Chest Infection

Question 1

When to treat patients in the community vs hospital for pneumonia?

Answer 1

CURB-65 score
0-1 - treat in comm
2 - intermediate risk - should have a hospital care
3+ high risk - consider intensive care

Question 2

Investigation for pneumonia with CRB-65 1 or more

Answer 2

CXR

Plus blood tests, sputum cultures, and urinary pneumococcal and legionella antigen.

Question 3

Reactivation of TB can be caused by

Answer 3

Immunosuppressive drugs (steroids and anti-TNFa)
HIV
Malnutrition

Question 4

Where are the sites for secondary tuberculosis spread?

Answer 4

1) lungs 
Then extrapulmonary sites include: 
CNS (meningitis)
Vertebral bodies (Potts disease)
Cervical LNodes (scrofuloderma)
Renal 
Gastroinstenal tract

Question 5

What blood test can help determine whether a patient with pneumonia needs abx?

Answer 5

CRP

<20 no abx
20-100 delayed prescription
>100 abx therapy

Question 6

In COPD patient what is the most common agent to 1) give consolidation 2) give infective exacerbation?

Answer 6

1) strep pneumonia

2) haemophilus influenzae

Question 7

Dry cough and positive urinary antigen suggests which organism?

Answer 7

Legionella

Can get renal impairment, hepatitis, hyponatrimia and SIADH

Question 8

Signs of empyema on aspiration

Answer 8

Frank pus

Or cloudy aspirate with low ph <7.2, low glucose, high LDH, or bacteria growth upon culture

Question 9

Treatment for klebseillia pneumonia

Answer 9

Carbapenem to begin eg meropenem