Respiratory infections

Question 1

Whats this?

Answer 1

Viridans streptococci gram +ve cocci in chains - normal commensal in respiratory tract

Question 2

Whats this?

Answer 2

Neisseria meningitidis - gram -ve cocci, normal comensal

Question 3

Whats this?

Answer 3

Oral candidiasis candida albicans - normal commensal in resp tract, if overgrows can cause oral thrush

Question 4

Whats this?

Answer 4

Streptococcus pneumoniae - transient commensal in resp tract

Question 5

Whats this?

Answer 5

Streptococcus pyogenes - beta haemolytic (full haemolysis), transient in resp tract

Question 6

Whats this?

Answer 6

Haemophilus influenzae - gram -ve coccobacilli, transient in respiratory tract

Question 7

Whats this?

Answer 7

Gram -ve bacilli - either pseudomonas aeruginosa or escherichia coli, rare in resp tract

Could also be klebsiella, legionella or chlamydia pneumoniae but these are atypical

Question 8

Whats this?

Answer 8

Gram -ve diplococci - Moraxella Catarrhalis

Question 9

What 4 organisms often cause acute bronchitis?

Answer 9

Viruses - most common
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella Catarrhalis

Question 10

Treatment for bronchitis?

Answer 10

Virus - self limiting
Can have physiotherapy, bronchodilation +/- abx if bacterial

Question 11

4 types of pneumonia

Answer 11

Community
Hospital - 48hrs post admission
Ventilation - 48hrs post intubation
Immunosupressed

Question 12

CXR signs of pneumonia

Answer 12

Patchy consolidation/opacification
Cavitations - gas filled spaces within consolidated zone

Question 13

What anatomy type of pneumonia is this?

Answer 13

Lobar pneumonia - can see where horizontal fissure consolidation stops, therefore isolated to one lobe (eg superior lobe)

Question 14

What type of pneumonia is this?

Answer 14

Bronchopneumonia - diffuse, multiple zones affected

Question 15

Typical community acquired pneumonia organisms

Answer 15

• Streptococcus pneumoniae - gram +ve cocci chains, alpha haemolysis
• Haemophilus influenzae - gram-ve coccobacilli
• Moraxella catarrhalis - gram -ve diplococci
• Group A streptococcus pyogenes - gram +ve cocci chains, beta haemolytic in blood agar
• Viruses

Question 16

Atypical organisms causing community acquired pnuemonia

Answer 16

• Mycoplasma pneumoniae - no gram stain
• Legionella - esp contaminated water sources (gram -ve bacilli)
• Staphylococcus aureus - grapes, gram +ve
• Klebsiella pneumoniae - gram -ve bacilli
• Coxiella burnetii - farm animals, gram -ve rod
• Chlamydia pneumoniae - gram -ve

Question 17

What is this rash and what infection is it associated with?

Answer 17

Erythema multiforme - target like rash
Associated with mycoplasma pneumoniae infection (atypical community acquired pneumonia)

Question 18

Presentation of pneumonia

Answer 18

Tachypnoea
Wheeze
Cough
Sputum production
Crackles in lungs on auscultation, bronchial breathing
Dullness to percussion
Fever
Tachycardia
Pleuritic chest pain
Organ dysfunction? - hypotension, confusion

Question 19

What scoring system is used to decide if someone should be admitted to hospital with pneumonia?

Answer 19

CURB 65
Confusion
Urea >7mmol/L
Respiratory rate >30
Blood pressure <90 systolic or <60 diastolic
Or >65

Question 20

Why do you get urine sample in pneumonia presentation?

Answer 20

Test for legionella pneumophilia or pneumococcus cause of pneumonia (eg streptococcus pneumoniae)

Legionella

Question 21

How to test for viruses in pneumonia presentation?

Answer 21

Nose/throat swab or nasopharyngeal aspirate

Question 22

Which pneumonia organisms are a retrospective diagnosis so you send a blood/serum antibody test for?

Answer 22

Mycoplasma pneumoniae
Coxiella Burnetti

An antibody test is not used for any other causes apart from these

Question 23

Management for mild CAP

Answer 23

Amoxicillin - emperical abx, effective against most common organisms
Clarithromycin/Erythromycin/Doxycycline if allergic to penicillin

Question 24

Moderate CAP management - investigations

Answer 24

• Blood culture
• Sputum sample
• Urinary streptococcal antigen (for legionella and pneumococcus)
• Viral screen

Question 25

Treatment for severe CAP

Answer 25

All things from moderate + bronchoscopic specimen

Question 26

Mild vs severe antibiotic treatment length

Answer 26

Mild - 5-7 days
Severe 7-10 days

Question 27

Antibiotic for severe CAP

Answer 27

Co-amoxiclav + Clarithromycin/erythromycin or doxycycline

Levofloxacin in penicillin allergy (Quinolones)