week 3

Question 1

what is a major side effect of ethambutol which is used for treatment against tb

Answer 1

optic neurosis

so patients routinely have their vision monitored

Question 2

what is Pseudomonas aeruginosa usually associated with

Answer 2

pseudomonas infection is typically seen in cystic fibrosis and other bronchiectatic disease. It causes copious, green, foul-smelling sputum.

Question 3

what are people with neuromuscular disorders more at risk of

Answer 3

people with some neuromuscular disorders are at higher risk of aspiration pneumonia, through impaired swallowing mechanism.

Question 4

how does lung consolidation effect vocal reasonance

Answer 4

Consolidated lung transmits sound more effectively than aerated lung, so the voice of the patient is heard more clearly over abnormal lung, i.e. vocal resonance is increased.

Question 5

what is rusty brown sputum usually caused by

Answer 5

rusty brown sputum is classically seen with pneumonia caused by Streptococcus pneumoniae.

Question 6

what is the most common cause of pneumonia in adults

Answer 6

Streptococcus pneumoniae is the most common cause of pneumonia in adults. it accounts for 39% of all adult pneumonias

Question 7

what is a good antibiotic for anaerobic infections

Answer 7

Metronidazole

Question 8

what is croup and what is it treated with

Answer 8

Croup – or laryngotracheobronchitis – is a common childhood illness, most commonly caused by the Parainfluenza I virus. It causes a barking cough and stridor (sound caused by upper airway obstruction). Treatment, when required, is with dexamethasone (a steroid) to reduce inflammation.

Question 9

do patients often present during primary infection with tb

Answer 9

the primary infection (i.e. the point at which the person becomes infected; the first exposure to TB) is often asymptomatic, and in the majority of people it will either be cleared completely or contained within a granuloma as latent TB. Most symptomatic presentations of TB result as a reactivation of latent TB.

Question 10

does a postitive AAFB score indicate tb

Answer 10

AAFB - acid alcohol fast bacilli smear
while some positive tests may be tb. not all positive AAFB smears are TB, and a negative AAFB smear does not rule out TB.

Question 11

how fast can nasal high flow oxygen deliver oxygen

Answer 11

high flow nasal oxygen can be delivered up to 70L/min! The oxygen is warmed and humidified, otherwise this would be prohibitively drying and uncomfortable. It is important to be aware that this is classed as an aerosol-generating procedure.

Question 12

how does the incidence on mycoplasmae pneumonia increase

Answer 12

in 4-5 year cycles

Question 13

what is the hyperinflammatory phase of COVD-19

Answer 13

this is a feature of severe Covid, and is a pathological host response. In the hyperinflammatory phase, a cascade of pro-inflammatory molecules (a cytokine storm) leads to uncontrolled inflammation.

Question 14

what is the hyperinflammatory phase of COVD-19

Answer 14

this is a feature of severe Covid, and is a pathological host response. In the hyperinflammatory phase, a cascade of pro-inflammatory molecules (a cytokine storm) leads to uncontrolled inflammation.

Question 15

by how much does a reservoir mask increase the concentration of oxygen being delivered

Answer 15

a reservoir or “non-rebreathe” mask uses a bag to create a reservoir of oxygen and increase the concentration of oxygen being delivered to around 60-90%.

Question 16

what ix coxiella burnetti pneumonaie related to exposure with

Answer 16

C. burnetti is classically associated with exposure to farm animals. Bird owners are classically prone to pneumonia from Chlamydia psittaci.

Question 17

what are features of atypical pneumonia

Answer 17

caused by atypical organisms classically presents slightly differently to typical pneumonia. Features include diarrhoea and vomiting, headache, myalgia (muscle ache) and dry cough.

Question 18

what are the key cells in the respiratory systems immune defence

Answer 18

macrophages. They participate in the macrophage-mucociliary escalator, and clear debris from the lungs by phagocytosis.

Question 19

what treatment is used for acute bronchitis

Answer 19

there is no specific treatment required, Supportive management includes paracetamol and good fluid intake.

Question 20

what kind of organisms can amoxicillin treat

Answer 20

typical. Amoxicillin does not have much activity against atypical organisms. When pneumonia is severe or atypical infection is suspected, treatment should include a macrolide antibiotic like clarithromycin, or an alternative like doxycycline, levofloxacin or co-trimoxazole.

Question 21

can acute epiglottitis be fatal

Answer 21

Most upper respiratory tract infections are self-limiting. However, rarely, the epiglottis can become inflamed from a bacterial infection (such as Haemophilus influenzae) and this can lead to airway obstruction and even death. This used to be more common in children than it is now, but fortunately incidence is falling due to the Hib vaccine.

Question 22

what is the number one cause of death due to infectious disease globally

Answer 22

tuberculosis

Question 23

what is an epidemic

Answer 23

a sudden increase in cases of a disease, above what would normally be expected in a given population.

Question 24

what is an endemic

Answer 24

An endemic disease is maintained at a consistent and predictable level in a given population, for example chickenpox in the UK.

Question 25

what do viral respiratory infections do to the mucosa

Answer 25

infiltrate the mucosa and impair the mucociliary escalator, resulting in stagnation of secretions and bacteria and leading to infection.

Question 26

what type of infection is commonly associated with alcoholism

Answer 26

Klebsiella pneumoniae

Question 27

what does moraxella catarrhalis cause

Answer 27

LRTI in COPD

Question 28

what type of infection is bronchiolitis usually

Answer 28

it is usually caused by a respiratory syncytiovirus, and is most common in babies.

Question 29

when would you not give a child antibiotics for a LRTI

Answer 29

if the child is eating and drinking well, and their oxygen levels are normal, it is reasonable to keep a close eye on them and do nothing.

Question 30

when is pneumonia classed as hospital acquired

Answer 30

if it occurs at least 48hrs after youve been admitted to hospital

Question 31

what symptoms are common in LRTI

Answer 31

dull percusiion, bronchial breath sounds, fever, cough and crepitations
NO WHEEZE

Question 32

where does pulmonary tb most commonly affect

Answer 32

the apices of the lungs as more of the tidal vol (vol b reathed in) reaches the apex of the lung

Question 33

why are recurring lung infections concerning

Answer 33

because it shows that the bodys defence mechanism is failing. Examples include diseases such as COPD, cystic fibrosis, or bronchiectasis; localized obstruction such as a tumour or a foreign body; or immunocompromise due to HIV or medications.

Question 34

what is the treatment for bronchiolitis

Answer 34

there is no known treatment for bronchiolitis. just make sure the patients o2, fluid and nutritional intake is sufficient.

Question 35

is whooping cough (pertussis) still common

Answer 35

although vaccination has significantly reduced morbidity and mortality from pertussis, this is still a common cause of childhood cough resulting from lower respiratory tract infections

Question 36

what treatment should be given for strep throat infections

Answer 36

use penicillin when antibiotics are required as amoxicillin will cause a rash

Question 37

what are iv drug abusers at higher risk of

Answer 37

staph aureus bacteraemia and staph aureus pneumonia

Question 38

what is tb spread by

Answer 38

its airborne so not physical contact

Question 39

does rifampicin harm unborn babies

Answer 39

no but it can reduce the effectiveness of the pill

Question 40

describe the pathogenicity of opportunistic pathogens

Answer 40

They have a low pathogenicity. some micro-organisms do not normally cause infections in healthy people, as the immune system is easily able to resist or overcome them. However, if a person has a compromised immune system, these organisms can cause disease.

Question 41

is cystic fibrosis a cause of bronchiectasis

Answer 41

Cystic Fibrosis is a multi-system disease affecting multiple organs. It causes impaired ciliary motility, and in the lungs this results in pooled secretions and bronchiectasis.

Question 42

does latent tb require treatment

Answer 42

latent TB (positive Mantoux or IGRA test in a person who has had contact with TB, but is asymptomatic and has a normal CXR) is treated to reduce the chance of developing active TB. The same antibiotics are used, for a slightly shorter course, usually 3 to 6 months.

Question 42

does latent tb require treatment

Answer 42

latent TB (positive Mantoux or IGRA test in a person who has had contact with TB, but is asymptomatic and has a normal CXR) is treated to reduce the chance of developing active TB. The same antibiotics are used, for a slightly shorter course, usually 3 to 6 months.

Question 43

is hospital acquired or community acquired more likely to be antibiotic resistant

Answer 43

Hospitals are breeding grounds for superbugs! Patients who develop a pneumonia in hospital are more likely to have picked up a multi-drug-resistant infection, which can make these infections harder to treat. Careful use of antibiotics is essential at all times, as we don’t want to speed up the evolution of resistant bacteria.

Question 44

what is a secondary bacterial infection after flu usually due to

Answer 44

damage to the mucociliary escalator, which results in bacteria and mucus accumulating in the lower respiratory tract.

Question 45

where are anaerobic organisms more likely to come from

Answer 45

the gut

Question 46

what is a good antibiotic for anaerobic organisms

Answer 46

Metronidazole

Question 47

what drug can cause polyneuropathy

Answer 47

Isoniazid can cause polyneuropathy, and Vitamin B6 (Pyridoxine) is given alongside it to prevent this.

Question 48

what is the curb 65 scoring system

Answer 48

confusion 
blood urea >7
respiratory rate over 30
systolic bp >90 diastolic >60
aged 65 or over

Question 49

what type of vaccines are pfizer and moderna

Answer 49

mRNA

Question 50

what is pneumonia

Answer 50

an infection within the alveolar air space.,You will often hear the term “consolidation” used in this context, usually to describe an X-ray or pathology finding. Consolidation simply means that the air in the alveoli has been replaced by solid material – in the case of pneumonia, it is bacteria and inflammatory cellular debris.

Question 51

what is miliary tb

Answer 51

a rare complication of primary tb, involving the wide dissemination through the bloodstream of TB granulomata, and commonly involves spread to the brain and meninges.

Question 52

what bacteria is associated with intravenous drug use

Answer 52

Intravenous drug users are at higher risk of S. aureus bacteraemia (as S. aureus is a common skin commensal) and S. aureus pneumonia. It is also classically seen following influenza infection.

Question 53

is pseudomonas aeruginosa typically associated with cystic fibrosis

Answer 53

pseudomonas infection is typically seen in cystic fibrosis and other bronchiectatic disease. It causes copious, green, foul-smelling sputum.

Question 54

what signs do you look for in bacterial LRTIs

Answer 54

dullness to percussion, crepitations, bronchial breath sounds, fever and cough.

Question 55

at what speed does a reservoir mask deliver oxygen

Answer 55

15L/MIN