsiella pneumoniae

Question 7

Buzzword: mucoid sputum

Answer 7

chlamydia psittaci

Question 8

Patient: Been abroad and now has GI symptoms

Answer 8

Legionella

Question 9

On CXR - R heart border is obscured but diaphragm border visible

Answer 9

R middle lobe pneumonia

Question 10

On CXR - L heart border obscured

Answer 10

Lingular pneumonia

Question 11

Displaced L oblique fissure, sail sign, translucency in upper L zone

Answer 11

Left lower lobe collapse

Question 12

Displaced R horizontal fissure upwards, R hemidiaphragm raised, Golden S sign or smooth arc

Answer 12

R upper lobe collapse

Question 13

Veil-like opacity of left lung on CXR, oblique fissure pulled anteriorly

Answer 13

L upper lobe collapse

Question 14

R heart border obscured and R hemidiaphragm raised, mediastinal shift to the R

Answer 14

right middle lobe collapse

Question 15

Diffuse R lung opacification, mediastinal shift to the R, bronchial cut off sign

Answer 15

Right lung collapse

Question 16

URTIs =

Answer 16

coryza, pharyngitis, sinusitis, epiglottitis

Question 17

LRTIs =

Answer 17

acute bronchitis, acute exacerbation of chronic bronchitis, pneumonia, empyema, flu

Question 18

Coryza =

Answer 18

acute viral infection of nasal passages often w fever and sore throat
droplet/fomite spread

Question 19

Cause of coryza

Answer 19

adenovirus, rhinovirus, RSV

Question 20

coryza can lead to

Answer 20

sinusitis, acute bronchitis

Question 21

sinusitis =

Answer 21

preceeded by coryza
purulent nasal discharge, resolves in 10 days
most are viral, some bacterial

Question 22

complication of tonsilitis =

Answer 22

quinsy - abscess between tonsil and throat wall

Question 23

diphtheria causes a ____ to form

Answer 23

pseudomembrane across the back of the mouth

Question 24

epiglottitis is caused by ____

Comonest in ___

Answer 24

H. influenzae

Children - obstructs quickly - can be fatal

Question 25

acute bronchitis signs:

Answer 25

preceeded by coryza productive cough, transient wheeze, normal chest exam and CXR self-limiting

Question 26

Virus that causes glandular fever

Answer 26

EBV

Question 27

Management of acute exacerbation of COPD =

Answer 27

``` iSOAP ipratropium salbutamol Oxygen Amoxicillin - short course Prednisolone ```

Question 28

Investigations if suspected pneumonia

Answer 28

Blood culture, FBC, ABG, UandEs, LFTs, CXR, serology

Question 29

Score to measure severity of pneumonia

Answer 29

CURB65

Question 30

Causes of influenza

Answer 30

Primary = influenza A/B virus parainfluenza virus Secondary = H. influenzae

Question 31

Give antivirals in flue when

Answer 31

It is circulating, is an at risk group, early in disease or prophylactically eg. osletamivir, zanamivir

Question 32

Killed flu vaccine contains

Answer 32

2A and 1B virus give to at risk adults, health care workers and at risk kids 6m to 2yos

Question 33

Live attenuated flu vaccine is more effective for ___ yos

Answer 33

2-17yos

Question 34

Qfever organism

Answer 34

Coxiella burnetti from sheep

Question 35

Bronchiolitis occurs in ages ___

Answer 35

1-2yo

Question 36

Bronchiolitis signs:

Answer 36

fever, coryza, cough, wheeze, GRUNTING, STERNAL COSTAL INDRAWING

Question 37

Main cause of bronchiolitis =

Answer 37

RSV

Question 38

2nd commonest cause of bronchiolitis, most kids have Ig against it by 5yo

Answer 38

metapneumovirus

Question 39

Epiglottitis signs:

Answer 39

sore throat, drooling, pyrexia, severe cough/stridor acute onset

Question 40

treatment for epiglottitis

Answer 40

ceftriaxone

Question 41

Defences against URTI in nasopharynx

Answer 41

IgA, nasal hairs, cilia

Question 42

Defences against URTI in oropharynx

Answer 42

saliva, sloughing, cough reflex

Question 43

For epiglottitis how do you confirm the organism?

Answer 43

Blood culture | NOT SWAB -IRRITATES MORE

Question 44

Defences against URTI in conducting airways

Answer 44

mucociliary escalator, cough, AMPs, cellular and humoral immunity

Question 45

COPD exacerbation organisms

Answer 45

H. influenzae, Moraxella catarrhalis, gram -ves

Question 46

CF infection organisms

Answer 46

S. aureus, H. influenzae, Pseudomonas aeruginosa | Burkholderia cepacia - only seen in CF and HIV

Question 47

Pertussis = | Presents like ____

Answer 47

whooping cough - acute tracheobronchitis | Coryza-like, paroxysmal cough, violent expirations with inspiratory whoop, vomiting

Question 48

Organism that causes whooping cough

Answer 48

bordetella pertussis | pernasal swab and PCR/culture to confirm

Question 49

Defences against URTI in lungs

Answer 49

Surfactant, IgA, complement, FFA, AMPs, macro, neutro

Question 50

Most common cause of pneumonia

Answer 50

bacteria | Pneumococcus Pneumoniae

Question 51

legionella pneumonia infection characteristics

Answer 51

contaminated water confusion, sever pneumonia, acute renal failure, GI symptoms deranged LFTs

Question 52

Fungal cause of pneumonia in AIDS

Answer 52

PCP - pneumocystis pneumonia | fever and dry cough

Question 53

Treatment of PCP pneumonia

Answer 53

co-trimoxazole

Question 54

Immunocompromised get infected with this fungus

Answer 54

Aspergillus

Question 55

tb is caused by ___

Answer 55

mycobacterium tuberculosis

Question 56

Viruses that can cause pneumonia

Answer 56

influenza, parainfluenza, measles, varicella-zoster, RSV

Question 57

Bronchopneumonia occurs when ___ | Most commonly seen in ____

Answer 57

airway infection spreads to adjacent alveolar lung | elderly, young, CHD, cancer COPD, aspiration, viral causes

Question 58

Bronchiectasis caused by

Answer 58

fixed-scarring post infection | CF can get it

Question 59

Kartagener's Syndrome (primary) or Youngs (2ndry)

Answer 59

Primary ciliary dyskinesias

Question 60

Organisms that cause intrapulmonary abscess

Answer 60

strep., staph., E. coli, gram -ves, aspergillus

Question 61

Empyema sign on CXR:

Answer 61

D sign

Question 62

treat empyema by:

Answer 62

IV amoxicillin and metronidazole

Question 63

CXR sign of bronchiectasis

Answer 63

signet ring sign - bronchi larger than pulmonary artery

Question 64

Bronchiectasis exacerbation treatment

Answer 64

low dose macrolides - erythro-/clarithro-/azithromycin

Question 65

Chronic bronchial sepsis common in who? Signs on CXR Diagnosis

Answer 65

younger, women, work in childcare NO CXR signs +ve sputum

Question 66

Mycoplasma pneumonia affects ______ | Treat with ___

Answer 66

young and asthmatics | macrolides and fluoroquinolones

Question 67

H. influenza occurs in ____

Answer 67

childcare workers | COPD

Question 68

PWID RTIs organism

Answer 68

S aureus - septic emboli from DVT

Question 69

Treatment for PCP

Answer 69

High dose septrin