Respiratory Tract Infections

Question 1

Define URTI

Answer 1

Infections larynx and above
pharyngitis, sinusitis, tonsillitis

Question 2

Define LRTI

Answer 2

Lung infection
pneumonia bronchiectasis empyema abscess

Question 3

Define Bronchitis

Answer 3

Infections larynx and above
pharyngitis, sinusitis, tonsillitis

Question 4

Define pneumonia

Answer 4

Inflammation of the lung alveoli

Question 5

What is a hospital acquired pneumonia?

Answer 5

Pneumonia after >48 hours in hospital

Question 6

Most common HAP organism

Answer 6

Enterobacteriaceae

Question 7

Most common CAP organism

Answer 7

Strep pneumoniae

Question 8

Typical features of streptococcus pneumoniae pneumonia

Answer 8

Rusty-coloured sputum
Lobar CXR

Question 9

Microscopy appearance of streptococcus pneumoniae pneumonia

Answer 9

Gram +ve diplococci

Question 10

Typical features of haemophilus influenzae pneumonia

Answer 10

Smoker, COPD
Bronchopneumonia

Question 11

Microscopy appearance of Haemophilus influenzae pneumonia

Answer 11

Gram -ve cocco-bacilli

Question 12

Typical features of Moraxella catarrhalis pneumonia

Answer 12

Smoker, COPD

Question 13

Microscopy of Moraxella catarrhalis pneumonia

Answer 13

Gram -ve diplococci

Question 14

Typical features of Staphylococcus aureus pneumonia

Answer 14

Recent viral infection
Cavitating lesion on CXR

Question 15

Microscopy of Staphylococcus aureus pneumonia

Answer 15

Gram +ve cocci “grape clusters”

Question 16

Typical features of Klebsiella pneumonia

Answer 16

Alcoholics, DM, elderly
Upper lobe cavitating lesion

Question 17

Risks, features and diagnosis of Legionella pneumophila

Answer 17

Risks: air conditioning, hotels
features - hepatitis, hyponatraemia
Dx - urinary antigen test

Question 18

Risks, features and management of Mycoplasma pneumoniae

Answer 18

Risks - young people
Features - dry cough, arthralgia, cold agglutinin / AIHA, erythema multiforme
Mx - tetracycline or macrolide

Question 19

RTIs to consider in HIV patients

Answer 19

PCP
TB

Question 20

PCP features and Mx

Answer 20

Features - severe SOB, CXR bat wing
Mx - co-trimoxazole

Question 21

What organisms are splenectomy patients susceptible to?

Answer 21

Encapsulated bateria - NHS

Question 22

What organisms are patients with cystic fibrosis susceptible to?

Answer 22

Pseudomonas aeruginosa - ceftazadime
Burkholderia cepacia

Question 23

What organism are patients with neutropenia susceptible to?

Answer 23

Aspergillus - halo sign on CT

Question 24

Pneumonia Dx

Answer 24

1. CXR
2. Sputum MCS - bronchoalveolar lavage if dry cough
3. Atypical screen - urinary antigens for legionella, serum antibodies for difficult to culture antigens

Question 25

CURB-65 score

Answer 25

Confusion Urea > 7 RR > 20 BP < 90/60 >65

Question 26

CAP Mx based on CURB-65 score

Answer 26

0-1 - PO amox 5d - OPD 2 - PO amox + clarithromycin - admit 3-5 - IV amox and clarithro - consider ITU

Question 27

HAP Mx

Answer 27

1. cipro + vanc 2. tazocin + van 3. Aspiration - taz + metronidazole