Upper & Lower Resp. Infections

Question 1

where is the respiratory tract sterile?

Answer 1

below the epiglottis

Question 2

are there anaerobic bacteria in your URT?

Answer 2

Yes, small niches but numbers are comparable and even more in some places

Question 3

Higher number of serotypes of strep are more dangerous? which is the most dangerous?

Answer 3

Lower numbers more dangerous: strep ‘3’ is most dangerous

Question 4

Haemophilus influenza has 6 types: they are:

Answer 4

a,b,c,d,f, non typable

Question 5

How is Haemophilus influenza typed based on?

Answer 5

capsule

Question 6

What is the most common source of infective endocarditis?

Answer 6

viridans streptococci

Question 7

Corynebacterium spp. includes which important disease?

Answer 7

diphtheria

Question 8

occasional URTI (1-10%) caused by?

Answer 8

strept pyogenes

meningococci

Question 9

Will I get meningitis if the meningococci have capsules?

Answer 9

YES YOU WILL!!

Question 10

What is P.Jirovecii(carinii) ?

Answer 10

resident yeast-like fungus in latent state in lung

Question 11

3 examples of viruses that hang around in the nerves/lymph nodes

Answer 11

CMV
HSV
EBV

Question 12

What is croup?

Answer 12

laryngo-tracheal bronchitis

Question 13

pertussis infects which part of resp tract?

Answer 13

lower

Question 14

Where does RSV infect?

Answer 14

upper and lower

Question 15

What time of the year do you get enterovirus more likely?

Answer 15

summer

Question 16

What time of the year do you get rhinovirus more likely?

Answer 16

winter

Question 17

What causes epiglottitis?

Answer 17

Haemophilus Influenzae B

Question 18

If you have a case of pharyngitis/tonsillitis with no nasal involvement, would you treat with antibiotics despite only 1in 5 cases being bacterial?

Answer 18

Yes you would. Complications from Group A Strep pyogenes are nasty, could lead to rheumatic fever, septicaemia.

Question 19

What can happen after 48 hours of RSV infection in the respiratory tract?

Answer 19

cilial destruction, secondary commensal bacterial infection

Question 20

What is a commensal that can cause otitis media?

Answer 20

Moraxella catarrhalis

Question 21

When you you need to make a laboratory diagnosis?

Answer 21

epiglottitis, pharyngitis/tonsillitis

Question 22

How to take collect a sample from epiglottitis?

Answer 22

NOT swab.
Blood culture
X-ray

Question 23

What is herpangina?

Answer 23

painful mouth sores in back of throart caused by Coxsackie A virus

Question 24

white spots on throat = strep?

Answer 24

Nope. not necessarily, could be hand foot mouth disease (coxsackie A)

Question 25

Otitis media in Australia when do you treat?

Answer 25

If younger than 2 | if older than 2 and lasts for more than 48 hours.

Question 26

Which URTI is essential to treat?

Answer 26

epiglottitis

Question 27

How to treat Croup if severe?

Answer 27

inhaled steroids

Question 28

What does not require antibiotics?

Answer 28

``` Common cold sore throat: pharyngitis sinusitis laryngitis croup acute bronchitis bronchiolitis influenza SARS/MERS ```

Question 29

What's a frequent aetiological agent of acute bronchitis?

Answer 29

part of viral URTI

Question 30

What's a frequent aetiological agent of acute exacerbation of chronic bronchitis/emphysema?

Answer 30

pneumococci/H. influenzae

Question 31

Why would smokers tend to get acute exacerbation of chronic bronchitis/emphysema?

Answer 31

decrease in innate immune system, commensals move in

Question 32

What population mostly gets bronchiolitis?

Answer 32

Babies/kids in first few years of life

Question 33

What normally causes bronchiolitis?

Answer 33

RSV

Question 34

What's the theory of RSV?

Answer 34

Mother's RSV antibodies cross placenta, then when baby exposed to RSV, it sets up immune complex inflammation

Question 35

What causes 80% of community, and 50% of hospital acute bacterial pneumonia?

Answer 35

pneumococci

Question 36

Which bacteria has the worst prognosis if it's acute bacterial pneumonia?

Answer 36

Klebsiella pneumoniae

Question 37

what vector do you typically get Chlamydophila pneumoiae?

Answer 37

zoonosis

Question 38

What is 'walking pneumonia'?

Answer 38

milder course, lasts longer, patchy on x-ray

Question 39

acute bacterial pneumonia severe version presentation?

Answer 39

high fever, consolidated lobe of lung via percussion = dull and opaque on x-ray

Question 40

What's the most common 'atypical' pneumonia?

Answer 40

mycoplasma, viruses

Question 41

Can you treat mycoplasma with penicillin? Why?

Answer 41

Nope. No cell wall for penicillin to act on

Question 42

What is empyema?

Answer 42

pus in the pleural space

Question 43

What causes empyema?

Answer 43

staph aureus

Question 44

What does histoplasma, aspergillus, pneumocystis cause?

Answer 44

'other' pneumoniae

Question 45

what are important underlying illnesses re: pneumonia?

Answer 45

COPD, AIDS, CF

Question 46

What is legionnaire's pneumophilia? how do they survive and invade us?

Answer 46

live in air conditioning ameoba, hard to grow in lab, they survive in ameobi and then get into our macrophages and survive in us

Question 47

how is occupation important in pneumonia diagnosis? 4 things:

Answer 47

animals, hides (anthrax spores), air conditioning, soils

Question 48

Where do you find legionella long-beachy?

Answer 48

potting soil in Australia

Question 49

What is pleomorphic? example?

Answer 49

takes on different shapes eg. H. influenzae

Question 50

Lab diagnosis of pneumonia, how should you collect sputum?

Answer 50

proper cough, not just spitting in the cup

Question 51

When do you use aspiration via bronchoscope?

Answer 51

CF

Question 52

when do you use a pleural tap?

Answer 52

empyema

Question 53

When to get a lung biopsy?

Answer 53

If it's not responding to initial treatment due to sputum misdirection

Question 54

Can you diagnose pneumonia in the blood?

Answer 54

Yes, and if it's in the blood and you have pneumonia... it's probably the cause.

Question 55

When would you use a serological diagnosis of pneumonia?

Answer 55

if difficulty culturing

Question 56

which organisms would you use a serological diagnosis of pneumonia for?

Answer 56

mycoplasma pneumoniae legionella pneumophila chlamydophila/chlamydia coxiella burnetii

Question 57

What causes Q-fever?

Answer 57

coxiella burnettii = same family as ricketsia(typhus) and is an obligate intracellular bactera

Question 58

Which type pneumophila is 80% cause of pneumonia? how dx?

Answer 58

Type 1. Antigen detection Dx from Urine

Question 59

What are 'must know' pathogens for Dx of pneumonia?

Answer 59

``` SARS MERS Avian FLU Legionella bioterrorism (anthrax/plague) community acquired MRSA ```

Question 60

What are 'should know' pathogens for Dx of pneumonia?

Answer 60

penicillin G resistant S. pneumoniae | P. aeruginosa

Question 61

What's the best guess 'shotgun' treatment for penumonia?

Answer 61

PEnG/amoxycillin + doxycycline/macrolide

Question 62

atypical bugs of pneumonia are all susceptible to what?

Answer 62

doxycycline/macrolide

Question 63

who is 23 valent polysaccharide for?

Answer 63

Penumococcal vaccines for adults only

Question 64

Why is 23 valent polysaccharide only for adults?

Answer 64

children can't handle 23 capsular types of pneumococcus, so go with 13

Question 65

2 examples of specialised vaccines?

Answer 65

anthrax | plague

Question 66

Why conjugate vs. polysaccharide vaccine?

Answer 66

conjugate has a polysaccharide antigen attached to a carrier protein to get proper immuno response (memory B)