Resp Quiz

Question 1

What is the first line treatment for Mild Community Acquired Pneumonia?

Answer 1

Amoxycillin OR Clarythromycin (if Atypical)

Question 2

What is the first line treatment for Moderate Community Acquired Pneumonia?

Answer 2

Benzylpenicillin (IV) PLUS either doxycycline (oral) or clarythromycin (oral). If GNR identified - add Gentamycin OR replace benzylpenicillin with IV Ceftriaxone

Question 3

What is the first line treatment for Severe Community Acquired Pneumonia?

Answer 3

Ceftriaxone (IV) OR benzylpenicillin IV plus Azithromycin (IV). In tropical regions: Meropenem (IV) PLUS Azithromycin (IV)

Question 4

What is the first line treatment for Mild Hospital Acquired Pneumonia? (Low Risk of MDR)

Answer 4

Amoxycillin + Clavulanic Acid (Augmentin) OR Benzylpenicillin (IV) plus Gentamycin.

Question 5

What is the first line treatment for Moderate Hospital Acquired Pneumonia? (Low Risk of MDR)

Answer 5

Ceftriaxone (IV) OR benzylpenicillin IV plus Gentamycin (IV).

Question 6

What is the first line treatment for Severe Hospital Acquired Pneumonia? (High Risk of MDR)

Answer 6

Piperacillin + Tazobactam OR Ticaracillin + clavulanic acid

Question 7

What are the clinical features of Active TB infection?

Answer 7

1.) Productive Cough. 2.) Haemoptysis 3.) Systemic: weightloss - fevers - sweats - lethargy - pallor. 4.) Pleuritic pain - if pleural involvement.

Question 8

What is the pathogenic mechanism of haemoptysis in TB?

Answer 8

Erosion of capillaries by granuloma inflammation or cavity wall eruption.

Question 9

What would be seen on a chest X-ray of someone with TB?

Answer 9

Focal area of consolidation with or without cavitation / pleural effusion / hilar adenopathy. Node of Ghon

Question 10

What are some extrathoracic features of active TB infection?

Answer 10

Lymph node TB - can become necrotic and liquefy. Miliary TB - spreads to liver / spleen / bones - (vascular organs)

Question 11

What are the pathogenic steps in primary pulmonary TB?

Answer 11

1.)Mycobacteria deposit in lung apices and bind macrophage mannose receptor via mannose on bacterial cell surface. 2.) Endosomal manipulation by maturation arrest / inhibiting phagolysosome formation. 3.) TH1 cell response - activates macrophages to form epitheloid granuloma which forms the Focus of Ghon. This is often the only remaining feature of primary TB infection.

Question 12

What are Six features of dormant/previous TB infection.

Answer 12

1.) Dormant organisms (few). 2.) Acid Fast Bacilli not detectable. 3.) Diagnosed by immune response (Mantoux). 4.) No symptoms. 5.) Never infectious. 6.) ‘Cured’ by preventative treatment.

Question 13

What are Six features of active TB disease.

Answer 13

1.) Actively dividing organisms (makes them susceptible to Abx!!!). 2.) AFBs usually grown and detectable. 3.) Diagnosed by detecting M.Tb in sputum. 4.) Symptoms present. 5.) Can be infectious. 6.) Can be cured with full treatment.

Question 14

What are five methods of TB detection?

Answer 14

1.) Acid Fast Bacilli stain. 2.) Culture. 3.) PCR (But dont get Abx Sens.). 4.) Mantoux test. 5.) Quantiferon test.

Question 15

What is the BCG TB vaccination? What is it good for?

Answer 15

Live attenuated vaccine derived from M.bovis. Good for “At-Risk” populations. It is administered to children to prevent miliary TB and TB meningitis.

Question 16

What is the DOT Scheme for TB? What are the FIVE elements?

Answer 16

Directly Observed Therapy Scheme: 1.) Sustained political funding. 2.) Quality assured case detection. 3.) Standardized and supervised treatment. 4.) Effective (Free) drug supply and managment system. 5.) Monitoring and Evaluation of Efficacy.

Question 17

What are the 4 pharmacological components of TB treatment?

Answer 17

1.) Isoniazid (Bacteriostatic) 2.) Rifampicin (specific for prokaryocytes). 3.) Ethambutol (Bacteriostatic for mycobacteria only). 4.) Pyrazinamide (Mechanism Unknown)

Question 18

What is the link between Isoniazid and Vit. B6 deficiency?

Answer 18

Isoniazid binds pyridoxal 5-phos. (active form of pyridoxine/Vit. B6). So it can deplete Vit. B6. This is important because Pyridoxal 5-Phos is a co-factor in the GABA pathway. So reduced GABA will increase cerebral excitability and can lead to seizures.

Question 19

What is the mechanism of action of Isoniazid?

Answer 19

A prodrug - activated by bacterial enzymes. It inhibits mycolic acid synthesis. It can penetrate caseous TB lesions. Unwanted Effects: Skin allergies/Rash and Fever and hepatotoxicity. Reduces metabolism of antiepileptic drugs (eg. Phenytoin). Can cause Pyroxidine (Vitamin B6) deficiency.

Question 20

What is the mechanism of action of Rifampicin?

Answer 20

Binds and inhibits DNA-dependent RNA pol. In prokaryocytic cells (so its very specific). Kills intracelluar organisms. SIDE EFFECTS: Widely distributed and turns tissues and body fluids ORANGE. Induces hepatic enzymes - so degrades drugs like warfarin/steroids/estrogen (NO PILL!!). Resistance can develop rapidly.

Question 21

What is the mechanism of action of Ethambutol?

Answer 21

Inhibits growth of mycobacteria (only). UNWANTED EFFECTS: Optic neuritis, esp with renal failure. Red/Green colour blindness.

Question 22

What is the mechanism of action of Pyrazinamide?

Answer 22

Mechanism unknown! Inactive at neutral pH - activated when it enters phagolysozyme (acidic). UNWANTED EFFECTS: Gout / GI upsets / rapid development of resistance

Question 23

What is the U-shaped curve of concern?

Answer 23

Incidence of TB decreased rapidly until the 80s and we thought it would be erradicated so funding and interest deteriorated. Now incidence has increased to the point where erradication may never be possible.

Question 24

Why does Australia have a very high burden of TB despite having one of the lowest rates worldwide?

Answer 24

We have an increasing number of overseas migrants that are testing positive to TB ande were originally mis-diagnosed. Our close neighbours (East Timor and SE Asia) also have a high incidence.

Question 25

What are the 2 key features of TB control?

Answer 25

Early detection/Diagnosis. Effective treatment.

Question 26

What is COPD?

Answer 26

Chronic Obstructive Pulmonary Disease. An airflow limitation that is NOT fully reversible. Due to partial or complete obstruction at any level of the trachea/bronchial tree. COPD encompasses both Emphysema and Chronic bronchitis. (Also Asthma and Bronchiectasis - According to Havlat…)

Question 27

What are THREE causes of airway limitation in COPD?

Answer 27

1.) Loss of Alveolar attachements (Emphysema). 2.) Inflammatory obstruction of airways (Oedematous). 3.) Luminal obstruction due to mucus plug.

Question 28

What are some epidemiological features of COPD?

Answer 28

4th major cause of mortality in Australia. More common in people over 65. It is Underrecognised / Underdiagnosed / Unertreated.

Question 29

What sample/test do you request for TB?

Answer 29

3x Early morning sputum for Acid Fast Bacilli / ZN stain.

Question 29

What are SIX risk factors for COPD?

Answer 29

1.) Smoking. 2.) Age (>65). 3.) Genetics (anti-alpha-1-antitrypsin deficiency - emphysema). 4.) Occupation (dusts / fumes / chemicals).