Respiratory Tract Infection

Question 1

What is optochain sensitive?

Answer 1

Streptococcus pneumonia

Question 2

Streptococcus pneumonia is generally what-resistant?

Answer 2

Penicillin resistant

Question 3

Predisposing factors for nosocomial pneumonia

Answer 3

Surgery, intubation, antibiotics, intensive care unit, immunosuppression

Question 4

E. coli and Klebsiella are what?

Answer 4

Coliforms

Question 5

Organisms causing nosocomial pneumonia

Answer 5

Pseudomonas aeruginosa, coliforms (E.coli, Klebsiella)

Question 6

Treatment of severe nosocomial pneumonia

Answer 6

IV amoxicillin, metronidazole and Gentamicin. Step down to oral co-amoxiclav (total 7-10 days treatment)

Question 7

Treatment of non-severe nosocomial pneumonia

Answer 7

Amoxicillin and metronidazole for 7 days

Question 8

Clinical features of legionella pneumophila

Answer 8

Flu-like illness, renal failure, GI symptoms, mental confusion

Question 9

Diagnosis of legionella

Answer 9

Serology, legionella urinary antigen. (PCR test on sputum also available)

Question 10

Treatment for legionnaires disease

Answer 10

Erythromycin/clarithromycin

Fluoroquinolones e.g levofloxacin

Question 11

Treatment of PCP

Answer 11

Cotriamoxazole, pentamidine

Question 12

You would use a bronchoalveolar lavage or identification of cysts in induced sputum to identify what?

Answer 12

PCP. Who gets PCP? AIDS.

Question 13

Organism causing acute epiglottitis?

Answer 13

Haemophilus influenza (gram negative)

Question 14

Chocolate culture with small translucent colonies/ X and V test used to confirm what?

Answer 14

Haemophilus influenza causing actue epiglottitis. H. influenza requires both factors X and V to grow. Diagnosis by blood culture.

Question 15

Treatment for acute epiglottitis?

Answer 15

ITU and ceftriaxone

Question 16

Haemophilus influenze, streptococcus pneumonia and moraxella catarrhalis can cause what?

Answer 16

Exacerbations of COPD (all 3 organisms are present in the normal upper respiratory tract flora)

Question 17

Casual bacteria not good for cystic fibrosis

Answer 17

Haemophilus influenza, staphylococcus aureus, pseudomonas aureginosa, Burkholderia cepacia

Question 18

What can Aspergillus fumigatus cause?

Answer 18

Severe pneumonia/systemic infection/aspergillus (in immunocompromised) Diagnosed by culture

Question 19

What is I.V amphotericin B used to treat?

Answer 19

Aspergillus fumigatus

Question 20

Acid alcohol fast bacilli?

Answer 20

Mycobacterium lawl

Question 21

What grows on Lowenstein-Jensen medium?

Answer 21

Mycobacterium tuberculosis

Question 22

What grows on Bordet-Gengal medium?

Answer 22

Bordatella pertusis

Question 23

Is tuberculosis transmissable between humans?

Answer 23

Yes. The mycobacterial species themselves are not directly transmissable

Question 24

Drawback of Ziehl-Neisson stain

Answer 24

You cannot identify the species or tell what antibiotic they are resistant to. (Remember they appear as red rods on the stain). PCR provides information of species and some on sensitivity.

Question 25

Direct immunofluorescence used for what?

Answer 25

PCP

Question 26

Forms of respiratory infection spread?

Answer 26

Droplet spread, airborne precautions

Question 27

Anti-virals used in treatment of flu

Answer 27

Ozeltamivir, Zanimivir

Question 28

Lab confirmation of Flu

Answer 28

PCR (nasopharyngeal swab, throat swab) immunofluorescence antigen detector (near patient) virus culture

Question 29

What does the killed influenza vaccine contain?

Answer 29

2 influenza A viruses, 1 influenza B virus

Question 30

Other causes of community acquired pneumonia

Answer 30

Mycoplasma pneumonia, Coxiella burnetti, Chlamydia

Question 31

Treatment of community acquired pneumonia

Answer 31

Tetracycline and macrolides (e.g. clarithromycin)

Question 32

Who is affected by community acquired pneumonia?

Answer 32

Young children, old adults (person-person spread)

Question 33

Coxiella burnetti (Q fever) causes what?

Answer 33

Pneumonia, fever

Question 34

Complications of coxiella burnetti (Q fever) ?

Answer 34

Culture negative endocarditis

Question 35

Chlamydia pstittici causes what?

Answer 35

Psittacosis (and this usually presents as pneumonia

Question 36

Clinical presentation of severe bronchiolitis?

Answer 36

Grunting, sternal indrawing. Complications of bronchiolitis include respiratory/cardiac failure

Question 37

Main cause of bronchiolitis?

Answer 37

Respiratory syncitial virus. Bronchiolitis epidemics common in winter, no vaccine, nosocomial spread in hospitals. passive immunisation has poor efficacy

Question 38

Metapneumovirus symptoms similar to those of?

Answer 38

RSV. (range of severity from mild to requiring ventilation)

Question 39

What may be second only to RSV in bronchiolitis?

Answer 39

Metapneumovirus

Question 40

Laboratory confirmation of metapneumovirus?

Answer 40

PCR

Question 41

What is chlamydia trachomatis?

Answer 41

STI which can cause infantile pneumoniae. (Diagnosis by PCR on urine of mother or by nasal swab of child)

Question 42

What does chlamydia pneumonia cause?

Answer 42

Mostly mild respiratory infections. May be picked up by test for psittacosis.

Question 43

Presentation of Pertussis

Answer 43

Acute tracheobronchitis

Question 44

Acute tracheobronchitis is the clinical presentation of what?

Answer 44

Pertussis

Question 45

Sinusitis and acute bronchitis complications of what?

Answer 45

Coryza

Question 46

Characteristic of diptheria?

Answer 46

Pseudo-membrane

Question 47

Chest X-ray and examination in bronchitis?

Answer 47

Normal. May have transient wheeze

Question 48

When are antibiotics indicated in bronchitis?

Answer 48

When they have underlying lung disease, otherwise they are not indicated.

Question 49

Acute exacerbation of bronchitis symptoms

Answer 49

Wheeze, coarse crackles, may be cyanosed, breathless, ankle oedema (in advanced cases)

Question 50

Treatment of acute exacerbation of chronic bronchitis

Answer 50

Antibiotics (e.g doxycycline or amoxicillin) Bronchodilators Short course of steroids in some cases

Question 51

Will you hear crackles and rub in pneumonia?

Answer 51

Yeah man

Question 52

``` Other severity markers of pneumonia: Temperature Cyanosis PaO2 WCC Multi-lobar involvement ```

Answer 52

Temperature: 40 Cyanosis: PaO230

Question 53

Chest symptoms may be absent in which kind of pneumonia?

Answer 53

Legionella

Question 54

What is primary influenzal pneumonia?

Answer 54

Complication of influenza. Dry cough, bloody sputum and respiratory failure within 24 hours of initial fever

Question 55

What is secondary bacterial pneumonia?

Answer 55

When you get a new fever on day 7 after your initial (flu) fever

Question 56

Myositis (cardiac and skeletal), encephalitis and depression can be complications of what?

Answer 56

Influenza

Question 57

Benefits of oseltamivir?

Answer 57

Shortens symptoms by 1 day. Reduced use of antibiotics