Infection Tutorial

Question 1

Give examples of URTIs

Answer 1

The common cold

Rhinosinusitis

Pharyngitis

Tonsillitis

Quincy

Epiglottitis

Question 2

Which types of antibtioics are ineffective against mycoplasma pneumoniae and why ?

Answer 2

Beta-lactams are ineffective
-bacteria lacks cell wall

Question 3

What are synptoms of pneumonia ?

Answer 3

Older people, particularly, present in atypical ways. It is not uncommon for older people to present with confusion, reduced mobility, diarrhoea and not much in the way of cough.

Question 4

What is what ?

Answer 4

Ateclestasis is a veil sign

Question 5

What is this ?

Answer 5

Right midzone opacification; Consolidation pattern.
-Can’t see fissures so can’t tell which lobes are involved without a lateral CXR or a CT

Question 6

What is this ?

Answer 6

More extensive opacification left lower and mid zones; Consolidation pattern.
-Could be either upper or lower lobe, need a lateral CXR or CT to be certain

Probably pneumonia if symptoms agree

Question 7

What is this ?

Answer 7

Widespread bilateral miliary shadowing, typical of TB
-Bilateral nodular change, everything filled with pus
-Differential includes varicella pneumonitis

Question 8

What is this ?

Answer 8

Patch of consolidation adjacent to the left heart border

if symptoms agree, pneumonia

Question 9

What is this ?

Answer 9

Right lower zone consolidation
-Middle lobe, given the demarcation by the horizontal fissure

Question 10

What does CURB65 really measure ?

Answer 10

Really is testing organ function due tohypoperfusion due to sepsis, put is used for CAP
-can overestimate illness in old people and underestimate it in young people

Question 11

Which antibiotics should be used for S. Pneumoniae ?

Answer 11

in pneumonia ocntext

Question 12

Which antibiotics should be used for S. Aureus ?

Answer 12

Question 13

Which antibiotics should be used for H. influenzae ?

Answer 13

Question 14

Which antibiotics should be used for P. Aeruginosa ?

Answer 14

Question 15

Which antibtioics should be used for M. Caterrhalis ?

Answer 15

Moraxella are all resistant to amoxicillin, but almost always sensitive to Co-Amoxiclav.

Question 16

Which antibtioics are used for M. Pneumoniae ?

Answer 16

Question 17

What should be tested for in a patient with meningitis or a neisseria infection ?

Answer 17

Compliment as compliment important in clearing neisseria

Question 18

Pneumonia, confusion, diarrhoea in a returning traveller. What is up with this guy ?

Answer 18

Legionella Pneumonia
-Lives in warm water
-Commonly found in air conditioning units
Levofloxacin treatment

Question 19

How does tracheitis present ?

Answer 19

Central burning chest pain on coughing

Question 20

How is Mycoplasma Pneumoniae treated ?

Answer 20

Sensitive to macrolides, fluoroquinolones,
-Lacks peptioglycan wall so resistant to beta lactams;
glycopeptides, sulfonamides, trimethoprim, polymixins, rifampicin
-Indolent presentation
-Tested for by checking IgM and IgG and PCR

Indolent = causing little or no pain.

Question 21

Where does Haemophilus Influenzae show up ?

Answer 21

Very common pathogen in younger patients with bronchiectasis
-Nursery workers particularly at risk
-Must rule out cystic fibrosis in patients with bronchiectasis under the age of 40

Coloniser

Question 22

IV drug abuser with sepsis and boggy sweling in groin. What’s happened ?

Answer 22

Sepsis; Systemic Inflammatory Response Syndrome (SIRS) with a probable site of infection
-Injection site infection
-Septic emboli (With or without endocarditis)
-Very high suspicion of Staph Aureus bacteraemia
-Needs iV fluclox and vanc

Question 23

Give examples of causes of cavitating pneumonia

Answer 23

TB
Klebsiella
Enterobacteria
Aspiration pneumonia (?)

Question 24

How does a pneumocystis pneumonia present in history and on examination ?

Answer 24

History
-Dry cough for several weeks
-Breathlessness
-Poor response to first line antibiotics

Examination
-Very little to find, or fine inspiratory crepitations
-Cyanosis
-Breathlessness of exertion
-?Other features of immunosuppression (HIV)

Question 25

How is pneumocystis pneumonia treated ?

Answer 25

Treatment -High Dose Cotrimoxazole -High Dose Steroids

Question 26

What are complications of pneumocystic pneumonia ?

Answer 26

Complications -Pneumothorax -Respiratory Failure -Death | V high mortality