How can direct virus detection be done for PCR?
Nasopharyngeal swabs
Where does H. influenzae tend to colonise in the body?
Upper respiratory tract
H. influenza is a Gram positive bacillus. True/False?
False
Gram negative bacillus
Which organisms are most commonly associated with exacerbations of COPD?
H. influenzae
Strep pneumoniae
Moraxella catarrhalis
Which organism causes whooping cough? How is it treated?
Bordetella pertussis
Macrolides
Strep pneumoniae is a B-haemolitic cocci in clusters. True/False?
False
A-haemolytic cocci in chains
The majority of organisms that cause HAP are Gram what?
Negative
If CURB56 score 0-2, which antibiotics are given?
Amoxicillin (Doxycycline if penicillin allergic)
If CURB65 score 3-5, which antibiotics are given?
Co-amoxiclav + IV clarithromycin/PO doxycyline (IV levofloxacin if penicillin allergic)
In severe HAP, which antibiotics are given?
Amoxicillin (Co-trimoxazole if penicillin allergic), Metronidazole, Gentamicin
Which antibiotics are used for Legionnaire’s disease?
Erythromycin/Clarithromycin
Levofloxacin if penicillin allergic
Which organism particularly causes pneumonia in AIDS patients?
Pneumocystis jiroveci
Which organisms are most common in CAP?
Strep pneumoniae
HI
Mycoplasma pneumoniae
Which organisms are most common in viral pneumonia?
Influenza Parainfluenza Measles Varicella zoster RSV
Give the two main classifications of pneumonia
Bronchopneumonia
Lobar pneumonia
List the main complications of pneumonia
Pleurisy
Empyema
Abscess
Bronchiectasis
List the main reasons for reactivation of TB
More virulent organism
Reduced T cell function - age, HIV, immunosuppression
What is the most likely source of infection in an immunocomprimised host? How is it typically treated?
Opportunistic pathogen e.g. aspergillus, candidas
Variconazole, amphotericin B
Give two methods for diagnosing lung infection
Broncho-alveolar lavage (bronchoscope passed through mouth and fluid squirted into lung and collected)
Biopsy with stains
What is coryza?
Common cold - acute inflammation of nasal passages
How does diphtheria present?
Sore throat, low fever and pseudomembrane on tonsils/pharynx/nasal cavity
Describe acute epiglottitis and give its classic symptom
Inflammation and swelling of the epiglottis obstructs the vocal folds/trachea: life-threatening in children
CONSTANT DROOLING, sore throat, stridor
What are some symptoms of acute bronchitis? How does it arise?
Productive cough (with fever in minority)
Transient wheeze
Cold which goes to the chest
CXR and chest examinations are usually normal in acute bronchitis. True/False?
True
Are antibiotics indicated in acute bronchitis?
No, unless there is underlying (chronic) lung disease (amoxicillin 1st line, doxycycline 2nd line)
Abdominal pain is not a symptom of pneumonia. True/False?
False
It could well be
What does CURB65 stand for? When is it used?
Confusion Urea more than 7 Resp rate more than 30 BP less than 90/61 65 yrs old Used to assess community-acquired pneumonia
What is the commonest pathogenic cause of pneumonia?
Streptococcus pneumoniae
What is special about legionella-acquired pneumonia? Detected via…
Chest symptoms may be absent - usually more GI disturbance
Urine antigen testing
How does influenza present?
High fever of abrupt onset
Malaise and myalgia
Headache
Cough (initially dry and painful)
Haemophilus influenzae is the primary cause of flu. True/False?
False
May be secondary invader
Which influenza virus is present in pandemics?
Influenza A
When are antivirals given for flu?
When patient is at risk of complications (such as pneumonia)
Give examples of 2 antivirals
Oseltamavir
Zanamivi
Which disease(s) arises due to Coxiella burnetti? (3)
Pneumonia
Q fever
Endocarditis
What is bronchiolitis? Who is mainly affected? What is the common sign?
LRTI common in babies and young children
Similar symptoms to a cold - cough, wheeze, fever
STERNAL INDRAWING
Which virus is responsible for 90% of bronchiolitis?
RSV
What is an abscess? What name is given for an abscess in the tonsils?
Local collection of pus
Quinsy
Which 3 main types of virus cause coryza?
Rhinoviruses, RSV, adenoviruses
How does sinusitis present?
Frontal headache, facial pain
Purulent rhinorrhoea
Fever
What does xylometazoline do?
Nasal decongestant
Which group of viruses most commonly cause pharyngitis?
Adenoviruses
What is laryngotracheobronchitis? Who is it most severe in? What is its classical sign? How is it treated?
Inflammatory oedema that can affect vocal cords, usually following parainfluenza infection (CROUP)
Most severe in kids under 3yrs
BARKING COUGH
Oral steroid
What common organism causes epiglottis? How would acute epiglottitis be treated?
Haemophillus influenza type B
Urgent endotracheal intubation
IV antibiotics - CEFTRIAZONE
How quickly can influenza viruses incubate?
3 days
Which patients are at risk of acute bronchitis?
Bacterially infected
COPD
Antibiotics would immediately be given to acute bronchitis patients. True/False?
False
Only given if underlying lung disease present
Describe chest pain in pneumonia
Usually pleuritic
Describe treatment for mild/moderate CAP
Amoxicillin IV for 7 days
Doxycycline if pen-allergic
Describe treatment for severe CAP
Co-amoxiclav IV + Clarythromicin IV
(Levofloxacin if pen-allergic)
Step down to Doxycycline
Total duration = 10 days
Describe treatment for non-severe HAP
moxicillin + Metronidazole for 7 days
Describe treatment for severe HAP
Amoxicillin + Metronidazole + Gentamicin for 10 days
What is bronchiectasis?
Abnormal fixed dilation of bronchi, resulting in inflammation and build-up of mucus
What is the most common cause of bronchiectasis?
Cystic fibrosis
What is halitosis?
Bad breath
What happens clinically in bronchiectasis?
Recurrent bacterial infections
Productive cough
Which antibiotic is given for mild bronchiectasis?
Cefaclor/Ciprofloxacin
Flucloxacillin if S. aureus
Which antibiotic is given for persistent bronchiectasis?
Ceftazidime
Erythema marginatum is present in sarcoidosis. True/False?
FalseErythema nodosum, not marginatum
What happens to calcium and ACE levels in sarcoidosis?
They are raised
What is cystic fibrosis?
Autosomal recessive disorder in which there is a defect in the CFTR gene of chromosome 7
List some symptoms of CF
Thick sputum Recurrent infections Malabsorption Steatorrhoea Abnormal teenage milestones
What are the clinical features of an acute exacerbation of COPD? How is it treated?
Increased sputum production and purulence
Increased SOB/ wheeze
Productive cough
Coarse crackles
Antibiotics if increased sputum purulence - amoxicillin 1st line, doxycycline 2nd line
What is pneumonia?
Complete filling of alveolar spaces with inflammatory cells leading to impaired gas exchange
List some signs of pneumonia
Hypotension Fever and rigors SOB Productive cough Haemoptysis Pleurisy
How is pneumonia investigated?
CXR ABG/ O2 sats Sputum culture Bronchoscopy Blood test - urea Viral PCR
When is Klebsiella usually identified in pneumonia?
In alcoholics, described as ‘red jelly sputum’
What are the common complications of flu?
Pneumonia
Pericarditis
Bronchitis
Otitis media
What is advised in the management of pneumonia?
Antibiotics Vaccination Fluids Bed rest No smoking
What is advised in the management of flu?
Vaccination
Paracetamol
Bed rest
Fluids
When in the vaccination of flu is live attenuated vaccine preferred over the killed form?
In young children