Respiratory

Question 1

What complications can pulmonary infection cause?

Answer 1

Organisation (fibrous scarring)
Abscess
Bronchiectasis
Empyema

Question 2

What causes TB?

Answer 2

mycobacterium

Question 3

What type of sensitivity is there in TB?

Answer 3

delayed Type 4

Question 4

Do granulomas occur in TB?

Answer 4

yes, with necrosis

Question 5

What are the symptoms of influenza?

Answer 5

Fever: high, abrupt onset
Malaise
Myalgia
Headache
Cough
Prostration

Question 6

What occurs pathologically in pneumonia in the acute inflammatory response?

Answer 6

Exudation of fibrin-rich fluid
Neutrophil infiltration
Macrophage infiltration
Resolution

Question 7

What is opsonisation?

Answer 7

Tagging of microbes by antibodies

Question 8

What are the complications of pneumonia?

Answer 8

Organisation (fibrous scarring)
Abscess
Bronchiectasis
Empyema

Question 9

When is bronchopneumonia most often seen?

Answer 9

Most often seen in the context of pre-existing disease

Question 10

What is an abscess?

Answer 10

Localised collection of pus

Question 11

What is bronchiectasis and what is it often due to?

Answer 11

Abnormal fixed dilatation of the bronchi

Usually due to fibrous scarring following infection

Question 12

What is pathogenicity in TB due to?

Answer 12

due to ability:

• to avoid phagocytosis
• to stimulate a host T-cell response

Question 13

What can detect microbial genome in TB?

Answer 13

PCR

Question 14

What does T cell response in TB cause?

Answer 14

-enhances macrophage ability to kill mycobacteria
(this ability constitutes immunity)
-causes granulomatous inflammation, tissue necrosis and scarring
(this is hypersensitivity (type IV))

Question 15

In which type of TB is there a Ghon focus?

Answer 15

primary

Question 16

Why does TB reactivate?

Answer 16

Decreased T-cell function

e.g. due to HIV or immunosuppresive therapy

Question 17

Is Haemophilus influenzae a primary cause of influenza?

Answer 17

No

Question 18

Which of Primary influenzal pneumonia and

Secondary bacterial pneumonia is more likely to occur in young adults?

Answer 18

Primary influenzal pneumonia

Question 19

What antivirals may be used for the flu?

Answer 19

oseltamivir

Zanamivir

Question 20

How is influenza virus detected?

Answer 20

-PCR
Nasopharyngeal swabs in virus transport medium
Throat swabs in virus transport medium
other respiratory samples
-Other labs / hospitals may use immunofluorescence, antigen detection (near patient), virus culture

Question 21

Can antivirals be used as prophylaxis for influenza?

Answer 21

Yes (although rarely used in practice)

Question 22

What do Mycoplasma, coxiella and Chlamydophila psittaci all respond to?

Answer 22

tetracycline and macrolides (eg clarithromycin)

Question 23

How are is lab confirmation of mycoplasma, coxiella and Chlamydophila psittaci carried out?

Answer 23

By serology

Question 24

Which type of pneumonia occurs commonly in younger people?

Answer 24

mycoplasma

Question 25

What is Coxiella burnetii also known as and what can cause it?

Answer 25

Q fever, farming (sheep and goats etc)

Question 26

What is a complication of Q fever?

Answer 26

culture negative endocarditis

Question 27

What is Chlamydophila psittaci often caught from?

Answer 27

birds

Question 28

How does bronchiolitis present?

Answer 28

``` 1st or 2nd year of life Fever Coryza Cough Wheeze Severe cases grunting reduced PaO2 Intercostal / sternal indrawing ```

Question 29

What is bronchiolitis most commonly caused by and how is it diagnosed?

Answer 29

Respiratory Syncytial Virus | PCR on throat or pernasal swab

Question 30

What is Chlamydia trachomatis and how is it diagnosed?

Answer 30

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

Question 31

What does Haemophilus influenzae | do clinically?

Answer 31

Acute epiglottis, causes Croup in infants

Question 32

How is Haemophilius influenzae identified clinically?

Answer 32

“X and V test”; H influenzae requires both factors X and V to grow.

Question 33

What is the gram stain of Haemophilus influenzae like?

Answer 33

small gram negative bacillus

Question 34

How is acute epiglottis diagnosed?

Answer 34

blood culture

Question 35

How is acute epiglottis treated?

Answer 35

ITU and ceftriaxone

Question 36

What are the most common organisms involved in exacerbations of COPD? Where are they all present?

Answer 36

Haemophilus influenzae Streptococcus pneumoniae Moraxella catarrhalis Present in normal upper respiratory tract flora

Question 37

When should antibiotics be given for exacerbation of COPD?

Answer 37

consolidation on CXR or signs of pneumonia or increased sputum purulence

Question 38

Which antibiotics should be given for exacerbation of COPD?

Answer 38

1ST LINE Amoxicillin 500mg three times daily (5days) | 2ND LINE Doxycycline 200mg on day 1 then 100mg daily for 4 days

Question 39

What does cystic fibrosis cause?

Answer 39

abnormally viscid mucus which blocks tubular structures in many different organs including the lungs.

Question 40

Chronic respiratory infection is a large problem in cystic fibrosis - which organisms are usually responsible?

Answer 40

Staphylococcus aureus and Haemophilus influenzae Pseudomonas aeruginosa Burkholderia cepacia

Question 41

What organism causes whooping cough?

Answer 41

Bordetella pertussis

Question 42

What are the symptoms of whooping cough?

Answer 42

cold like symptoms for two weeks paroxysmal coughing (2 weeks) repeated violent exhalations with severe inspiratory whoop, vomiting common residual cough for month or more

Question 43

When is treatment of whooping cough most effective?

Answer 43

1st 10 days

Question 44

How is whooping cough diagnosed?

Answer 44

``` pernasal swab (charcoal blood agar/ Bordet-Gengou medium) serology ```

Question 45

What is pneumonia most often caused by?

Answer 45

Streptococcus pneumoniae

Question 46

What is the gram stain of Streptococcus pneumoniae like?

Answer 46

gram positive cocci in pairs/short chains

Question 47

What does the culture of Streptococcus pneumoniae look like?

Answer 47

Alpha haemolytic colonies, typically “draughtsmen” ie with sunken centre

Question 48

How should CAP be treated with a CURB score less than 3?

Answer 48

amoxycillin 1g 3x/day for 7 days

Question 49

With a CURB65 score of more than 3, how should CAP be treated?

Answer 49

Co-Amoxiclav IV 1.2g 3x daily AND Clarithromycin 500mg 2x daily

Question 50

What is nosocomial pneumonia?

Answer 50

hospital acquired

Question 51

What normally causes hospital acquired pneumonia?

Answer 51

gram negative organisms : includes Pseudomonas aeruginosa, and Coliforms (such as E.coli, Klebsiella sp) If aspiration pneumonia anaerobes may be involved

Question 52

How should severe HAP be treated?

Answer 52

Severe IV Amoxicillin + Metronidazole + Gentamicin

Question 53

How should non severe HAP be treated?

Answer 53

Severe IV Amoxicillin + Metronidazole

Question 54

How does Legionairre's disease present?

Answer 54

flu like illness which may progress to a severe pneumonia, with mental confusion, acute renal failure and GI symptoms.

Question 55

What is Legionairre's usually associated with?

Answer 55

travel, water

Question 56

How is Legionairre's diagnosed?

Answer 56

Legionella urinary antigen/ Serology

Question 57

How is Legionairre's treated?

Answer 57

Erythromycin/clarythromycin | Fluoroquinolones eg levofloxacin

Question 58

What is Pneumocysitis carinii pneumonia (Pneumocystis jiroveci)?

Answer 58

pneumonia in patients with AIDs

Question 59

How is PCP treated?

Answer 59

Cotrimoxazole, pentamidine

Question 60

How is aspergillus pneumonia treated?

Answer 60

iv Amphotereicin B

Question 61

What is the growth of TB like?

Answer 61

Bread crumb like growth on special medium (Lowenstein-Jensen media), after prolonged (up to 3 months) incubation

Question 62

What type of coat do Mycobacteria bacilli have?

Answer 62

thick waxy coat

Question 63

How do mycobacteria bacilli appear on a Ziehl-Neelsen (ZN) stain?

Answer 63

red rods

Question 64

Are larger or smaller particles spread as droplets?

Answer 64

larger