CAP

Question 1

Most common bacterial microbe 3w to4y

Answer 1

Strep pneumoniae

Question 2

Most common bacterial pathogen 5y and older

What microbes commonly complicates influenza A

Answer 2

Mycoplasma
Chlamydia pneumoniae

S pneumoniae ( most common), haemophilus influenzae, S aureus

Question 3

Ddx of recurrent pneumonia

Answer 3

CF, sickle cell

Immune disorders: HIV, bruton, CVID, SCID, CGD, hyper IgE, leukocyte adhesion defect

Cilia disorders: immotile cilia, kartageners

Anatomic: sequestration, lobar emphysema, GORD, foreign body, H type TOF, bronchiectasis, aspiration, aberrant bronchus

Question 4

Bronchiectasis exacerbation

Dx

Answer 4

Major criteria
wet cough for 72h or increased cough frequency for 72h

Minor criteria 
Change in sputum colour
Breathless 
Chest pain
Crackles
Wheeze

Lab criteria
Crp, serum il6, serum amyloid a, elevated neutrophils

2 major
1 major & 1 lab
1 major & 2 minor

Question 5

Bronchiectasis predisposing conditions

Answer 5

Proximal airway narrowing
Airway wall compression
Intraluminal obstruction
Airway stenosis or malacia

Airway injury
BO, recurrent pneumonia

Altered host defence
CF, ciliary dyskinesia, impaired cough

Altered immunity: hypogamm, HIV or immunosuppressants

Other: ABPA, plastic bronchitis

Question 6

CF
Disease frequency 
No of amino acids
Most common mutation 
Basic defect

Answer 6

1 in 3,500
1,480 amino acids
F508 del. 50% of northern euro CF homozygous for this. 80% hetero for this
Epithelial cells unable to secrete Cl- in response to cAMP
Increased Na+ resorption in respiratory epithelial cells