Respiratory tract infections

Question 1

3 main types of community acquired LRTIs?

Answer 1

Exacerbation of COPD

Non pneumonic LTRI

Community acquired pneumonia

Question 2

Define an exacerbation of COPD

Answer 2

2/3 of Anthonisen criteria (increased SOB, increase in sputum or increase in sputum volume) in order to receive abx

Question 3

Cardinal symptom of CAP?

Answer 3

Cough plus one other

Should also have at least one systemic feature and new focal CXR signs

Question 4

Most common agents in CAP?

Answer 4

Strep. pneumoniae
H. influenzae
Mycoplasma pneumonia

Question 5

How ot differentiate pneumonia and acute bronchitis?

Answer 5

Acute bronchitis will have normal vital signs and no focal signs on CXR

BUT need to careful with elderly pts and people with comorbidities

Question 6

CURB 65 score?

Answer 6

Confusion
Urea>7
RR>30
BP<90/60
>65

0-manage at home
1-2 Hospital referral
3 or 4 urgent admission

Question 7

Investigations for community acquired pneumonia

Answer 7

CXR

Sputum culture

Blood culture

FBC.CRP

Urinary antigens (legionella)

Serology (for atypical pneumonia)

Question 8

Tx for mild community acquired pneumonia?

Answer 8

Amoxacillin or macrolide PO

Question 9

Tx for community aquired pneumonia? (non severe but admitted to hospital)

Answer 9

Combination

PO amoxicillin + macrolide
(if allergic, quinolone)

IV penicillin + clarithromycin

Question 10

Tx for severe pneumonia?

Answer 10

IV co-amoxiclav + clarithromycin

+/- rifampicin for legionella

Question 11

What does MIC stand for?

Answer 11

Minimum inhibitroy concentrations

Accurate quantitative way of measuring penicillin resistance

Question 12

How many people infected with TB show symptoms?

Answer 12

10% show signs of TB throughout lifespan

Question 13

Clinical signs of TB?

Answer 13

Chronic pneumonia signs therefore always have it as a differential in CAP

Fever, night sweats, cough, SOB etc

Can cause infection of any body system

Question 14

TB risk factors (3)

Answer 14

Close contact

Travel/working history

Immunosuppression

Question 15

TB xray signs

Answer 15

Hilar lymphadenopathy

Upper lobe consolidation

Calcified lymph nodes

Question 16

WHat is the mantoux test?

Answer 16

Measures host skin reaction to injection of tuberculous antifens

Question 17

Gold standard lab diagnosis of TB?

Answer 17

Culturing (but very slow)

Question 18

Pros /cons of microscopy in TB diagnosis?

Answer 18

Pros: rapid, will show infectiousness

Cons: not sensitive

Question 19

Pros/cons of PCR in TB diagnosis

Answer 19

Pro: rapid, sensitive and specific

Cons: Expensive

Question 20

Pros/ cons gamma interferon tests (blood test version of Mantoux) for latent B diagnosis

Answer 20

Pros: only need single visit unlike mantoux test, also more sensitive in latent infection

Cons: expensive

Question 21

Treatment of TB?

Answer 21

RIPE for 2 months, RI for a further 4 months

Question 22

Main ways of preventing TB (6)

Answer 22

Riase living standaards
Rapid diagnosis
COntact tracing, and notification

Isolation
COntroversial BCG vaccine

Reduce bovine TB by milk pasteurisation and slaughter cows infected with latent or active TB