lower respiratory

Question 1

acute bronchitis

Answer 1

preceded by common cold

cold which goes to the chest

Question 2

acute bronchitis clinical features

Answer 2

productive cough
fever 
normal CXR
normal chest exam 
transient wheeze

Question 3

acute bronchitis treatment

Answer 3

usually self limiting
antibiotics not indicated
can lead to significant morbidity in patients with chronic lung disease

Question 4

infections in patients with COPD

Answer 4

variable disease 
chronic sputum production 
bronchoconstriction 
inflammation of the airways 
SOB
chest pains 
exacerbation - infective, non-infective

Question 5

acute exacerbation of COPD

Answer 5

may be preceded by upper respiratory infection - sputum, wheezy, SOB
examination - respiratory distress, wheeze, coarse crackles, cyanosed, ankle oedema

Question 6

management of acute exacerbation of COPD primary care

Answer 6

antibiotic - doxycycline or amoxicillin
bronchodilator inhalers
short course of steroids
refer to hospital if evidence of respiratory failure, not coping at home

Question 7

management of COPD exacerbation in hospital

Answer 7

arterial blood gases
CXR
oxygen if hypoxaemic
rest, then mobilise

Question 8

red hpatisation

Answer 8

consolidation caused by pneumonia

named as looks more like liver tissue

Question 9

pneumonia symptoms

Answer 9

malaise
anorexia
sweats
rigors
myalgia 
arthralgia 
headache
confusion
cough 
pleurisy
haemoptysis
dyspnoea
preceding URTI
abdominal pain
diarrhoea

Question 10

pneumonia signs

Answer 10

fever 
rigors
herpes labialis
tachypnoea
crackles
rub
cyanosis
hypotension

Question 11

pneumonia investigation

Answer 11

blood culture
serology
arterial blood gases
full blood count
urea
liver function
CXR

Question 12

CURB65

Answer 12

community required pneumonia 
Confusion
Urea>7
Respiratory rate 
Blood pressure systolic <90 or diastolic <60
65 years or older

Question 13

community acquired pneumonia management

Answer 13

antibiotics - amoxicillin, doxycycline
oxygen 
fluids
bed rest
no smoking

Question 14

pathogens

Answer 14

S. pneumoniae
H. influenzae
legionella sp
staph aureus
M. pneumoniae
C. pneumonia
Gm -ve enterobacteria
viruses
influenza A & B
chlamydia psitacci
coxiella burnetii

Question 15

mycoplasma pneumonia

Answer 15

wide range of pathologies 
pneumonia
hepatitis
immune thrombocytopenic purpura
autoimmune haemolytic anaemia
arthritis
no cell wall
causes protracted paroxysmal cough
common cause of community acquired pneumonia 
person to person spread

Question 16

hospital acquired pneumonia

Answer 16

need extended gram negative cover

amoxicillin, gentamicin

Question 17

apiration pneumonia

Answer 17

need anaerobic cover

amoxicillin, metronidazole

Question 18

legionella

Answer 18

chest symptoms may be minimal
GI disturbance is common
confusion common
levofloxacin

Question 19

IV antibiotics when

Answer 19

oral route not available
sensitivities
deep seated infections -abscesses, bone, endocarditis, meningitis
first dose

Question 20

lifestyle

Answer 20

HIV - PCP
PWID - staph aureus
alcohol/homeless - TB, Klebsiella
frequently hospitalised - pseudomonas
returning traveller - legionella, TB
indian sub-continent - TB
eastern Europe - MDR TB

Question 21

complications of pneumonia

Answer 21

respiratory failure
pleural effusion
empyema
death

Question 22

influenza clinical presentation

Answer 22

fever - high, abrupt onset
malaise
myalgia
headache
cough
prostration

Question 23

classical flu

Answer 23

influenza A

influenza B

Question 24

Flu like illnesses

Answer 24

parainfluenza viruses

Question 25

haemophilus influenzae

Answer 25

bacterium not a primary cause of flu may be a secondary invader

Question 26

flu transmission

Answer 26

by droplets, through direct contact with secretions of someone with the infection

Question 27

flu complications

Answer 27

``` primary influenzal pneumonia secondary bacterial pneumonia bronchitis otitis media perinatal mortality, prematurity, smaller neonatal size, lower birth weight ```

Question 28

flu therapy

Answer 28

symptomatic - bed rest, fluids, paracetamol | antivirals - oseltamivir (tamiflu), zanamivir

Question 29

lab confirmation of influenza

Answer 29

direct detection of virus PCR nasopharyngeal swabs throat swabs

Question 30

coxiella burnetii

Answer 30

``` Q fever - pyrexia of unknown orign pneumonia uncommon, sporadic zoonosis sheeps and goats complication - culture negative endocarditis ```

Question 31

chlamydophila psittaci

Answer 31

casues Psittacosis uncommon, sporadic zoonosis caught from pet birds presents as pneumonia

Question 32

bronchiolitis

Answer 32

lung infection and causes inflammation and congestion in bronchioles 1st or 2nd year of life fever coryza cough wheeze severe cases - grunting, decrease PaO2, intercostal/sternal indrawing

Question 33

bronchiolitis complications

Answer 33

respiratory and cardiac failure

Question 34

chlamydia trachomatis

Answer 34

STI which can cause infantile pneumonia | diagnosed by PCR on urine of mother or pernasal/throat swabs of child

Question 35

chlamydophila pneumoniae

Answer 35

person to person mostly mild respiratory infection may be picked up by test foe psittacosis