Respiratory

Question 1

Streptococcus pneumoniae

Answer 1

Gram-POSITIVE diplococci

ALPHA-haemolytic colonies on BLOOD agar

RUSTY-coloured sputum

Question 2

Mycobacterium tuberculosis

Answer 2

ACID-FAST bacilli on Ziehl-Neelsen stain

Rough, dry, yellow colonies on LOWENSTEIN-JENSEN medium

Cavitating shadows on CXR

Question 3

Mycoplasma pneumoniae

Answer 3

Pleiomorphic bacteria in ‘fried-egg’ colonies

Non-specific Sx

Patchy consolidation + cold agglutinins

Question 4

Legionella pneumoniae

Answer 4

Slender Gram-NEGATIVE rods in MILKY WHITE colonies on CHARCOAL YEAST EXTRACT agar

Air con, smoker, deranged LFTs, HYPONATRAEMIA

Question 5

Pseudomonas aeruginosa

Answer 5

Gram-NEGATIVE motile bacilli growing in YELLOW, NON-LACTOSE-FERMENTING colonies on MacConkey agar

Most common HAP, CF

Question 6

Management of COPD

Answer 6

A) Bronchodilator

B) LABA or LAMA –> persistent symptoms = BOTH

C) LAMA –> exacerbations = add LABA** or change to LABA + ICS

D) LAMA –> LAMA + LABA –> LAMA + ICS –> LAMA + LABA + ICS

Question 7

Indications for home oxygen therapy?

Answer 7

Chronic hypoxaemia with PaO2 7.3-8 AND pulmonary HTN / secondary polycythaemia

Clinical diagnosis of associated disorder

On optimal treatment and clinically stable for 5 weeks

ABD measured twice 3+ weeks apart

Question 8

What is the Wells score and how is it used to direct patient management?

Answer 8

Assesses clinical probability of a pulmonary embolism:

3 points = clinically suspected DVT
1.5 points = tachycardia
1.5 points = Immobilisation/surgery in last 4 weeks
1.5 points = Hx DVT/PE
1 point = haemoptysis
1 point = malignancy
- 3 points = alternative diagnosis less likely

<4 = D-Dimer
>4 = CTPA

Question 9

Which antibiotic is most commonly given to treat Legionella pneumonia?

Answer 9

Erythromycin