respiratory infections

Question 1

how can someone catch bovine TB?

Answer 1

drinking unpasteurised milk from cows

Question 2

risk factors for TB

Answer 2

diabetes mellitus
immunocompromised (incl. HIV +ve)
poor nutrition 
homelessness
alcoholics
viral hepatitis B/C
pathophysiology
born in high prevalence area

Question 3

organisms responsible for TB

Answer 3

Mycobacterium tuberculosis
Mycobacterium bovis
Mycobacterium africanum
Mycobacterium microti

Question 4

pathology of TB

Answer 4

TB survives inside phagolysosome –> macrophage recruits T cells –> granuloma

Question 5

what is the time frame for primary TB?

Answer 5

within 2 years of infection

Question 6

in what percentage of people will latent TB not do anything?

Answer 6

90%

Question 7

signs of pulmonary TB

Answer 7

productive cough
haemoptysis
weight loss
night sweats
malaise
fever
anorexia

Question 8

signs of lymph node TB

Answer 8

non-tender lymphadenopathy + systemically unwell

Question 9

signs of CNS TB

Answer 9

symptoms of meningitis
raised intracranial pressure (and its associated symptoms)
systemically unwell

Question 10

signs of bone TB

Answer 10

osteomyelitis + systemically unwell

Question 11

signs of abdominal TB

Answer 11

ascites + systemically unwell

Question 12

how many deaths per year worldwide are due to TB?

Answer 12

1.6 million

Question 13

complications of TB

Answer 13

consolidation 
collapse
pleural effusion
pericardial effusion 
extra pulmonary TB

Question 14

which part of the lung is TB most likely to affect?

Answer 14

the apex

Question 15

diagnostic tests for TB

Answer 15

CXR

Ziehl-Neelson test with sputum

Question 16

how to test for active TB

Answer 16

microbiology
microscopy
culture
sputum
urine
CSF
pleural fluid
biopsy

Question 17

how to test for latent TB

Answer 17

Mantoux test (type 4 hypersensitivity)
interferon gamma release assay 
test for memory T cells

Question 18

disadvantages of Mantoux test for latent TB

Answer 18

won’t distinguish infection from disease

false negative for immunocompromised and military TB

Question 19

risk factors for pneumonia

Answer 19

immunocompromised
elderly
infants
COPD
nursing home
impaired swallow
diabetes
congestive heart failure
alcoholics
IVDU

Question 20

which organism is responsible for 40% of community acquired pneumonia?

Answer 20

S.pneumoniae

Question 21

causes (organisms) of community acquired pneumonia

Answer 21

S.pnuemoniae
H.influenzae
S.aureus

atypical:
Legionella pneumophila
Chlamydia pneumoniae

Question 22

most common cause (organism) of hospital acquired pneumonia

Answer 22

P.aeruginosa

Question 23

organisms that are responsible for hospital acquired pneumonia

Answer 23

P.aeruginosa
S.aureus
K.pneumoniae

Question 24

methods of spread of pneumonia

Answer 24

inhalation
aspiration of gastric contents
haematogenous spread

Question 25

pathology of pneumonia

Answer 25

alveolar macrophages release cytokines --> attract neutrophils --> build up of pus, fluid, and cells

Question 26

signs of pneumonia

Answer 26

``` pyrexia cyanosis dehydration confusion tachypnoea hypotension dull percussion note high respiratory rate tachycardia ```

Question 27

symptoms of pneumonia

Answer 27

``` fever rigors anorexia dyspnoea sputum/cough pleuritic pain haemoptysis ```

Question 28

signs of lung consolidation

Answer 28

``` dull percussion decreased air entry bronchial breath sounds crackles ± wheeze increased vocal resonance ```

Question 29

how will inflammation lower lung manifest?

Answer 29

irritation in back of throat --> cough

Question 30

mortality of pneumonia

Answer 30

CAP 1% HAP 10% ITU 30%

Question 31

diagnostic tests for pneumonia

Answer 31

``` bloods - FBC, U&E, CRP endoscopy biopsy CXR O2 sats (<92%) urine, blood, and sputum culture ECG - tachycardia and arrhythmia ```

Question 32

CURB65 what does it stand for? when to admit someone to hospital?

Answer 32

``` Confusion Urea >7 mmol/L RR >30/min BP - systolic >90 or diastolic <60 65 or older ``` score of 3 or more is severe score of 2 or more --> admit patient to hospital score of 4 or 5 --> ITU admission

Question 33

CURB65 and antibiotic treatments

Answer 33

0-1 --> amoxicillin 2 --> amoxicillin and clarithromycin 3-5 --> IV co-amoxiclav and clarithromycin

Question 34

how to treat P.aeruginosa pneumonia in patients with CF?

Answer 34

ceftazidine

Question 35

incubation period of Bordetella pertussis

Answer 35

5-21 days

Question 36

what percentage of cases of pharyngitis are viral?

Answer 36

70-80%

Question 37

sign of diphtheria

Answer 37

thick grey membrane on tonsils produced by WBCs

Question 38

complications of sinusitis

Answer 38

brain abscess sinus vein thrombosis orbital cellulitis

Question 39

complications of whopping cough

Answer 39

pneumonia encephalopathy subconjunctival haemorrhage

Question 40

treatment of whooping cough

Answer 40

clarithromycin

Question 41

proper name for croup

Answer 41

acute laryngo-tracheobronchitis

Question 42

what causes epiglottitis?

Answer 42

Haemophilus influenzae type B (Hib)

Question 43

signs of influenza

Answer 43

``` high fever runny nose sore throat muscle pains headache coughing fatigue weakness ```

Question 44

complications of influenza

Answer 44

viral pneumonia secondary bacterial pneumonia sinus infection

Question 45

how do neuraminidase inhibitors (oseltamivir) target the influenza virus?

Answer 45

inhibits virus from cutting loose from infected cells | inhibits virus' ability to stop clumping together

Question 46

bronchiectasis definition

Answer 46

permanent dilatation of bronchi and bronchioles, obstruction and severe inflammation usually of the lower lobes destruction of bronchial and alveolar walls

Question 47

main organisms responsible for bronchiectasis

Answer 47

H.influenzae Strep. pneumoniae S.aureus P.aeruginosa

Question 48

signs of bronchiectasis

Answer 48

reduced VC chronic cough foul smelling sputum dyspnoea

Question 49

complications of bronchiectasis

Answer 49

``` pneumonia lung abscess emphysema metastatic abscesses amyloid pulmonary fibrosis cor pulmonale chronic infection fungal colonisation septicaemia meningitis ```

Question 50

diagnosis of bronchiectasis

Answer 50

sputum culture cystic shadows on contrast XR obstructive pattern on spirometry bronchoscopy shows haemoptysis

Question 51

treatment of bronchiectasis

Answer 51

antibiotics physiotherapy bronchodilators (ß2 agonists) surgery if advanced