Week 3 formative quiz questions Flashcards
Wheeze is uncommon in bacterial lower respiratory tract infections.
True – clinical signs you are looking for in bacterial LRTI are dullness to percussion, crepitations, bronchial breath sounds, fever and cough.
Miliary TB is a rare complication of primary TB infection.
True – this involves the wide dissemination through the bloodstream of TB granulomata, and commonly involves spread to the brain and meninges.
Pulmonary TB most commonly affects the apices of the lungs.
True – TB is an aerobic bacterium, and is an inhaled pathogen, therefore commonly affects the apices of the lungs (remember that during normal tidal breathing, more air goes to the apex than the base of the lung).
The hyperinflammatory phase of Covid-19 is part of the normal physiological host response to infection.
False – 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.
Pseudomonas aeruginosa pneumonia is typically associated with cystic fibrosis.
True – pseudomonas infection is typically seen in cystic fibrosis and other bronchiectatic disease. It causes copious, green, foul-smelling sputum.
Opportunistic microorganisms have low pathogenicity.
True – 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.
Mycoplasma pneumoniae tends to increase in incidence in 4-5 year cycles.
True – Pneumonia caused by Mycoplasma pneumoniae tends to occur in 4-5 yearly epidemics.
Patients with childbearing potential taking Rifampicin for TB should take the oral contraceptive pill, as it can harm the baby.
False – Patients should be advised that rifampicin will reduce the effectiveness of the OCP, as it increases the activity of the liver enzymes that metabolise the pill. Barrier contraception should be used if a patient wishes to avoid pregnancy. There is no evidence that any of the firstline antibiotics for TB are harmful in pregnancy.
A 34 year old patient with pneumonia who is disorientated, has a respiratory rate of 33, a blood pressure of 87/55mmHg and a blood urea of 9.4mmol/L has a CURB 65 score of 4.
True. Remember:
C = confusion
U = blood urea >7mmol/L
R = respiratory rate over 30
B = systolic BP <90mmHg, diastolic BP <60
and 65 = age over 65.
Each component scores 1 point. Patients with a CURB 65 score over 3 have a significant risk of death and require critical care input.
Staphylococcus aureus pneumonia is associated with intravenous drug abuse.
True – 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.
Bacterial lower respiratory tract infections in children always requires antibiotics.
False – 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.
The upper respiratory tract extends from the nasal cavity down to the main bronchi.
False – the limit of the upper respiratory tract is the larynx. Below this is the lower respiratory tract.
Pneumonia caused by anaerobic organisms are more common following aspiration.
True – this is because the organisms are likely to have come from the gut, rather than the respiratory tract. Metronidazole is a good antibiotic for anaerobic infections.
A positive AAFB smear is diagnostic of pulmonary TB.
False – while pulmonary TB will often give a positive Acid Alcohol Fast Bacilli smear, not all positive AAFB smears are TB, and a negative AAFB smear does not rule out TB.
The Pfizer/BioNTech Covid vaccine uses attenuated virus.
False – both the Pfizer/BioNTech and Moderna vaccines use mRNA to stimulate an immune response. The AstraZeneca vaccine uses attenuated SARS-COV2.
Amoxicillin will treat pneumonia caused by most typical and atypical organisms.
False – 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.
Bronchiolitis is treated with oral steroid.
False – there are no medications which have been shown to be beneficial in bronchiolitis. Management is supportive – i.e. ensure oxygen, fluid and nutritional intake is sufficient.
Cystic fibrosis is a cause of bronchiectasis.
True – 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.
Bronchiolitis is not a recurrent illness.
True – unlike bronchitis, which can occur in recurrent cycles, bronchiolitis tends to be a once-off illness of infancy.
Most patients with TB will present during their primary infection.
False – 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.
Patients with a streptococcal throat infection require 10 days of amoxicillin.
False – one of the differential diagnoses of a sore throat with purulent exudate and tonsillitis is Epstein-Barr Virus (or glandular fever), and it can be hard to distinguish between this and streptococcal infection clinically. Classically, giving a person with EBV amoxicillin will result in a rash, so instead penicillin is used when antibiotics are required.
Acute epiglottitis is dangerous and can be fatal.
True –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.
Rifampicin (an antibiotic used to treat TB) can cause polyneuropathy.
False – Isoniazid can cause polyneuropathy, and Vitamin B6 (Pyridoxine) is given alongside it to prevent this. Of note, rifampicin causes all bodily fluids to turn orange-red, so it is best to advise patients not to wear contact lenses!
Diarrhoea and vomiting are a feature of atypical pneumonia.
True – pneumonia caused by atypical organisms classically presents slightly differently to typical pneumonia. Features include diarrhoea and vomiting, headache, myalgia (muscle ache) and dry cough.
