Respiratory tract infections

Question 1

Pneumonia 0-1m

Answer 1

E coli, GBS, Listeria

Question 2

Pneumonia 1-6m

Answer 2

Chlamydia, S aureus, RSV

Question 3

Pneumonia 6m-5y

Answer 3

Mycoplasma, influenza

Question 4

Pneumonia 16-30

Answer 4

S pneumoniae, H influenzae

Question 5

Risk factors for pneumonia

Answer 5

Poor swallow (CVA, alcohol)
Reduced ciliary function (CF)
Dilated airways (bronchiectasis)
Reduced immunity (HIV)

Question 6

Rusty coloured sputum
Lobar consolidation
Gram positive Cocci - optochin sensitive, Quelling +, alpha-haemolytic

Answer 6

S pneumoniae

Question 7

Smoking + COPD

Gram -ve coccobacilli, chocolate agar, Quelling +

Answer 7

H influenzae

Question 8

Quelling’s test

Answer 8

Tests for capsulated bacteria

NHS - Neisseria, Haemophilus influenzae, Strep pneumoniae

Question 9

Optochin sensitive

Answer 9

S pneumoniae

Question 10

Alcoholism, homeless, haemoptysis

Gram negative bacilli

Answer 10

Klebsiella

Question 11

Post-flu

Gram positive clusters

Answer 11

S aureus

Question 12

Smoking + COPD

Gram negative diplococci

Answer 12

M catarrhalis

Question 13

Tx typical CAP

Answer 13

Mild - Amoxicillin 5-7d (clarithromycin if allergic)

Moderate / severe - Clarithromycin + Co-amoxiclav (+ Hospital)

If S aureus - Flucloxacillin

Question 14

What is the problem with atypical pneumonias?

Answer 14

Usually don’t have cell wall so penicillins don’t work - therefore we usually target protein synthesis

Question 15

Hyponatraemia, confusion, air-con

Urine antigen test

Answer 15

Legionella pneumophilia

Question 16

‘Walking pneumonia’

Cold agglutinin test positive

Answer 16

Mycoplasma pneumonia

Question 17

BIRDS

Answer 17

Chlamydia psittaci

Question 18

Domestic / farm animals

Q fever

Answer 18

Coxiella burnetti

Question 19

Whooping cough

Travelling community

Answer 19

Bordatella pertussis

Question 20

Apical shadowing, haemoptysis, weight loss
Auramine + ZN stains positive (acid-fast bacilli)
Lowenstein Jensen medium

Answer 20

TB

Question 21

Auramine stain

Answer 21

Acid-fast bacilli

Binds myolic acid - fluo yellow

Question 22

ZN stain

Answer 22

Acid-fast bacilli

Binds myolic acid -

Question 23

Ground glass shadowing, HIV signs, Bat wings on CXR

BAL immunofluorescence, Silver Stain

Answer 23

Pneumocystis jirovecii

pneumocystis pneumonia

Question 24

Interstitial change on CT scan

Answer 24

Fungal

Question 25

Chronic wheeze, eosinophils, bronchiectasis

Answer 25

Allergic bronchopulmonary aspergillosis (ABPA)

Question 26

Fungal ball in pre-existing cavity

Answer 26

Aspergilloma

Question 27

Immunocompromised
Halo sign
Needs Amphotericin B Tx

Answer 27

Invasive aspergillosis

Question 28

Likely organisms - HIV

Answer 28

PCP, TB, Cryptococcus neoformans

Question 29

Tx atypical CAP

Answer 29

Chlamydia, mycoplasma: Clarithromycin or doxycycline

Legionella: Clarithromycin + Rifampacin

PCP: Co-trimoxazole (septrin)

TB: RIPE

Question 30

HAP criteria

Answer 30

> 48h in hospital w/o previous infection

Question 31

HAP causative organisms

Answer 31

31% Enterobacter
19% S aureus
17% Pseudomonas
7% Candida
5% H influenzae

Question 32

Tx HAP

Answer 32

Ciprofloxacin + Vancomycin

If ITU: Piptazobactam + Vancomycin (MRSA more likely)

Question 33

Pseudomonas

Answer 33

Piptazobactam

Question 34

Cystic fibrosis

Answer 34

Pseudomonas aeruginosa (green)
Burkholderia cepacia

Question 35

Splenectomy

Answer 35

Capsulated bacteria

NHS

Question 36

Tx aspiration pneumonia

Answer 36

Cefuroxime + Metronidazole