Respiratory Flashcards
The BCG vaccine can be best described as a:
Inactivated vaccine
Subunit (purified antigen) vaccine
Toxoid vaccine
Conjugate vaccine
Live attenuated vaccine
Live attenuated vaccine
A 60 year old man presents to the emergency department with increasing shortness of breath and productive cough. He started feeling sick 3 weeks ago, when he came down with ‘a cold’, where his main symptoms were a runny nose and sore throat. It failed to resolve, and he developed slight shortness of breath and productive cough. His GP prescribed him with amoxycillin for a presumed pneumonia. That course was started three days ago but his symptoms have been getting worse. This morning he was unable to get out of bed because he ‘felt so bad’ and ‘couldn’t catch his breath’. His son called him an ambulance to bring him into hospital. His CURB 65 score is now 2.What is the best course of action?
Send sputum for microscopy and culture. Arrange admission. Prescribe azithromycin to cover atypicals with intrinsic resistance to amoxicillin
Check the number of pills in the bottle and chastise the patient if he hasn’t been taking them
Arrange admission. Treat with ceftriaxone and azithromycin to cover atypicals with resistance to amoxicillin
Send sputum for microscopy and culture. Prescribe azithromycin to cover atypicals with intrinsic resistance to amoxicillin. Discharge for treatment in the community
Send sputum for microscopy and culture. Arrange admission. Prescribe azithromycin to cover streptococcal infection with acquired resistance to amoxicillin
Arrange admission. Treat with ceftriaxone and azithromycin to cover atypicals with resistance to amoxicillin
Mr H, a 66 year-old Maori gentleman, was admitted to the Emergency Department with a 3-day history of rapidly deteriorating chesty cough and shortness of breathes. On admission, his heart rate was 115bpm, blood pressure 88/52mmHg, respiratory rate 32 per minute, O2 saturation 90% on room air. He has deranged arterial blood gas results which were consistent with acute respiratory acidosis. His chest X-ray showed non-segmental consolidation of the right middle lobe. Peripheral blood cultures have been taken, results pending. He has a history of gout and occasional flu in winter but has never experienced anything like this. No known drug allergies. He is an ex smoker and occasional drinker within recommended limits.Please select from the following the most appropriate antibiotics to treat his condition.
Cefuroxime and metronidazole
Amoxicillin and clavulanate acid (Augmentin)
Amoxicillin and erythromycin
Ceftriaxone and azithromycin
Flucloxacillin and erythromycin
Ceftriaxone and azithromycin
Doris a 69 year old lady present with symptoms that are consistent with pneumonia.Doris is usually a healthy and very active 69 year old who enjoys long walks, bowls, aqua jogging and yoga. She is known to have a slight hypertension and is on an ACE inhibitor for this.Its noted she has a blood pressure of 140/95 respiratory rate of 34/min, she is orientated but appears unwell.what is the best appropriate treatment for Doris ?
Select one:
Treat her with oral amoxicillin and azithromycin as an outpatient
Take a sputum culture and blood culture and wait for results before starting antibiotic treatment
Take a sputum culture and start Roxithromycin
Start ceftriaxone and azithromycin and admit her to hospital
Start Amoxicillin and Azithromycin and admit her to hospital.
When assessing the severity of a pneumonia you can use the CURB65 score.But what are the CURB65 Criteria?
C - Creatinine >200 mmol/LU - Urea >7 mmol/LR - Respiratory failure type 1B - Blood pressure <90 systolic or <60 diastolic65 - <65 y/o
C - ConfusionU - Urea >7 mmol/LR - Respiratory failure type 1B - Blue mucous membranes65 - <65 y/o
C - ConfusionU - Urea >7 mmol/LR - Resp Rate >30B - Blood Pressure <90 systolic or <60 diastolic65 - >65 y/o
C - Creatinine > 200 mmol/LU - Urea >7 mmol/LR - Resp rate <10B - Breathing is laboured65 - >65 y/o
C - ConfusionU
Urea >7 mmol/LR
Resp Rate >30B
Blood Pressure <90 systolic or <60 diastolic65
>65 y/o
A 70 year old woman is admitted to ICU as she is febrile, drowsy and delirious. You take bloods and intubate her. You suspect pneumonia and take a sputum sample, which shows gram positive cocci, and start a course of antibiotics. 48 hours later she is not improving, continues to be ventilated and still has the clinical signs of pneumonia. You take another sputum sample and the results now show gram negative rods. Which antibiotic do you prescribe her now?
Select one:
Amoxicillin - as her pneumonia is community acquired, this is the first line treatment. It covers Strep pneumoniae but it also covers other gram negatives such as Haemophilus influenzae and E. Coli, which she now needs to be covered for.
Augmentin - her pneumonia is now caused by hospital-acquired organisms. Augmentin is now the first-line treatment and will cover gram positive and negative organisms as well as some anaerobes. It is fair at covering staph aureus as well, which she may have acquired in hospital.
Ceftriaxone - to treat her hospital acquired pneumonia. Ceftriaxone works like Amoxicillin in treating gram positives likeStrep pneumoniae and some gram negatives, but has better action on E. coli, which we need to target as they reside in the intestinal tract and she has been intubated.
Vancomycin - her pneumonia may have been community acquired, but she is febrile and not responding to treatment in hospital. As she has been intubated, you need to cover her for MRSA.
Augmentin - her pneumonia is now caused by hospital-acquired organisms. Augmentin is now the first-line treatment and will cover gram positive and negative organisms as well as some anaerobes. It is fair at covering staph aureus as well, which she may have acquired in hospital.
Rawiri is a 56 year old male who has been on the general surgery ward for a week following a Whipples procedure. One day on ward rounds, Rawiri tells you (the registrar) that taraumu feels sore and he has developed a maremare. Being a culturally competent doctor, you ask to examine Rawiri’s chest and find crackles in the left lower zone. You get one of your med student underlings to collect a sputum sample and send it to the lab. Later that day the lab reports that the sputum contained Pseudomonas aeruginosa. What would be the most appropriate treatment for Rawiri?
Select one:
PrescribeCeftriaxone, because he has a gram negative infection
Prescribe piperacillin-tazobactam, he has a pseudomonas infection
Its just referred pain from the Whipple procedure, no treatment is needed
He probably has heart failure, treat with cilazapril and digoxin
Prescribe amoxicillin, he has a strep pneumonia infection
Prescribe piperacillin-tazobactam, he has a pseudomonas infection
Harry Potter, a 14-year-old boy, develops pneumonia after swimming in a cold lake for over an hour during the Triwizard Tournament. A sputum sample is collected in the hospital wing by Madam Pomfrey and Harry is diagnosed as being infected with Streptococcus pneumoniae.Unfortunately, there is no magical solution to Harry’s problem, so he is given antibiotics. Which of the following antibiotics is NOT suitable for S. Pneumoniae?
Select one:
Doxycycline
Amoxycillin
Erythromycin
Ceftriaxone
Gentamicin
Gentamicin
Miriram Williams is a 25 year old female who presents with flu like symptoms persisting for the last two weeks. She tells you, the 5th year medical student, that she has been an active gardener her whole life and that her peonies are not doing so well. Microscopy reveals a gram negative diplococci, what empiric antibiotic therapy would be effective for this patient?
Select one:
Ceftriaxone
Amoxicillin
Penicillin
Piperacillin
Roxyithromycin
Roxyithromycin (she has legionella)
You are seeing Mrs P in your GP practice in the middle of winter. She is 34 and has been unwell with a fever, cough and shortness of breath. She has no past medical history. You examine her and find coarse crepitations at the right base. Her respiratory rate is 24 breaths/min, BP 130/70, oxygen saturations 98% on room air and she is alert and orientated. What is your treatment plan?
Select one:
Amoxicillin and azithromycin
Ceftriaxone
Ceftriaxone and azithromycin
Amoxicillin
Azithromycin
Amoxicillin (CAP)
Kingi, a 6 month old male is brought into your GP practice by his parents with a cough and inspiratory whoop which has developed over the past two weeks. You suspect he has whooping cough and perform an oropharyngeal swab for confirmation. During the consultation, Kingi has a coughing fit and you are worried about his condition and consider admitting Kingi to the nearby hospital. Which of the following is unlikely to be a complication of Kingi’s condition?
Select one:
Apnoea
Pneumonia
Dehydration
Sepsis
Sepsis
A mother comes into your clinic with her 2-year old child. She is concerned about her child’s ongoing cough. Upon further questioning, it was revealed that the child has been experiencing paroxysms of coughing, an inspiratory whoop and post-tussive vomiting for the last 4 weeks. What is the typical incubation time for this disease:
Select one:
21-24 days
7-10 days
1-3 days
14-17 days
7-10 days
A 6 month old female infant presents to your GP practice with a 11 day history of coughing, turning red, choking spells and gasping for breath. She has had vomiting associated with these choking spells for the past two days. The infant’s parents report that it feels like she has a fever but they have not checked her temperature. Vital signs taken in the clinic show a heart rate of 164, temperature of 38.1degree celsius and a respiratory rate of 74. On examination, you note the child is coughing. Lung sounds are clear.You order a FBC which shows the child has an elevated white blood cell count of 15,300 with 70% lymphocytes. Gram negative coccobacillus were recovered from a specimen from her posterior nasopharynx. What is the most suitable treatment for this infant?
Select one:
Amoxicillin
Azithromycin
Vancomycin
Erythromycin
Azithromycin
A 60 year old man presents to ED with a 3 day history of SOB, fever, chest pain and a productive cough. There has been a recent outbreak of legionella in the community and you are wary due to his hobby of gardening. If you were covering him for a legionella pneumonia which of the following antibiotics would you use?
Select one:
Piperacillin tazobactam
Ceftriaxone
Azithromycin
Amoxicillin
Penicillin
Azithromycin
What is the main purpose of vaccinating for Bordetella pertussis?
Select one:
There is no point of vaccination as protection wanes over time making the adult population largely susceptible to Bordatella pertussis
A pregnant lady who develops Whooping Cough has a higher rate of miscarriage, so by vaccinating the community this reduces that risk greatly
Prevent disease in infants due to potential serious health outcomes
Gives an unpleasant cough to children and adults which requires a course of antibiotics
It is very hard to treat so vaccination severely reduces the negative health outcomes of a community
Prevent disease in infants due to potential serious health outcomes
