abx (rti)

Question 1

pharyngitis bacteria, first line

Answer 1

streptococcus pyogene (gram pos), amoxicillin

Question 2

GOT of pharyngitis

Answer 2

• Reducing symptom severity and duration
• Prevention of acute complications, such as otitis media,
  peritonsillar abscesses, or other invasive infections
• Prevention of delayed complications or immune sequelae, particularly acute rheumatic fever
• Prevention of spread to others (no longer infectious after 24
  hours of antibiotics)

Question 3

modified centor criteria

Answer 3

• Fever > 38
• Swollen, tender anterior cervical lymph nodes
• Tonsillar exudate
• Absence of cough
• Age:
  3 – 14 years (+1)
  15 – 44 years (0)
  45 years or older (-1)

Question 4

rhinosinusitis pathogen, first line

Answer 4

Streptococcus pneumoniae
Haemophilus influenzae
(gram neg)

augmentin

Question 5

differential diagnoses of rti

Answer 5

bronchitis, pneumonia, acute asthma, or an exacerbation of COPD

Question 6

acute bronchitis cough advice

Answer 6

Patients with acute bronchitis should be told that their cough
may last for at least 3 weeks and that antibiotics will not hasten
resolution of the cough.

Question 7

risk factors of pneumonia

Answer 7

smoking, chronic lung conditions (eg asthma, copd), immunosuppression

Question 8

lung auscultation for pneumonia

Answer 8

• Diminished breath sounds over the affected area
• Inspiratory crackles during lung expansion

Question 9

symptoms of pneumonia

Answer 9

• Cough, chest pains, shortness of breath, tachypnoea, hypoxia
• Increased sputum production

Question 10

cxr finding pneumonia

Answer 10

evidence of a new
infiltrates or dense consolidations

Question 11

urinary antigens in pneumonia

Answer 11

Streptococcus pneumonia
y Legionella pneumophilia

Question 12

when are urinary tests recommended for pneumonia?

Answer 12

severe CAP or hospitalized patients

Question 13

what is CAP

Answer 13

Onset in the community or < 48
hours after hospital admission

Question 14

what is HAP

Answer 14

Onset ≥ 48 hours after hospital
admission

Question 15

what is VAP

Answer 15

Onset ≥ 48 hours after mechanical
ventilation

Question 16

CAP outpatient pneumonia pathogens (no comorb)

tx?

Answer 16

Streptococcus pneumoniae

amox or FQL

Question 17

CAP
- outpatient comorb
- inpatient pathogens non severe

Answer 17

s.pneumoniae, h influenzae + atypicals

beta lactam +
macrolide/doxy
OR
FQL

Question 18

CAP if inpatient non severe but have risk factors for MRSA

Answer 18

linezolid, vanco

Question 19

what are macrolides/doxycycline often used for

Answer 19

covering atypicals

Question 20

why do we avoid cipro in CAP/VAP/HAP

Answer 20

does not cover s.pneumoniae

Question 21

CAP inpatient pathogens severe

Answer 21

outpatient
s.aureus
atypicals
klebsiella pneumoniae
BULKHOLDERIA PSEUDOMALLEI

Question 22

CAP inpatient severe tx

Answer 22

beta‐lactam (amoxicillin/clavulanate OR Penicillin G)
+
Ceftazidime (pseudomonas)
+
Macrolide (atypical)

OR

Respiratory FQ (levofloxacin OR moxifloxacin)

Ceftazidime (bulkholderia)

Question 23

what is CURB 65

Answer 23

Confusion (new onset) 1
Urea > 7 mmol/L 1
RR ≥ 30 breaths/min 1
Blood Pressure: Low
Age ≥ 65 years

≥3: consider ICU admission

Question 24

uses of PO vanco

Answer 24

only cdad

Question 25

risk factors for MRSA

Answer 25

▪Resp isolation of MRSA in last 1 year ▪Hospitalisation or parenteral antibiotic use in last 90 days AND MRSA PCR screen positive

Question 26

risk factors for p aeru

Answer 26

▪Resp isolation of P. aeruginosa in last 1 year

Question 27

which fql covers for pseudomonas

Answer 27

levoflox, ciproflox (but increasing resistance)

Question 28

anti pseudomonal agents

Answer 28

Piperacillin/tazobactam, Ceftazidime, Cefepime, Meropenem, Levofloxacin

Question 29

if lung abscess and empyema (pus collection), what additional coverage

Answer 29

anaerobes metronidazole / clindamycin

Question 30

adverse effects of fqls

Answer 30

tendonitis, tendon rupture, neuropathy, QTc prolongation, CNS disturbances, hypoglycemia

Question 31

CAP treatment duration

Answer 31

5d, 7d if MRSA/p.aeruginosa

Question 32

CAP need to repeat microbio test or cxr?

Answer 32

no unless clinical deterioration

Question 33

healthcare related risk factors for HAP/VAP

Answer 33

Healthcare‐related factors ▪ Prior antibiotic use ▪ Sedatives ▪ Opioid analgesics ▪ Mechanical ventilation ▪ Supine position

Question 34

minimum coverage for HAP/VAP

Answer 34

pseudomonas, s. aureus

Question 35

when to cover MRSA if VAP/HAP

Answer 35

- prior intravenous antibiotic use within 90 days - isolation of MRSA in last 1 year - hospitalization in a unit where >20% of S. aureus are MRSA - patient is at high risk for mortality (ie need for ventilatory support due to HAP and septic shock)

Question 36

when to cover pseudomonas in hap/vap

Answer 36

USE 2 AGENTS OF DIFF CLASSES - risk factor for antimicrobial resistance (prior intravenous antibiotic use within 90 d; acute renal replacement therapy prior to VAP onset; isolation of P. aeruginosa in last 1 year) - hospitalization in a unit where >10% of Pseudomonas isolates are resistant to an agent being considered for monotherapy - patient at high risk for mortality (include need for ventilatory support due to HAP and septic shock)

Question 37

why should you not given aminoglycoside more than a week

Answer 37

nephrotoxicity

Question 38

carbapenem first line for what

Answer 38

ESBL / MDRO

Question 39

does ceftazidime cover gram pos

Answer 39

no

Question 40

monitoring parameters

Answer 40

heart rate, respiratory rate, blood pressure, oxygen saturation, and temperature

Question 40

tx dx for hap/vap

Answer 40

7d