SBA

Question 1

20-year old with suspected asthma. What investigation should be used alongside spirometry?

1. FeNo
2. Allergy testing
3. Bronchial methacholine challenge
4. PEFR

Answer 1

FeNO.

If spirometry shows obstructive picture, perform reversibility test. If not, then perform PEFR.

Question 2

You meet some one with MND who coughs up red, foul-smelling sputum. What is the most likely causative agent?

1. Klebsiella pneumoniae
2. Chlamydia psittaci
3. Legionella pneumonphilia
4. Mycoplasma pneumoniae

Answer 2

Klebsiella.

Most likely due to aspiration pneumonia. Produces foul-smelling red current sputum.

Question 3

A 69 year old woman presents following a 3 day history of shortness of breath and a productive cough. Her initial observations are HR: 104bpm, RR:31, BP:90/65, O2 sats: 96%, Temp: 38.5C.

She is admitted to hospital and treated with IV amoxicillin and clarithromycin for the past week. However, since then her fever has persisted and she has developed foul smelling sputum.

A chest x-ray is requested and an aspirate of pleural fluid is obtained. The results demonstrate a pH<7.2.

What is the most appropriate management?

A. Change the antibiotic regimen to Tazocin
B. High flow O2 (60%)
C. Chest drain under ultrasound guidance
D. Antibiotic instillation
E. Add oral itraconazole

Answer 3

Ans: Chest drain under USS guidance

A recurrent fever despite Abx treatment suggests an empyema. pH < 7.2 is almost diagnostic. Tx: chest drain under radiological guidance

Antibiotic instillation –> considered for patient with lung abscess

Antifungals considered for neutropenic patients after 48 hours if pneumonia had not resolved. No evidence here that it is fungal pneumonia