Week 3 formative quiz questions

Question 1

Wheeze is uncommon in bacterial lower respiratory tract infections.

Answer 1

True – clinical signs you are looking for in bacterial LRTI are dullness to percussion, crepitations, bronchial breath sounds, fever and cough.

Question 2

Miliary TB is a rare complication of primary TB infection.

Answer 2

True – this involves the wide dissemination through the bloodstream of TB granulomata, and commonly involves spread to the brain and meninges.

Question 3

Pulmonary TB most commonly affects the apices of the lungs.

Answer 3

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).

Question 4

The hyperinflammatory phase of Covid-19 is part of the normal physiological host response to infection.

Answer 4

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.

Question 5

Pseudomonas aeruginosa pneumonia is typically associated with cystic fibrosis.

Answer 5

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

Question 6

Opportunistic microorganisms have low pathogenicity.

Answer 6

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.

Question 7

Mycoplasma pneumoniae tends to increase in incidence in 4-5 year cycles.

Answer 7

True – Pneumonia caused by Mycoplasma pneumoniae tends to occur in 4-5 yearly epidemics.

Question 8

Patients with childbearing potential taking Rifampicin for TB should take the oral contraceptive pill, as it can harm the baby.

Answer 8

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.

Question 9

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.

Answer 9

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.

Question 10

Staphylococcus aureus pneumonia is associated with intravenous drug abuse.

Answer 10

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.

Question 11

Bacterial lower respiratory tract infections in children always requires antibiotics.

Answer 11

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.

Question 12

The upper respiratory tract extends from the nasal cavity down to the main bronchi.

Answer 12

False – the limit of the upper respiratory tract is the larynx. Below this is the lower respiratory tract.

Question 13

Pneumonia caused by anaerobic organisms are more common following aspiration.

Answer 13

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.

Question 14

A positive AAFB smear is diagnostic of pulmonary TB.

Answer 14

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.

Question 15

The Pfizer/BioNTech Covid vaccine uses attenuated virus.

Answer 15

False – both the Pfizer/BioNTech and Moderna vaccines use mRNA to stimulate an immune response. The AstraZeneca vaccine uses attenuated SARS-COV2.

Question 16

Amoxicillin will treat pneumonia caused by most typical and atypical organisms.

Answer 16

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.

Question 17

Bronchiolitis is treated with oral steroid.

Answer 17

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.

Question 18

Cystic fibrosis is a cause of bronchiectasis.

Answer 18

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.

Question 19

Bronchiolitis is not a recurrent illness.

Answer 19

True – unlike bronchitis, which can occur in recurrent cycles, bronchiolitis tends to be a once-off illness of infancy.

Question 20

Most patients with TB will present during their primary infection.

Answer 20

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.

Question 21

Patients with a streptococcal throat infection require 10 days of amoxicillin.

Answer 21

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.

Question 22

Acute epiglottitis is dangerous and can be fatal.

Answer 22

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.

Question 23

Rifampicin (an antibiotic used to treat TB) can cause polyneuropathy.

Answer 23

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!

Question 24

Diarrhoea and vomiting are a feature of atypical pneumonia.

Answer 24

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.

Question 25

“Pneumonia” is infection within the pleural cavity.

Answer 25

False – pneumonia is infection within the alveolar air spaces. 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 26

Acute bronchitis in adults does not require any specific treatment.

Answer 26

True – acute bronchitis is usually a self-limiting condition, with no specific treatment required. Supportive management includes paracetamol and good fluid intake.

Question 27

A patient with hypoxia due to pneumonia will have a CURB 65 score of at least 2.

Answer 27

False – not necessarily. CURB 65 does not account for hypoxia, and young patients with a good capacity to compensate physiologically may not have a high respiratory rate or low blood pressure until they are very unwell. Hypoxia is an important feature indicating severe illness regardless of CURB 65 score.

Question 28

People with neuromuscular disorders are at higher risk of opportunistic infections.

Answer 28

False – opportunistic infections generally occur in people with severely compromised immune systems, for example from untreated HIV. However, people with some neuromuscular disorders are at higher risk of aspiration pneumonia, through impaired swallowing mechanism.

Question 29

Influenza can lead to secondary bacterial infection by impairing the body’s ability to make antibodies.

Answer 29

False – secondary bacterial infection after flu is usually due to damage to the mucociliary escalator, which results in bacteria and mucus accumulating in the lower respiratory tract.

Question 30

Coxiella burnetti pneumonia is classically associated with exposure to birds.

Answer 30

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

Question 31

Hospital-acquired pneumonia is more likely to be antibiotic-resistant than community-acquired pneumonia.

Answer 31

True – 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 32

TB can be spread by physical contact, e.g. shaking hands or kissing.

Answer 32

False – TB is an airborne pathogen, and is not spread by physical contact.

Question 33

Bacterial bronchitis leads to decreased mucociliary clearance.

Answer 33

False – it is the other way around. Viral respiratory infections infiltrate the mucosa and impair the mucociliary escalator, resulting in stagnation of secretions and bacteria and leading to infection.

Question 34

Streptococcus pneumoniae is the most common cause of pneumonia in adults.

Answer 34

True – this accounts for about 39% of all adult penumonias.

Question 35

Recurrent lung infection is always concerning.

Answer 35

True – if a person is recurrently developing lung infections, this indicates that one or more parts of their body’s defence mechanism are not working. 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 36

Patients being treated for TB with ethambutol should have their vision monitored as it can cause optic neuritis.

Answer 36

True – this is a recognized side effect of ethambutol, so patients will routinely have their vision monitored during treatment.

Question 37

Whooping cough (pertussis) is still common, despite widespread vaccination.

Answer 37

True – 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 38

Lung consolidation results in a decrease in vocal resonance on examination.

Answer 38

False – vocal resonance is used as part of clinical examination to detect areas of consolidation in the lung. 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 39

Rusty brown sputum is a symptom of Staphylococcal pneumonia.

Answer 39

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

Question 40

Tuberculosis is the number 1 cause of death due to infectious disease globally.

Answer 40

True – worldwide, TB causes more deaths per year than HIV and Malaria combined.