Resp tract infections

Question 1

list some LRTI?

Answer 1

Bronchitis
Pneumonia
Empyema
Bronchiectasis
Lung abscess

Question 2

list some URTIs?

Answer 2

sinusitis

tonsillitis

Question 3

list some things can compromise normal respiratory defences?

Answer 3

Abnormal ciliary function - smoking
Abnormal mucus - cystic fibrosis

Dilated airways: bronchiectasis
Defects in host immunity - HIV

Poor swallow - weak muscles

Question 4

18 yr old woman
LLL pneumonia
Unwell
Raised WCC + CRP

most likely organism? and why?

Answer 4

strep pneumoniae

because is most common cause of CAP

Question 5

Characterise S. pneumoniae resp infection?

Answer 5

Acute onset
Severe pneumonia
Fever, rigors
Lobar consolidation*

Question 6

Pneumonia

Answer 6

inflammation of the lung alveoli

Question 7

how does pneumonia present?

Answer 7

Fever
Cough
Pleuritic chest pain
Shortness of breath

Question 8

list organisms most implicated In CAP - atypical and typical ?

Answer 8

§ TYPICAL (85%)
□ Streptococcus pneumoniae
□ Haemophilus influenzae

§ ATYPICAL (15%)
□ Legionella
□ Mycoplasma
□ Coxiella burnetii (Q fever)
® Exposure to farm animals
□ Chlamydia psittaci (Psittacosis)
Exposure to birds, splenomegaly, rash, haemolytic anaemi

Question 9

list come examination findings for pneumonia?

Answer 9

○ Pyrexia 
		○ Tachycardia 
		○ Tachypnoea 
		○ Cyanosis 
		○ Dullness to percussion
		○ Bronchial breathing 
		○ Crackles

Question 10

what is the score used to triage pneumonia patients?

Answer 10

• CURB-65
		○ Confusion 
		○ Urea > 7 mmol/L 
		○ RR > 30 
		○ BP < 90 systolic, < 60 diastolic 
		○ 65+ years 

	○ Interpretation
		§ 2 = consider admitting 
		§ 2-5 = manage as SEVERE pneumonia and consider ITU admission

Question 11

which are the most common pathogens causing respiratory infection in the very vey young?

Answer 11

0-1 mths- E.coli, GBS, Listeria

1-6mths- Chlamydia trachomatis, S aureus, RSV

Question 12

define Bronchitis

Answer 12

Inflammation of medium sized airways.

Question 13

who gets bronchitis?

Answer 13

smokers mainly

Question 14

symptoms of bronchitis?

xray will show what?

Answer 14

Cough, fever, increased sputum production, increased shortness of breath.

CXR: normal

Question 15

common organisms causing bronchitis?

Answer 15

S. pneumoniae
H. influenzae
M. catarrhalis

Question 16

treatment for bronchitis?

Answer 16

○ Bronchodilation
○ Physiotherapy
○ +- Antibiotics

Question 17

when is rusty sputum produced?

Answer 17

lobar pneumonia

Question 18

Classical Causes of Cavitation on CXR

Answer 18

○ Staphylococcus aureus
○ Klebsiella pneumoniae
○ TB

can be h.influenzae if older

Question 19

Consider H. influenzae as an important cause of community acquired pneumonia in which group?

Answer 19

specially in the elderly and adults WITH COPD

so pre-existing lung disease

Question 20

a patient presents with pneumonia type symptoms and is

Hyponatraemic !
Confusion !
Diarrhoea !
Abdominal pain !

CXR - Bilateral interstitial change

What is the likely organism?

Answer 20

Legionella

don’t be a clown know this one!

Question 21

how to culture legionella?

Answer 21

buffered charcoal yeast extract

-> urinary antigen too - not culture though

Question 22

legionella Can cause multi-organ failure. how can this be linked to low sodium?

Answer 22

hypervolaemic hyponatraemia - which is the organ failures

Question 23

Atypical pneumonia’s are caused by which organisms?

Answer 23

Mycoplasma
Legionella
Chlamydia
Coxiella

don’t have cell walls

Question 24

which abc can you NOT use for atypical pneumonia’s?

which can you use?

Answer 24

Cell-wall active antibiotics e.g. penicillins don’t work

can use:
Macrolides (clarithromycin / erythromycin)
Tetracyclines (doxycycline)

Question 25

which pneumonia's have Extrapulmonary features for example low sodium?

Answer 25

atypical ones

Question 26

which pneumonia's have a Flu-like prodrome before fever & pneumonia

Answer 26

atypical ones

Question 27

Legionella pneumophilia is spread by?

Answer 27

aerosol's

Question 28

which pneumonia presents with Lymphopenia?

Answer 28

Legionella pneumophilia

Question 29

Rx for Legionella pneumophila

Answer 29

Macrolides (clarithromycin / erythromycin)

Question 30

Chlamydia psittaci route of transmission?

Answer 30

birds - inhalation - macrolides

Question 31

coxiella burnetti route of transmission?

Answer 31

aerosol/milk - macrolides

Question 32

what is an empyema? risk factors?

Answer 32

Empyema is defined as a collection of pus in the pleural cavity, gram-positive, or culture from the pleural fluid. Empyema is usually associated with pneumonia but may also develop after thoracic surgery or thoracic trauma.

Question 33

reasons for Failure to improve on treatment?

Answer 33

``` Empyema / abscess - needs drainage Resistant organism (incl. Tb) Proximal obstruction (tumour) ``` Not receiving / absorbing Abx Immunosuppression

Question 34

the following are classic for what; Fevers Weight loss ! Haemoptysis CXR: Classically upper lobe cavitation

Answer 34

TB

Question 35

infections can be classified as HAI after what time period?

Answer 35

> 48 hours in hospital.

Question 36

what can help to differentiate upper respiratory from lower respiratory flora?

Answer 36

bronchial lavage

Question 37

most common cause of nosocomial pneumonia?

Answer 37

enterobacteriacae: Gram-negative bacteria of a large family that includes Escherichia coli, Klebsiella, Salmonella, Shigella

Question 38

Dry cough, weight loss, | bat’s wing” – bilateral ground glass on CXR is caused by which organism?

Answer 38

Pneumocystis jirovecii

Question 39

young man Chemotherapy for leukaemia Neutropenic Interstial change on CT caused by which organism? rx?

Answer 39

Aspergillus fumigatus - invasive aspergillosis Rx - Amphotericin B

Question 40

3 presentations of Aspergillus fumigatus?

Answer 40

Allergic bronchopulmonary aspergillosis -Chronic wheeze, eosinophilia Aspergilloma - Fungal ball often in pre-existing cavity , haemoptysis Invasive aspergillosis - Immunocompromised

Question 41

in immunosuppression, neutropenia puts you at risk of which infections?

Answer 41

fungi e.g. Aspergillus spp

Question 42

in immunosuppression, HIV puts you at risk of which infections?

Answer 42

PCP*, TB, atypical mycobacteria *pneumocystitis jerovici

Question 43

in immunosuppression, Bone marrow transplant puts you at risk of which infections?

Answer 43

CMV

Question 44

in immunosuppression, Splenectomy: puts you at risk of which infections?

Answer 44

encapsulated organisms | e.g. S. pneumoniae, H. influenzae, malaria

Question 45

In LRTI what ivx to send before abx?

Answer 45

Sputum/induced sputum (i.e. with nebulisers) | Blood cultures

Question 46

urine antigen tests can be done for? but when to do them though?

Answer 46

S. pneumoniae Legionella pneumophila send for severe community-acquired pneumonia

Question 47

mild/moderate CAP rx?

Answer 47

Amoxicillin

Question 48

Moderate-severe CAP rx?

Answer 48

co-amoxiclav AND clarithromycin.

Question 49

Treatment for HAP; A. 1st line mild B. ITU

Answer 49

A. First line: Ciprofloxacin +/- vancomycin. B. Second line/ITU: Piptazobactam AND vancomycin

Question 50

Treatment for MRSA HAP?

Answer 50

Vancomycin

Question 51

Treatment for Pseudomonas HAP?

Answer 51

Piptazobactam