Resp Infection

Question 1

In CF Organisms which may colonise Pts (4)

Answer 1

• Staphylococcus aureus
• Pseudomonas aeruginosa
• Burkholderia cepacia*
• Aspergillus

Question 2

Pancreatic & Liver sx of CF

Answer 2

1. pancreatic insufficiency- preventing digestive reaching the gut = fat isn’t absorbed, causing steatorrhea & vitamin A, D, E, and K, deficiencies
2. avitaminosis A= pancreatitis= insulin-dependent DM.
   biliary cirrhosis

Question 2

Genes effected in CF
Pathology of CF

Answer 2

AR Chrom 7 , ∆F508
resulting
CFTR mutation –> misfolded protiens –> Chloride channel dysfuntion in the mucus and sweat-producing cells= increased viscosity of secretions= Blockage

Question 2

bilateral absence of vas deferens & infertile occurs in what disease

Answer 2

CF

Question 2

Labs in CF (2)

Answer 2

1. HYPOkalemia
2. contraction ALKalosis in those with symptoms suggestive of hypovolemia.

Question 2

DX of CF

Answer 2

pilocarpine sweat test

Question 2

Respiratory sx in CF (4)

Answer 2

1. Bronchiectasis- obstructive pattern
   2.Pneumonias : Stap. A or MRSA; Pseudomonas aeruginosa
   3.Allergic bronchopulmonary aspergillosis, or ABPA (Hypersensitivity to Aspergillus fumigatus that can live in the sinus or lung cavity)
   4 Nasal polyps

Question 3

FEV1 in CF

Answer 3

decrease

Question 4

Rx CF (6)

Answer 4

1. Chest physio
2. Mucolytic
3. Bronchodilators
4. Anti-inflammatory
5. abx azithromycin
6. CFTR modulators- ivacaftor, tezacaftor
   and lumacaftor,

Question 5

Explain action of CFTR modulators ivacaftor, and lumacaftor

Answer 5

Lumacaftor-can correct the misfolded protein & bring it to the cell membrane,
Ivacaftor-which opens the chloride channels & improves the ion’s transport.

Question 6

Allergic Bronchopulmonary Aspergillosis (ABPA)
Labs
RAST
Ig

Answer 6

• eosinophilia
• flitting CXR changes
• positive radioallergosorbent (RAST) test to Aspergillus
• +ve IgG precipitins (not as positive as in aspergilloma)
• raised IgE

Question 7

Rx Allergic Bronchopulmonary Aspergillosis (ABPA)

Answer 7

• oral glucocorticoids
• itraconazole is sometimes introduced as a second-line agent

Question 8

Ix Aspergilloma

Answer 8

Investigations
1. Chest x-ray containing a rounded opacity. A crescent sign may be present
2. high titres Aspergillus precipitins

Question 9

Bronchiectasis on imaging & PFTS

Answer 9

tram-track and signet ring signs
Obstructive picture

Question 10

Pneumonia, particularly following influenza or Ass. w/
IV drug

Answer 10

Staphylococcus aureus

Question 11

Pneumonia ass w/ cold sores

Answer 11

Cold sores
Most common cause of CAP

Question 12

Pneumonia ass. w/ bronchiectasis exacerbations

Answer 12

Haemophilus influenzae

Question 13

Most common organisms isolated from patients with bronchiectasis:

Answer 13

Haemophilus influenzae (most common)
Pseudomonas aeruginosa
Klebsiella spp.
Streptococcus pneumoniae

Question 14

Pneumonia ass. w/ Aspiration, Alcoholic and Diabetics
Outcomes

Answer 14

Klebsiella pneumoniae
* commonly causes lung abscess formation and empyema & lung necrosis

Question 15

What are Atypicals of lung infection

Answer 15

1. Mycoplasma pneumoniae
   2.Legionella pneumophilia
   3.Chlamydia psittaci
   4.

Question 16

Chlamydia psittaci rx

Answer 16

doxycycline or erythromycin

Question 17

Pneumonia ass. w/ deranged LFT & HYPONa
RX

Answer 17

Legionella
erythromycin/clarithromycin

Question 18

Pneumonia ass w/
bullous myringitis
cold agglutins (IgM)
ITP
& RX

Answer 18

Mycoplasma pneumoniae
doxycycline or a macrolide

Question 19

Pneumocystis jiroveci/ Pneumocystis pneumonia rx & Prophylaxis

Answer 19

have few chest signs and develop exertional dyspnoea
trimethoprim/sulfamethoxazole is usually used for treatment and dapsone as a prophylaxis for HIV+ people with a CD4+ count under 200 cells per microliter

Question 20

common infective causes of COPD exacerbations

Answer 20

* Haemophilus influenzae (most common cause) * Streptococcus pneumoniae * Moraxella catarrhalis

Question 20

Ventilator-associated pneumonia,

Answer 20

Pseudomonas aeruginosa and Staph. aureus

Question 21

Pneumonia : Cavitation develop in (5)

Answer 21

1. S. aureus 2. Klebsiella 3. Legionella 4. Pseudomonas aeruginosa 5. Mycrobactum tuberculosis

Question 22

Primary tuberculosis vs secondary TB (reactivation )

Answer 22

Primary TB - Ghon focus is composed of tubercle-laden macrophages. The combination of a Ghon focus and hilar lymph nodes is known as a Ghon complex. Type 4 hypersensitivy

Question 23

Secondary TB is usually found where in the lung

Answer 23

upper lobes

Question 24

How does rifampin work

Answer 24

preventing transcription Not being able to generating mRNA, the bacteria will die.

Question 25

SE isoniazid (6) & what should it be prescribed with

Answer 25

1. Hepatotoxicity, 2. P- 450 inhibition, 3. drug-induced lupus, 4. anion gap metabolic acidosis, 5. seizures that are refractory to benzodiazepines. 6. **vitamin B6 deficiency**= peripheral neuropathy and sideroblastic anemia. Thus administered w/ **pyridoxine** which is B6 vitamin.

Question 26

SE of Pyrazinamide (2)

Answer 26

can cause 1. hyperuricemia and 2. hepatotoxicity.

Question 27

ethambutol SE

Answer 27

optic neuritis,

Question 28

Ix aspergillosis

Answer 28

Fungal infection Galactomannan Halo sign on HR CT BAL = fungal hyphea

Question 29

A cause of massive hemoptysis

Answer 29

Aspergilloma may require bronchial art embolism

Question 30

people where a tuberculin test may be falsely negative : *

Answer 30

miliary TB * sarcoidosis * HIV * lymphoma * very young age (e.g. < 6 months)

Question 31

causes of bilateral hilar lymphadenopathy

Answer 31

Sarcoidosis and tuberculosis. Other causes include: lymphoma/other malignancy pneumoconiosis e.g. berylliosis fungi e.g. histoplasmosis, coccidioidomycosis

Question 32

what is Kartagener's syndrome/ primary ciliary dyskinesia sx (4)

Answer 32

Features 1. dextrocardia or complete situs inversus 2. bronchiectasis 3. recurrent sinusitis 4. subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)