Respiratory

Question 1

How do you confirm a lower respiratory tract infection (LTRI)?

Answer 1

Cough (main symptom) 
At least one other:
Fever 
Sputum production 
Breathlessness 
Chest discomfort/pain 

AND no alternative diagnosis (asthma, sinusitis)

Question 2

What is pneumonia?

Answer 2

• Inflammation of the lung parenchyma characterised by consolidation of the affected area
• Alveolar airspace’s filled with exudate, inflammatory cells and fibrin
• Can limit oxygen intake

Question 3

Which bacteria causes pneumonia?

Answer 3

• Streptococcus pneumoniae (most common)
• Haemophilus infleunzae type B (Hib)
• Staphylococcus aureus
• Mycoplasma pneumoniae

Question 4

What can cause pneumonia?

Answer 4

Bacteria
Viruses
Fungi

Question 5

What viruses can cause pneumonia?

Answer 5

Influenza
Respiratory syncytial virus (RSV)
Coronaviruses

Question 6

How do you investigate respiratory symptoms?

Answer 6

1. Physical examination
2. Observations
3. Point of care testing - inflammatory markers (CRP)
4. CXR, FBC, U&Es, sputum and blood cultures, O2 SATS

Question 7

Who is more at risk of getting pneumonia?

Answer 7

Babies and very young children
Elderly
Smokers
Co-morbidities

Question 8

What physical examination findings would indicate pneumonia?

Answer 8

• Use of accessory respiratory muscles
• Adventitious breath sounds (rales/crackles, rhonchi, wheezes)
• Decreased intensity of breath sounds
• Dullness to percussion

Question 9

What are the signs of infection?

Answer 9

• Hyperthermia (fever >38) OR hypothermia (<35)
• Tachypnoea (>18 respirations/min)
• Tachycardia (>100 bpm) OR brachycardia (<60bpm)
• Central cyanosis

Question 10

What would a chest x ray find if pneumonia was present?

Answer 10

Evidence of consolidation

Question 11

How to assess if the pneumonia is severe?

Answer 11

Severe SOB at rest 
Haemoptysis 
Cyanosis 
Feeling cold and clammy with pale/mottled skin 
Syncope 
New confusion 
Difficult to rouse 
Little or no urine output
CURB-65 score

Question 12

How can you differentiate bacterial pneumonia from COVID-19 pneumonia?

Answer 12

With bacterial pneumonia:

• Rapidly unwell after few days of symptoms
• No history of typical COVID-19 symptoms
• Pleuritic pain (sharp chest pain)
• Purulent sputum

Question 13

How can you differentiate COVID-19 pneumonia from bacterial?

Answer 13

With COVID pneumonia:

• History of covid symptoms
• Severe muscle pain (myalgia)
• Loss of sense of smell
• Breathless but NO pleuritic pain
• History of exposure to covid

Question 14

What diagnostic tests can be done to confirm cause of pneumonia?

Answer 14

Microbiological samples for culture and sensitivities 
PCR test 
CXR/CT/Ultrasound 
FBC 
Urine sample

Question 15

Which oral antibiotics are used to treat community acquired pneumonia in adults in COVID times?

Answer 15

MODERATE:
1. Doxycycline 200mg on 1st day then 100mg once a day

2. Co-Amoxiclav 500mg/125mg TDS WITH Clarithromycin 500mg BD

SEVERE & other options unsuitable:
3. Levofloxacin 500mg OD or BD

Question 16

Which IV antibiotics are used to treat community acquired pneumonia in adults?

Answer 16

MODERATE:
1. Co-Amoxiclav 1.2g TDS WITH Clarithromycin 500mg BD

2. Cefuroxime with Clarithromycin

SEVERE:
3. Levofloxacin 500mg OD/BD

Question 17

When should you consider switchIng IV administration to oral?

Answer 17

• Resolution of fever > 24hrs
• Pulse rate <100
• Resolution of tachypnoea
• Well hydrated and taking oral fluids
• Absence of hypoxia
• Improving WCC
• No evidence of legionella, staphylococcal or gram negative enteric bacilli infection
• No concerns over GI absorption

Question 18

Which antibiotics are used to treat CAP?

Answer 18

1st line = Amoxicillin with Clarithromycin

2nd line = Doxycycline