Respiratory Disease

Question 1

Strep Pneumonia

Answer 1

Most common , weird presentations: herpes labialise
Urinary antigen, CXR (lobar consolidation)
Amoxicillin

Question 2

Staph Aureus

Answer 2

May complicate flu infection, IVDUS
CXR (bilat cavitations or patchiness)
Flucloxicillin
(Vancomycin if MRSA, linezolid/clindamycin if Panton-Valentine leucocidin).

Question 3

Klebsiella

Answer 3

Elderly, diabetic, alcoholic
Red currant sputum
CXR (cavitating upper lobe)
Usually drug resistant

Question 4

Aspiration Pneumonia

Answer 4

Pt w unsafe swallow, anaerobes = foul sputum, may need to add gram neg /anaerobe cover eg metronidazole

Question 5

Leigonella

Answer 5

Atypical. Thrive in water systems eg air con, cruise ship. HYPONATRAEMIA, confusion, D/V, deranged LFTs, AKI, lymphopenia
Urinary antigen
CXR (basal consolidation)
Macrolides or fluroquinolones

Question 6

Mycoplasma

Answer 6

Atypical. Winter epidemics. Erythema multiforme (target rash), cold agglutinin (IgM haemolytic anaemia in the cold), myocarditis, glomerulonephritis, meningoencephalitis.
Macrolides, fluroquinolones, tetracyclines

Question 7

Chlamydia psittaci

Answer 7

Atypical. Infected birds (parrots).
Meningo-encephalitis, culture neg infective endocarditis, hepatitis, AKI, splenomegaly
Serology
Tetracyclines, Macrolides

Question 8

Pseudomonas

Answer 8

Bronchiectasis + cystic fibrosis
Hospital acquired (ITU - tubes)
green sputum
Limited abx work: Tazosin, ciprofloxacin, meropenem, gentamicin, ceftazidine

Question 9

PCP

Answer 9

Immunosuppressed, SOBOE, low PaO2
CXR (ground glass opacification - bilateral perihilar interstitial shadowing)
BAL (?)
Co-trimoxazole

Question 10

TB

Answer 10

Pyrexia, night sweats, malaise, anorexia, clubbing, haemoptysis, cough.
Cardio (pericarditis), CNS/spine (potts disease, meningitis), GI/GU (abdo/loin pain, sterile pyuria, haematuria), Derm (erythema nodosum, lupus vulgaris), Milliary (disseminated by blood)
Offer HIV test
Notifiable disease
BCG to high risk areas, children <15 vaccinated as new born + high risk, Adults<35, neg Mantoux + high risk, HIV
RIFAMPICIN, ISONIAZID, PYRAZINAMIDE
ETHAMBUTOL

Question 11

Fungal Pneumonia

Answer 11

Immunosuppressed
Aspergillus, Candida (ICU patient), Histoplasmosis (bats (caves), birds), Blastomycosis (compost USA), Cryptococcus (pigeon droppings)
Aspergillus serology, cultures + PCR
Urine ag, serology, KOH culture, India ink stain and serology