Resp III Flashcards
Which atypical pneumonia is most likely to cause erythema multiforme?
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Legionella pneumonia
Chlamydia psittaci
Q fever pneumonia
Which atypical pneumonia is most likely to cause erythema multiforme?
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Legionella pneumonia
Chlamydia psittaci
Q fever pneumonia
Which atypical pneumonia is most likely to cause hyponatraemia?
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Legionella pneumonia
Chlamydia psittaci
Q fever pneumonia
Which atypical pneumonia is most likely to cause hyponatraemia?
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Legionella pneumonia - causes SIADH
Chlamydia psittaci
Q fever pneumonia
Which atypical pneumonia is most likely to caused by hanging out with a parrot?
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Legionella pneumonia
Chlamydia psittaci
Q fever pneumonia
Which atypical pneumonia is most likely to caused by hanging out with a parrot?
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Legionella pneumonia
Chlamydia psittaci
Q fever pneumonia
Which atypical pneumonia is most likely to caused by farm animals?
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Legionella pneumonia
Chlamydia psittaci
Q fever pneumonia
Which atypical pneumonia is most likely to caused by farm animals?
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Legionella pneumonia
Chlamydia psittaci
Q fever pneumonia
Which atypical pneumonia is can cause haemolytic anaemia if left untreated?
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Legionella pneumonia
Chlamydia psittaci
Q fever pneumonia
Which atypical pneumonia is can cause haemolytic anaemia if left untreated?
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Legionella pneumonia
Chlamydia psittaci
Q fever pneumonia
What CURB-65 scores would indicate:
Treatment at home [1]
Admission [1]
Intensive care [1]
Score 0/1: Consider treatment at home
Score ≥ 2: Consider hospital admission
Score ≥ 3: Consider intensive care
Which type of organisms are most likely to cause HAP? [1]
Which infective organisms are most likely to cause HAP? [4]
Gram negative organisms:
PEKA:
Pseudomonas aeruginosa,
Escherichia coli
Klebsiella pneumoniae
Acinetobacter species.
Which organisms are most likely to cause atypical pneumonias? [5]
TOM TIP: You can remember the 5 causes of atypical pneumonia with the mnemonic: “Legions of psittaci MCQs”:
Legions: Legionella pneumophila
Psittaci: Chlamydia psittaci
M – Mycoplasma pneumoniae
C – Chlamydophila pneumoniae
Qs – Q fever (coxiella burnetii)
Which drug do you use to tx Legionellas? [1]
With erythromycin/clarithromycin
Describe the clinical features of Mycoplasma pneumonia [3]
- prolonged and gradual onset
- Erythema multiforme RASH: effects 1/3rd of patients on trunks and limbs
- flu-like symptoms ( classically PRECEED a dry, persistent cough
- bilateral consolidation on x-ray
- cold autoimmune haemolytic anaemia
Describe ascultation findings of Mycoplasma pneumonia [1]
Coarse crackles will CHANGE to fine crackles at a late phase (3-5 days after initial onset).
If an atypical pathogen such as Mycoplasma pneumoniae is suspected, it is best to confirm the diagnosis using a [] ?
If an atypical pathogen such as Mycoplasma pneumoniae is suspected, it is best to confirm the diagnosis using a NAAT: e.g., polymerase chain reaction [PCR] on nose and throat swabs
Name and describe the rash exhibited by Mycoplasma pneumoniae [2]
erythema multiforme:
- Target lesions: pink rings and pale centres
State 4 clinical consequences of untreated Mycoplasma pneumonia [4]
Haemolytic anaemia
Erythema multiforme
Encephalitis
Peri / myocarditis
How do you treat Mycoplasma pneumonia? [2]
1st line:Erythromycin OR Clarithromycin
2nd line: Doxycycline or a macrolide (e.g. )
Because generally there is no diagnosis of the pathogen at the time of treatment, initiation of the treatment is usually empirical
BMJ BP
State and describe this complication of Mycoplasma pneuomia [2]
bullous myringitis: painful vesicles on the tympanic membrane
Which infective organsim causing atypical pneumonia is linked to exposure by bodily fluids of animals? [1]
Coxiella burnetii, or Q fever, is linked to exposure to the bodily fluids of animals. The typical exam patient is a farmer with a flu-like illness.
Atypical pneuomonia
[] is typically contracted from contact with infected birds. The typical exam patient is a parrot owner.
Chlamydia psittaci is typically contracted from contact with infected birds. The typical exam patient is a parrot owner.
What clinical presentation may indicate COVID caused pneuomonia? [1]
Silent hypoxia: Patients may not feel particularly short of breath despite having low oxygen saturations
Alongside CURB65, describe which test is sometimes used to determine Abx therapy in the primary care setting [3]
NICE also mention point-of-care CRP test. This is currently not widely available but they make the following recommendation with reference to the use of antibiotic therapy:
CRP < 20 mg/L - do NOT routinely offer antibiotic therapy
CRP 20 - 100 mg/L - consider a DELAYED antibiotic prescription
CRP > 100 mg/L - OFFER antibiotic therapy
Describe the treatment algorithm for mild / low severity CAP? [2]
First line: 5 day course
- Amoxicillin
- If if penicillin allergic: clarithromycin (macrolide) OR doxycycline (tetracycline)
Second line:
- No respond to amoxicillin monotherapy, consider adding, or switching to, a macrolide (e.g., clarithromycin).
Describe the treatment algorithm for confirmed CAP on chest x-ray: presenting in hospital | moderate-severity (CURB-65 = 2)?
7-10 day course is recommended
1st line:
- ORAL amoxicillin plus a macrolide: clarithomycin
- For patients who are allergic to penicillin in whom oral antibiotics are contraindicated: second-generation cephalosporin (e.g., cefuroxime) or a third-generation cephalosporin (e.g., cefotaxime or ceftriaxone)
PLUS
clarithromycin, or intravenous levofloxacin monotherapy
2nd line:
- Change to doxycycline or a fluoroquinolone: ciprofloxacin AND pneumococcal cover: levofloxacin or moxifloxacin
Describe the treatment algorithm for confirmed CAP on chest x-ray: presenting in hospital | high-severity (CURB-65 = 3-5)?
DOUBLE CHECK
1st line:
- A broad-spectrum beta-lactamase-resistant penicillin: amoxicillin/clavulanate plus a macrolide: clarithromycin
- If allergic to penicillin: second-generation cephalosporin (e.g., cefuroxime) or a third-generation cephalosporin (e.g., cefotaxime or ceftriaxone) PLUS a macrolide (e.g., clarithromycin)
2nd line:
- Doxycycline OR
- Cefalexin OR
- Trimethoprim
3rd Line:
- levofloxacin
BMJ BP
In patients with suspected or confirmed Staphylococcus aureus MRSA infection, what are the two treatments? [2]
IV Vancomycin
OR
IV teicoplanin
with or without
Rifampicin (orally or intravenously)
State the treatments for these atypical pneumonias [5]
A: Clarithromycin (orally or intravenously)
B: Fluoroquinolone (ciprofloxacin) (orally or intravenously)
C: Amoxicillin (orally) or
D: benzylpenicillin
(intravenously)
E: Doxycycline (orally)
In patients with suspected or confirmed Staphylococcus aureus non-MRSA infection, what are the two treatments? [2]
Flucloxacillin (intravenously)
with or without
Rifampicin (orally or intravenously)
What is the treatment algorithm for mild to moderate symptoms/signs and not at higher risk of resistance for HAP? [2]
How long for? [1]
5 day prescription
ORAL:
- amoxicillin/clavulanate (aka Co-amoxiclax)
- If allergic: Doxycycline
Cefalexin (use caution in penicillin allergy)
Trimethoprim/sulfamethoxazole
NICE
What is the treatment algorithm for severe symptoms/signs and not at higher risk of resistance for HAP? [2]
How long for? [1]
1st line:
- piperacillin/tazobactam OR
- ceftazidime OR
- cefuroxime OR
- meropenem
2nd line:
- levofloxacin
Label the progress expected post-pneumonia from 1 week - 6 months
1 week:
- Fever should have resolved
4 weeks:
- Chest pain and sputum production should have substantially reduced
6 weeks:
- Cough and breathlessness should have substantially reduced
3 months
- Most symptoms should have resolved but fatigue may still be present
6 months:
- Most people will feel back to normal.
All patients with moderate-severe pneumonia should have what investigations? [3]
(NICE & BTS)
All in patients:
- CXR
- FBC (WCC raised; CRP raised)
- U&E
- LFTS
- Oxygen sats
Moderate-Severe:
- Blood and sputum culture
- Pneumococcal urinary antigen
- Legionella urinary antigen + sputum
All patients with severe + outbreaks of pneumonia should have what investigations? [3]
(NICE & BTS)
All in patients:
- CXR
- FBC (WCC raised; CRP raised)
- U&E
- LFTS
- Oxygen sats
Moderate-Severe:
- Blood and sputum culture
- Pneumococcal urinary antigen
- Legionella urinary antigen + sputum
Severe+:
- Mycoplasma PCR
- Chlamydophilia PCR
- Viral PCR
Urine dipstick tests are only currently available for which two pathogens? [2]
Pneumococcal
Legionella
BUT - don’t give data on sensitivity
BTS guidelines:
What are the treatments for
S. aureus non-MRSA? [1]
S. aureus MRSA? [2]
S. aureus non-MRSA: flucloxacillin
S. aureus MRSA: vancomycin OR linezolid OR teicoplanin +/- rifampicin
A 69-year-old male is investigated by the respiratory team for worsening shortness of breath and cough over the past nine months. He has never smoked and is usually fit and well. The only significant history of note is that he has taken up pigeon racing since retiring. Following investigation, the patient is diagnosed with interstitial pneumonia.
Which of the following organisms is most commonly associated with interstitial pneumonia?
Haemophilus
Klebsiella
Streptococcus
Staphylococcus
Mycoplasma
Mycoplasma
TOM TIP: The typical MCQ exam patient for a presentation of sarcoidisis consistents of what presentation? [4]
20-40 y/o black women
Dry cough
SOB
Nodules on shin (erythema nodosum)
State what is meant by Lofgren’s syndrome [1]
How does Lofgren’s syndrome usually present? [4]
Lofgren’s syndrome is an acute form of the disease characterised by:
- bilateral hilar lymphadenopathy (BHL)
- erythema nodosum
- fever
- polyarthralgia.
It usually carries an excellent prognosis
Explain what is meant by Heerford’ts syndrome [1]
What is the classical presentation? [3]
Heerfordt’s syndrome (uveoparotid fever) there is parotid enlargement, fever and uveitis secondary to sarcoidosis
Describe the clinical features of sarcoidosis if each of the following are effected:
- Skin [3]
- Lungs [3]
- Systemically [3]
Skin:
- Erythema nodosum - raised, red, tender painful subcut nodules across both shins. Over time they appear as bruises
- Papular sarcoidosis: multiple papules develop, generally on the head and neck or areas of trauma.
- Lupus pernio: specific to sarcoidosis and presents with raised purple skin lesions, often on the cheeks and nose.
What is the name for this symptom of sarcoidosis
Papular sarcoidosis
Lupus pernio
Erythema nodosum
Lofgrens syndrome
What is the name for this symptom of sarcoidosis
Papular sarcoidosis
Lupus pernio
Erythema nodosum
Lofgrens syndrome
What is the name for this symptom of sarcoidosis
Papular sarcoidosis
Lupus pernio
Erythema nodosum
Lofgrens syndrome
What is the name for this symptom of sarcoidosis
Papular sarcoidosis
Lupus pernio
Erythema nodosum
Lofgrens syndrome
What is the name for this symptom of sarcoidosis
Papular sarcoidosis
Lupus pernio
Erythema nodosum
Lofgrens syndrome
What is the name for this symptom of sarcoidosis
Papular sarcoidosis
Lupus pernio
Erythema nodosum
Lofgrens syndrome
Describe the manifestation of sarcoidosis if the effects the following systems:
Pulmonary [3]
Liver [5]
Systemic [3]
Lungs:
* Mediastinal lymphadenopathy
* Pulmonary fibrosis
* Pulmonary nodules
Liver:
* Liver nodules
* Cirrhosis
* Pruritis
* Jaundice
* Cholestasis
Systemic Symptoms:
* Fever
* Fatigue
* Weight loss
Describe the manifestation of sarcoidosis if the effects the following systems:
CNS [3]
Eyes [3]
Heart [3]
Eyes:
* Uveitis
* Conjunctivitis
* Optic neuritis
Heart:
* Bundle branch block
* Heart block
* Myocardial muscle involvement
Central nervous system:
* Nodules
* Pituitary involvement (diabetes insipidus)
* Encephalopathy
State the 5 different CXR stages of sarcoidosis [5]
A chest x-ray may show the following changes:
- stage 0 = normal
- stage 1 = bilateral hilar lymphadenopathy (BHL)
- stage 2 = BHL + interstitial infiltrates (granulomas in the lungs)
- stage 3 = diffuse interstitial infiltrates only
- stage 4 = diffuse fibrosis
Which stage of sarcoidosis is depicted in this CXR?
Stage 0
Stage 1
Stage 2
Stage 3
Stage 4
- stage 0 = normal
- stage 1 = bilateral hilar lymphadenopathy (BHL)
- stage 2 = BHL + interstitial infiltrates
- stage 3 = diffuse interstitial infiltrates only
- stage 4 = diffuse fibrosis
Which stage of sarcoidosis is depicted in this CXR?
Stage 0
Stage 1
Stage 2
Stage 3
Stage 4
stage 1: bilateral hilar lymphadenopathy
Bilateral hilar lymphadenopathy. No lung infiltrations are shown. No fibrosis.
Which stage of sarcoidosis is depicted in this CXR?
Stage 0
Stage 1
Stage 2
Stage 3
Stage 4
Which stage of sarcoidosis is depicted in this CXR?
Stage 0
Stage 1
Stage 2
Stage 3
Stage 4
Which stage of sarcoidosis is depicted in this CXR?
Stage 0
Stage 1
Stage 2
Stage 3
Stage 4
Which stage of sarcoidosis is depicted in this CXR?
Stage 0
Stage 1
Stage 2
Stage 3
Stage 4
There is diffuse reticulonodular
pattern, the lung parenchyma is distorted by fibrosis, and
the right hilum is retracted due to right upper lobe fibrosis
Which stage of sarcoidosis is depicted in this CXR?
Stage 0
Stage 1
Stage 2
Stage 3
Stage 4
Which stage of sarcoidosis is depicted in this CXR?
Stage 0
Stage 1
Stage 2
Stage 3
Stage 4
Stage 2 sarcoidosis with bilateral hilar and right
paratracheal adenopathy and diffuse reticulonodular disease
pattern in the lungs. The appearance is of fine lines and tiny
nodules.
Which stage of sarcoidosis is depicted in this CXR?
Stage 0
Stage 1
Stage 2
Stage 3
Stage 4
Which stage of sarcoidosis is depicted in this CXR?
Stage 0
Stage 1
Stage 2
Stage 3
Stage 4
What is the name for this symptom of sarcoidosis
Papular sarcoidosis
Lupus pernio
Erythema nodosum
Lofgrens syndrome
What is the name for this symptom of sarcoidosis
Papular sarcoidosis
Lupus pernio
Erythema nodosum
Lofgrens syndrome
Describe the treatment plan for sarcoidosis for symptomatic patients / moderate & severe disease [4]
First line: Prednisolone:
- High-dose induction: typically 20 - 40mg each day for 4 - 6 weeks
- Dose tapering: the initial dose is gradually reduced (e.g. 5mg every two weeks)
- Maintenance dose: typically 5 - 10mg each day
Second-line agents: classical immunosuppressants
- Methotrexate (first line)
- Azathioprine
- Mycophenolate mofetil.
Third line / refractory disease: biologic therapies
- infliximab
- adalimumab
Lung transplantation
Severe sarcoidosis can lead to which two lung pathologies? [2]
What would indicate lung transplantation for sarcoidosis ptx? [2]
Advanced pulmonary fibrosis
Pulmonary hypertension
Describe the diagnosis pathway for sarcoidosis
What treatment might be given to for treating skin sarcoid? [1]
Hydroxychloroquine
Raised serum ACE is indicative of sarcoidosis. Name 4 other pathological states where you might see a raised serum ACE [4]
Raised serum ACE may also be moderate in human immunodeficiency virus (HIV), histoplasmosis, diabetes mellitus, hyperthyroidism, tuberculosis and leprosy.
a prolonged PR interval
