12 - Pneumonia

Question 1

What is CAP

Answer 1

Community Aquired Pneumonia - signs of lower respiratory tract infection (fever/cough/phlegm/crepitations or bronchial breathing) + CXR changes.

Question 2

What is CURB-65 used for?

Question 3

Assessing severity of CAP

Question 4

What criteria does CURB-65 include?

Answer 4

Confusion

Ureas > 7mmol/L

RR > 30

BP < 90/60

> 65 years

=> 0-1 - low, 2- moderate >3 servere risk of death.

Question 5

What conditions are included in URTI?

Answer 5

Common cold

Sinusited

Pharyngitis

Laryngitis

Question 6

What conditions are included in LRTI?

Answer 6

Acute bronchiectasis

Pneumonia

COPD exacerbation

Bronchiectasis exacerbation

Lung absess

Empyema

Question 7

Are UTRI mostly bacterial or viral?

Answer 7

Viral

Question 8

Are LRTI mostly bacterial or viral?

Answer 8

Bacterial

Question 9

Which LRTI condition is mainly viral?

Answer 9

Acute bronchiectasis

Question 10

What types of COPD exacerbations are there?

Answer 10

Simpe - no changes on CXR

Pnumonia - Changes on CXR

Question 11

Which bacteria cause COPD exacerbations?

Answer 11

H. influenza

S. pneumonia

Question 12

What is the pathology of bronchiectasis exacerbations?

Answer 12

Bronchioles have wall damaged leading dilatations causing bronchipneumonia.

Question 13

What quilifies someone as having Hospital aquired pneumonia (HAP)?

Answer 13

Developed within 48 hours of hosptial

Question 14

What complications can occur from pneumonia?

Answer 14

Effusion

Empyema

PE

AF

Antibiotic rash and phlebitis

Question 15

What does neutrophilia indicate?

Answer 15

Indicates bacterial infection

Question 16

What does neutropenia indicate?

Answer 16

Viral infection

Question 17

What does an increase white cell count indicate?

Answer 17

Acute infection

Question 18

What does lymphopenia indicate?

Answer 18

Severe infection

Question 19

What does Raised CRP indicate?

Answer 19

Indicates infection (more prominnat with bacteria), a lower increase indicates a inflammatory condition or malignancy.

Question 20

What is Rigor?

Answer 20

Symptom which describes a sudden feeling of cold with shivering but an increase in body temperature

Question 21

What is the Window peroid od HIV?

Answer 21

Time where blood test shows the person to be HIV negative however is infected and infectious. Antibodies are developed during this time.

Around 4 weeks

Question 22

How many days after hospital admission is late onset HAP?

Answer 22

5 days

Question 23

Bacteria causing CAP?

Answer 23

80% are Streptococcus pneumoniae

Question 24

Bacteria involved in late onset HAP?

Answer 24

Enterobacteria

MRSA

Pseudomonas

Question 25

Which lobe is aspiration pneumonia most likely tobe in?

Answer 25

Lower right as the bonchus is more in line with the right main bronchiole

Question 26

Which organisms cause TB?

Answer 26

Myobacterium tuberculosis Myobacterium bovis

Question 27

Descirbe the phases of TB?

Answer 27

Primary phase - no or minor symtpoms localised to lungs and may leaves domant myobacterium in macrophages Secondary phase - reactivation of persisting myobacterium leading to immunorepsonce and therefore symptoms

Question 28

What are the symptoms of TB?

Answer 28

Cough Weight loss Night sweats Fever Malaise Specific symptoms to the organ that TB has spread to...

Question 29

Investigations for TB

Answer 29

CXR ESR and CRP HIV test LFT Sputum and blood cultures

Question 30

What does CPE stand for?

Answer 30

**C**arba**p**en**e**mase **C**arbapenemase-**p**roducing **E**nterobacteriaceae

Question 31

What are the features of myobacteria?

Answer 31

**AAFB** -alcohol and acid fast bacilli Spread through droplets in the air

Question 32

What is Miliary TB?

Answer 32

TB spread to the lungs from othr areas of the body leading to comolidations the size of miliary seeds. These are scene on CXR.

Question 33

What is the standard Inital treatment for TB?

Answer 33

Isoniazide Rifampicin Pyrazinamide Ethambutol For 2 months

Question 34

What happens after the intial phase for TB treatment?

Answer 34

Isoniazide Rifampicin Ethambutol and Pyrazinamide are dropped.

Question 35

Which antibiotic in TB therapy has the side effect of turining body fliuds orange?

Answer 35

Rifampicin

Question 36

Is TB a notifiable disease?

Answer 36

Yes, Local health authority has to be notified.

Question 37

?What are the complications of TB?

Answer 37

Death Antibiotic SE (neuropathy from Isoniazide) Amyloidosis Site specific: Lungs - avities, pleural thickening, bronchiectasis Spine - paraplegia Brian - cranial nerve pulse, hemiparesis

Question 38

What and when should be done in follow up for TB?

Answer 38

CXR at 6 weeks

Question 39

What the features of consolidations which allow it to be differentiated from effusions on CXR.

Answer 39

Margines are not well defined Costo-phrenic angles are preserved There are air bronchiograms

Question 40

What are the features of effusion which alow it to be differentiated from consolidation on CXR?

Answer 40

No lung markings No air bronchiograms Costodiaphragmatic angles are lost

Question 41

What does the tuberculosis skin test and Interferon gamma release essay show?

Answer 41

Assesing previous exposer to TB Same in latent and active disease

Question 42

Who gets the pneumoccal vaccine?

Answer 42

\>65 years Chronic liver/heart and lung disease DM not controlled by diet Immunosupresseed (chemo, hyposplenic etc.)

Question 43

What harbours legionella pneumophilia?

Answer 43

Water tanks kept below 60°C

Question 44

What type of organism most comonly causes pneumonia in the immunosupressed?

Answer 44

Pneumocystis Jirovecci

Question 45

What type of organism most comonly causes pneumonia in bronchiectasis and cystic fibrosis?

Answer 45

Psuedomonas

Question 46

What type of organism most comonly causes pneumonia in IVDU?

Answer 46

Staphylococcus

Question 47

What the pathology behind bronchiectasis?

Answer 47

Inflammation leading to permanent dilatiotion of bronchioles

Question 48

What type of organism most comonly causes pneumonia for alcoholics?

Answer 48

Klebsiella pneumoniea