resp

Question 1

What finding on spirometry suggest asthma?

Answer 1

reversible airflow limitation—an increase in forced expiratory volume in 1 second (FEV1) of at least 200 mL and 12% from baseline 10 to 15 minutes after giving a short-acting beta2 agonist (SABA) (200 to 400 micrograms inhaled salbutamol or equivalent). A larger increase in FEV1 (eg more than 400 mL) in response to a SABA is strongly supportive of asthma
expiratory airflow limitation—reduced FEV1 to forced vital capacity (FVC) ratio (FEV1/FVC ratio).

Question 2

Most common pathogen in CAP?

Answer 2

Stre. Pneumonia

Question 3

What features are present in Legionella pneumonia?

Answer 3

May present with non-resp Sx including confusion, diarrhoea and hyponatraemia

Question 4

Risks for legionella pneumonia

Answer 4

COPD, smoking, diabetes, end stage kidney disease, cancers, immune suppression

Question 5

Young man presents with cought for > 5 days and bilateral infiltrates on CXR. What pathogens are more coomon in young people with CAP?

Answer 5

Mycoplasma pneumoniae and Chlamydophila (Chlamydia) pneumoniae

Question 6

Chlamydophila (Chlamydia) psittaci is more commonly found in what hobbiest?

Answer 6

Bird keepers

Question 7

A slaughter house worker presents with fever, cough, diarrhoea. Likely pathogen?

Answer 7

Coxiella burnetii - Q fever

Question 8

What pathogens must you consider in tropical AU?

Answer 8

Burkholderia pseudomallei and Acinetobacter baumannii

Question 9

WHat red flags in pneumonia require admission?

Answer 9

tachypnoea (respiratory rate 22 breaths/minute or more)
heart rate higher than 100 beats/minute
hypotension (systolic blood pressure lower than 90 mmHg)
acute-onset confusion
oxygen saturation lower than 92% on room air (or lower than baseline in patients with comorbid lung disease)
multilobar involvement on chest X-ray
blood lactate concentration more than 2 mmol/L [NB3].

Question 10

Low severity CAP treatment?

Answer 10

Amox 1g Q8H

Rural/remote - 1.5g IM daily

5 days, 7 days if slow to respond, if no response after 48 hours reconsider Dx

Question 11

Young person, cough >5 days, bilat infiltrates on CXR.

What treatment will you start?

Answer 11

doxycycline 100 mg orally, 12-hourly;
OR if doxycycline is poorly tolerated

clarithromycin 500 mg orally, 12-hourly;

5 days, 7 days if slow to respond, if no response after 48 hours reconsider Dx

Question 12

Your CAP patient isn’t responding after 48 hours - what is the treatment recommendation?

Answer 12

amoxicillin 1 g orally, 8-hourly;

PLUS

doxycycline 100 mg orally BD, (replace with clarithromycin 500mg BD if not tolerated)

Question 13

CAP pt non-severe allergy to penicillin. Treatment?

Answer 13

cefuroxime 500 mg orally, 12-hourly;

PLUS

doxycycline 100 mg orally, 12-hourly;

Question 14

CAP pt SEVERE allergy to penicillin. Treatment?

Answer 14

moxifloxacin 400 mg orally, daily

Question 15

Moderate severity CAP treatment?

Answer 15

benzylpenicillin 1.2 g intravenously, 6-hourly (can be oral amox)

PLUS EITHER

doxycycline 100 mg orally, 12-hourly;

OR if doxycycline is poorly tolerated

clarithromycin 500 mg orally, 12-hourly;

Question 16

Moderate CAP with non-severe penicillin allergy treatment?

Answer 16

ceftriaxone 1 g intravenously, daily;
OR
cefotaxime 1 g intravenously, 8-hourly;

PLUS EITHER

doxycycline 100 mg orally, 12-hourly;

Question 17

Moderate CAP in tropical regions - treatment?

Answer 17

ceftriaxone 2 g intravenously, daily;
OR
cefotaxime 2 g intravenously, 8-hourly;

PLUS

gentamicin intravenously, as a single dose
PLUS
doxycycline 100 mg orally, 12-hourly;