Pneumonia

Question 1

What is the most common causative organism of community acquired pneumonia?

Answer 1

Streptococcus Pneumonia

Question 2

What are the 4 common clinical features associated with pneumonia?

Answer 2

1. Cough
2. Breathlessness
3. Fever
4. Chest pain

Question 3

Pneumonia due to which 2 infective organisms are particularly associated with myalgia and arthralgia?

Answer 3

1. Legionella

2. Mycoplasma

Question 4

Outline the white cell derangements associated with a bacterial or viral infection respectively

Answer 4

Bacterial - neutrophilia

Virus - Neutropenia

Question 5

Name a fungi that can cause pneumonia

Answer 5

Pneumocystis Jiroveci

Question 6

What infective organism most commonly causes pneumonia in patients with COPD?

Answer 6

Haemophilus Influenza

Question 7

Name the organism most likely to cause pneumonia in alcoholics

Answer 7

Klebsiella Pneumonia

Question 8

What are the 3 main signs heard on auscultation that are associated with pneumonia?

Answer 8

1. Reduced breath sounds
2. Bronchial breathing
3. Coarse crackles

Question 9

Recall the components of the CURB-65 scoring system

Answer 9

C - Confusion (AMT < 8/10)
U - Urea > 7mmol/L
R - Respiratory Rate > 30 breaths per minute
B - Blood pressure: systolic < 90, diastolic < 60

65 - Aged > 65

Question 10

What are the 4 classical features of pneumococcal pneumonia?

Answer 10

1. Rapid onset
2. High Fever
3. Pleuritic chest pain
4. Herpes Labialis

Question 11

Give 4 clinical characteristics associated with Legionella pneumonia

Answer 11

1. Atypical Chest signs
2. Dry cough
3. Hyponatraemia
4. Lymphopenia

Question 12

What type of microbe is clostridium difficile?

Answer 12

Gram positive rod

Question 13

What is the name of the syndrome that can be caused by C.diff exotoxin?

Answer 13

Pseudomembranous colitis

Question 14

Which antibiotics are now thought to be the leading cause of C.diff infections in hospitals?

Answer 14

Second and third generation cephalosporins

Question 15

Aside from antibiotics, give another drug type that can increase an individuals risk of a C.diff infection

Answer 15

Proton pump inhibitors

Question 16

What is the first line therapy for C.diff infection

Answer 16

10-14 days of metronidazole

Question 17

Strep. Pneumonia menignitis commonly affects which age group?

Answer 17

3 months - 6 years

Question 18

What is the first line antibiotic used in the treatment of atypical pneumonias?

Answer 18

Clarithromycin

Question 19

What is the first line treatment for pneumocystis jiroveci Pneumonia?

Answer 19

Co- trimoxazole

Question 20

Name a common complication of pneumocystis jiroveci pneumonia

Answer 20

Pneuomothorax

Question 21

List 3 possible extra pulmonary manifestations of pneumocystis jiroveci pneumonia

Answer 21

1. Hepatosplenomegaly
2. Lymphadenopathy
3. Choroid lesions

Question 22

How does the CURB-65 score correspond to the risk of mortality at 30 days?

Answer 22

0-1 - < 5% mortality rate
2-3 - <10%
4-5 - 15-30%

Question 23

Give 3 inflammatory markers to look at when deciding whether an infective exacerbation of COPD requires antibiotics

Answer 23

1. Wheeze
2. Breathlessness
3. Increased eosinophil count

Question 24

Compare the aetiology of community and hospital acquired pneumonias

Answer 24

Community - Gram positive bacteria, Mycoplasma, influenza

Hospital - Gram negative bacteria, Staph Aureus

Question 25

Outline the main clinical findings seen in CAP (6)

Answer 25

1. Pyrexia 2. Tachypnoea 3. Dull to percussion 4. Bronchial breathing 5. Focal crackles 6. Mental confusion

Question 26

Patients with CAP that can be treated at home are given which antibiotic?

Answer 26

Amoxicillin

Question 27

Define empyema

Answer 27

Pus in the pleural space

Question 28

In suspected bacteraemia, how many blood culture samples should be taken?

Answer 28

Two sets of two bottles should be taken at different times and different sites. NB/ 3 cultures should be taken in cases of infective endocarditis and PUO (pyrexia of unknown origin)

Question 29

Recall 3 organisms that are considered to have multi drug resistance

Answer 29

1. Extended spectrum beta lactamases 2. Carbapenemases (CPE, KPC) 3. Colistin resistant E.Coli

Question 30

Name 2 organisms that can be investigated via urine antigen analysis

Answer 30

1. Pneumococcus | 2. Legionella

Question 31

What is beta-D-glucan and how is useful?

Answer 31

Used for the investigation of potential fungal infections. It is a pan fungal cell wall component released into the blood during invasive fungal infections (v.high sensitivity but not specific

Question 32

Name the 4 serological markers used to identify the different phases of a HBV infection

Answer 32

1. Hepatitis B surface antigen 2. Hepatitis B surface antibody 3. Total hepatitis B core antibody 4. IgM antibody to hepatitis B core antigen

Question 33

Name 2 drugs that can lead to re-activation of TB

Answer 33

1. Infliximab | 2. Corticosteroids

Question 34

Rifampicin is commonly associated with which adverse effect?

Answer 34

Hepatotoxicity