Respiratory

Question 1

Radiological findings for pneumocystis jirovecci pneumonia

Answer 1

Bilateral hilar infiltrates

Question 2

Blood cultures protocol for endocarditis

Answer 2

• 3 blood cultures from peripheral sites
• At least 6 hours apart
• Before starting antibiotics

Question 3

First line empirical antibiotic therapy for native valve endocarditis

Answer 3

Amoxicillin + gentamicin

Question 4

First line antibiotic therapy for native valve staphylococcal endocarditis

Answer 4

Flucloxacillin (+ gentamicin)

Question 5

First line empirical antibiotic therapy for non-native valve endocarditis

Answer 5

Vancomycin + gentamicin + rifampicin

Question 6

First line antibiotic therapy for severe native valve staphylococcal endocarditis

Answer 6

Vancomycin + gentamicin

Question 7

First line antibiotic therapy for native valve streptococcal endocarditis

Answer 7

Benzylpenicillin / ceftriaxone +/- gentamicin

Question 8

Complications of infective endocarditis

Answer 8

MI

Valvular insufficiency

Discitis

Retinal artery occlusion/ Microvascular emboli

Question 9

Major (Duke criteria) for infective endocarditis

Answer 9

Positive blood cultures (for typical organisms)

Endocardial involvement
- New murmur
- Positive echo

Question 10

Minor (Duke) criteria for infective endocarditis:

FIVE PM

Answer 10

• Fever (>38)
• Immunologic phenomena (GN, olser’s nodes, roth spots)
• Vascular phenomena (janeway lesions, splinter haemorrhages)
• Echocardio minor
• Predisposition (IVDU, heart condition)
• MIcrobiology (atypical positive blood culture, serology positive)

Question 11

Retinal haemorrhages with a pale centre called _______ are associated with infective endocarditis

Answer 11

Roth spots

Question 12

The most common cause of infective endocarditis is…

Answer 12

S. aureus

Question 13

First line antibiotics for IVDU in infective endocarditis

Answer 13

Vancomycin

Gentamicin

RIfampicin

Question 14

First line antibiotic for CAP CURB score 1-2

Answer 14

Amoxicillin

Question 15

______ is the oral switch for tazocin for chest infections

Answer 15

Co-amoxiclav

Question 16

First line antibiotic for mycoplasma pneumonia

Answer 16

macrolide: Erythromycin

Question 17

Influenza infection predisposes to what type of bacterial pneumonia?

Answer 17

Staphylococcus aureus

Question 18

Gold standard investigation for TB

Answer 18

Sputum culture

Takes 1-3 weeks

Question 19

Primary TB features

Answer 19

Primary TB infection of the lungs

Ghon focus
- If accompanied with hilar lymphadenopathy = Ghon complex

Question 20

Pulmonary reactivation of TB typically occurs….

Answer 20

Apex of the lungs

Question 21

Common sites for secondary TB

Answer 21

Lungs (most common)

CNS (meningitis)

Vertebral bodies (Pott’s disease)

Cervical lymph nodes (scrofuloderma)

Renal

GI

Question 22

The ______ test is used to screen for latent TB

Answer 22

Mantoux

Question 23

Process of mantoux test

Answer 23

Injection of purified protein derivative intradermally
- Read results 2-3 days later

Question 24

Intepretation of mantoux test

Answer 24

<6mm
- Negative, unvaccinated

6-15mm
- Positive, previous TB infection or vaccinated

> 15mm
- Suggests TB infection

Question 25

Diagnosis of active TB

Answer 25

CXR
- Upper lobe cavitation (reactivated TB)
- Bilateral hilar lymphadenopathy

Sputum smear
- 3 specimens
- Zihel-Neelsen stain

Sputum culture

NAAT (24-48 hours)

Question 26

What investigations should be carried out before starting co-trimoxazole

Answer 26

G6P levels

For PCP diagnosis
- ABG, SpO2
- CXR/ High resolution CT
- BAL

Question 27

What are the causative agents for cavitating pneumonia?

Answer 27

TB

Aspergillous

Klebsiella

Question 28

Pneumonia caused by _______ is commonly associated with a recent influenza infection

Answer 28

S. aureus

Question 29

Alcoholics are more likely to get pneumonia caused by_______

Answer 29

Klebsiella

Question 30

Bacterial infective exacerbations of COPD are likely to be caused by _______

Answer 30

H. influenzae