RESPIRATORY

Question 1

Pseudomonas lung infection causing bronchiectasis- How would you manage this?

Answer 1

I would first like to confirm the diagnosis and assess the severity of her lung bronchiectasis and possible other long pathology by initially
1. Performing a CXR, CT chest.
2. Looking at FBC to see any raised WCC, anaemia,
3. Inflammatory marker, CRP, Ferritin
4, Sputum culture and blood culture and reviewing the previous microbiology and sensitivities of the pathogen
5. I would also like to look at the oxygen saturation and arterial blood gas as well as previous and current spirometry and lung function test.

6. In term of medications- i would like to ensure that obstructive symptoms is being optimally managed by brochodilator, saline nebs, appropriate level of oxygenation is achieved and the right antimicrobial terapy used with the assistance of Infectious disease colleague- IV therapy- ceftzidime 2g TDS, or Tazocin plus Gentamicin or Ciprofloxacin 400mg TDS ( not licensed for children due 2 S/E to cartilage. Total of 14 days of Iv and oral therapy recommended.

Question 2

Cystic fibrosis

Question 3

Vaccination schedule for adults

Answer 3

Indigenous adult 50 years and older- pneumococcal
Ppl 70 years and older- pneumococcal
Ppl 65 years and over- influenzae
Ppl 70-79 years- Shingles ( VZV)

Question 4

Immunisation for ppl with medical risk conditions

Answer 4

1. Pneumococcal- eligible for ppl with asplenia( functional or anatomical), immune deficient, stem cell transplant and HIV infection, chronic diseases, Down syndrome, cochlear implant and shunt, condition with spinal fluid leakage, ppl with previous invasive pneumococcal disease
2. Meningococcal- asplenia as above, complement deficiency, Eculizumab therapy
3. Influenzae- chronic heart, lung, kidney disease and neurological condition, impaired immunity and blood disorders ( haemoglopbinopathies)
4. Haemophillus influenzae- asplenia, not fully vaccinated in early childhood.

Question 5

Booster vaccine

Answer 5

1. Diphteria-causes pseudomembrane and cause obstruction of airways ( nose, tonsils, larynx, bronchus)- difficulty swallowing and breathing, can cause skin ulcers,myocarditis, polyneuropathy, kidney failure. Treat with penicillin and macrolides ( erythromycin, azithromycin and clarithromycin)
2. Tetanus - those 50 years and older, not had one in past 10 years, have a wound or minor cut and not had one in last 5 years so long they had a primay course of 3 doses in the past. ( Thats why its called booster)
3. Whooping cough ( Bordetella pertussis)- 65 years or older and had close contact with infants.

Question 6

GOLD Classification

Question 7

Steroid use in COPD

Answer 7

Strongly Recommended in
1. History of hospitalisation
2.> 2 mod exac of COPD
3. Eosinophil > 300cells/ uL
4. history of or concomitant asthma

Mod recommendation
1. Hospitalisation
2.Eosinophil between 100-300