LRTI

Question 1

Croup- aetiology

Answer 1

• usually in children

- COVID-19, parainfluenza virus, influenza virus, RSV, mycoplasma pneumoniae

Question 2

Croup- symptoms

Answer 2

• seal’s bark, hoarseness
• precedent URTI (fever, laryngitis, tachypnea and wheezing, inspiratory stridor, hypoxemia)
• steeple sign on XR

Question 3

Croup- diagnosis

Answer 3

• clinical

- viral antigen detection, PCR for NPA

Question 4

Croup- treatment

Answer 4

oxygen therapy
ventilatory support
nebulised bronchodilator

Question 5

Pertussis- Treatment

Answer 5

• macrolides

- supportive

Question 6

Community acquired pneumonia- treatment

Answer 6

• beta lactam + macrolide/tetracycline

- supportive

Question 7

Atypical pneumonia syndrome

Answer 7

• walking pneumonia
• No significant pathogen in routine culture
• not responding to beta lactam
• long course of illness

Question 8

Atypical pneumonia syndrome- aetiology

Answer 8

• mycoplasma pnuemoniae (special culture)
• chlamydia trachomatis (cell culture)
• chlamydophila pneumoniae (cell culture)
• chlamydophila psittaci - parrot fever, psittacosis (cell culture)
• legionella pneumophila (special culture, antigen)
• respiratory viruses (cell culture, antigen)

PCR/nucleic acid amplification

Question 9

Legionnaire/ legionellosis

Answer 9

• urine antigen detection, in fresh water
• charcoal based medium
• treatment: macrolides, fluoroquinolones

Question 10

nosocomial pneumonia- predisposinng factors

Answer 10

• advanced age, underlying diseases
• gastric acid suppression
• intubations and use of respiratory equipment

Question 11

Nosocomial pneumonia- aetiology

Answer 11

• MRSA, non-fermenters: pseudomonas, acinetobacter baumanii, legionella penumophila, gram negs

Question 12

Aspiration pneumonia

Answer 12

• elderly, drunk, unconscious, iV drug addicts
• loss of gag and swallowing reflex, loss of consciousness
• obstruction, chemical pneumonitis, bacterial pneumonia

Question 13

Complications- lung abscess

Answer 13

• necrotising lung parenchyma, with pus containing cavitations (air fluid level)
• bronchiectasis, bronchial obstruction, aspiration pneumonia, septic emboli
  Secondary to aspiration: mixed oral flora, anaerobes
  Secondary to bacteremia: monobacteria e.g. S. aureus, K. pneumoniae, P. aeroginosa

Question 14

Complications- empyema thoracis

Answer 14

• predisposing factors: pneumonia, surgery, perforated oesophagus, mediastinitis
• Secondary to pneumonia: the one causing pneumonia
• Secondary to surgery or eosophagus: anaerobes, aerobic gram neg

Question 15

TB- diagnosis

Answer 15

clinical, radiological, acid fast stain
culture: faster culture system and earlier sensitivity result from BACTEC
tuberculin skin test
PCR

Question 16

Pneumocystosis- presentation

Answer 16

pneumocystis jirovecii
- commonly present as pneumonia
(pulmonary Pneumocystosis, extrapulmonary not common)

Question 17

Pneumocystosis- epidemiology

Answer 17

• immunocompromised people (AIDS-defining illness, malnourished premature and overcrowded children)
• transplant recipient, high dose corticosteroid
• chronic lung disease

Question 18

Pneumocystosis- diagnosis

Answer 18

Signs: diffuse bilateral infiltrate on CXR
hypoxemia

Definitive:
Sputum- induced sputum by nebulised hypertonic saline, expectorated not accepted
Bronchoalveolar lavage, transbonchial or open lung biopsy
Stain: methenamine silver stain, Giemsa stain and immunofluorescent stain

Question 19

Pneumocystosis- treatment

Answer 19

high dose cotrimoxazole

Question 20

Influenza symptoms

Answer 20

• systemic more prominent than respiratory
  system: fever, headache, myalgia, malaise, arthralgia
  respiratory: dry cough, sore throat, rhinorrhea

Question 21

Influenza- complications

Answer 21

• pneumonia

- myositis, encephalitis, Reye syndrome (with NSAID and aspirin)

Question 22

Influenza- diagnosis

Answer 22

• clinical/hx
• RT-PCR
• antigen detection: immunofluorescent study, immunochromatographic assay, ELISA

Question 23

Influenza- treatment

Answer 23

• supportive: analgesics, antipyretics (do not use aspirin and NSAID)
• antivirals: adamantanes, neuraminidase inhibitors (oseltamivir, zanamivir, baloxivir)

Question 24

Influenza- prevention

Answer 24

chemoprophylaxis: oseltamivir
vaccine: inactivated (not used, IM/ID), live attenuated (inhalation), recombinant hemagglutinin (not used)
composition: seasonal- trivalent or quadrivalent, pandemic- monovalent