Respiratory

Question 1

What is seen on chest radiographs that confirms a diagnosis of pneumonia?

Answer 1

New shadowing
Absence of any other likely diagnoses that would explain the clinical picture

Question 2

What things should be taken into account when determining the severity of pneumonia?

Answer 2

CURB-65 score
Co-morbidities
How much of the lung is involved?
Is the patient hypoxic?
High CRP

Question 3

What does the CURB-65 score stand for?

Answer 3

Confusion
Urea >7
Resp rate >30
Blood pressure systolic <90 or diastolic <60
65 years +

Question 4

What is the most common cause of CAP?

Answer 4

Strep pneumoniae

Question 5

What is the first line drug for CAP?

Answer 5

Amoxicillin 1g TDS IV/oral depending on severity

Question 6

What is the first line drug for CAP in someone with a penicillin allergy?

Answer 6

Doxycycline 200mg on day 1 then 100mg daily

Question 7

What is the first line drug for CAP in someone with a penicillin allergy who requires IV therapy?

Answer 7

Clarithromycin 500mg BD

Question 8

What is the first line drug for CAP in someone with a CURB65 of 3 or more?

Answer 8

IV co-amoxiclav 1.2g TDS AND doxycycline 100mg BD

Question 9

What is an empyema?

Answer 9

Pus in the pleural space

Question 10

How does an empyema present?

Answer 10

Fever
Pleuritic chest pain
Worsening symptoms despite antibiotics
High CRP
Dropping albumin

Question 11

What investigations should be done for an empyema?

Answer 11

1. CXR
2. USS if an effusion is seen on CXR
3. Pleural tap

Question 12

What result from the pleural tap identifies fluid as being an infection?

Answer 12

pH <7.2

Question 13

How is an empyema managed?

Answer 13

Drainage
Regular flushes with saline
Antibiotics