You are on page 1of 2

For Pulmonary infections TB

1. According to the American Thoracic Society Guidelines a patient who has treatment initiated as
an outpatient for community acquired pneumonia with no underlying cardiopulmonary or other
modifiers should be treated with either of the below except:
a. Advanced generation macrolide
b. Azithromycin or clarithromycin
c. Doxycycline
d. IV. Anti-pseudomonal fluoroquinolone
2. In community acquired pneumonia one can expect to recover the causative organism in what
percentage of cases?
a. 90%
b. < 50%
c. 65%
d. Almost never
3. The most common mechanism of pulmonary infection in an otherwise healthy individual is by:
a. Gross aspiration of oral flora in a person with periodontal disease
b. Microaspiration as might occur while asleep
c. Direct extension from a nearby foci
d. From a penetrating wound to the chest cavity
4. Host protective mechanism which help fortify us against inoculation and subsequent infection
of the lower respiratory tree are all except;
a. Entrapment in the mucous layer and sweeping up the mucociliary escalator of potentially
infectous material to the oropharynx to be swallowed or expectorated
b. Small particles in the range of 0.5 -2.0 microns, are deposited in the alveoli, where alveolar
macrophages phagocytize and destroy most pathogens
c. Use of anti-bacterial rinses to keep down the microorganism in the oral cavity
d. An intact gag reflex
e. Specific antibodies which opsonize greatly augment the ability of neutrophils and
macrophages to phagocytize and destroy the bacteria
5. The nonspecific sign(s) which may be the only prevailing clue to infection in the elderly and the
immunocompromised is/are :
a. Loss of appetite
b. Confusion
c. Dehydration
d. Worsening of chronic disease
e. All of the above
6. Clinical features of concern in CAP(community acquired pneumonia) include all except
a. Reparatory rate of >30
b. Diastolic B/P of >90mmHg
c. Evidence of poor end organ perfusion i.e., confusion or a ^BUN or creatinine level
d. multilobar disease on chest x-ray
e. hypoxemia
7. You go down to see a patient who was brought in smelling of ETOH. You immediately notice him
in a fit of cough that is productive of purulent foul smelling sputum in which streaks of blood are
noted. Examination of the oral cavity reveals significant caries and periodontal disease. He has
had malaise, fever associated with cough and weight loss. He has a Temp. of 102F. His lungs
have course rhonchi throughout all lung fields. Chest x-ray shows diffuse pulmonary process c/w
pneumonia . There is a cavitary lesion in the upper left upper lobe with an air fluid level
measuring >4cm. The hilum appears full.(suggesting adenopathy ) diagnostic concerns in this
patient are all except:
a. Lung abscess
b. Post obstructive pneumonia
c. Bronchogenic carcinoma with both a and b
d. Empyema
e. Influenza with a secondary bacterial pneumonia
8. You are called in as an infectious disease consultant. It has been observed that many patients in
the ICU on ventilators have acquired a strange ventilator acquired/ associated pneumonia.
Routine cultures of respiratory secretions have yielded no organisms on standard medium. Fiber
optic bronchoscopy and BAL were performed and the respiratory tubing fluid was cultured An
aquatic protozoan Harmonella vermiformis with an unidentified intracellular bacteria was
noted. Chest x-ray showed a fibro purulent multifocal pneumonia in all patients developing over
several days becoming confluent and c/w a lobar pneumonia. Silver staining of the bronchial
fluid revealed copious mononuclear phagocytes( high monocyte to neutrophil ratio )many
destroyed in the center of the leukocytoclastic regions. Noted were copious silver staining
bacteria in side large bubbly appearing macrophages. Direct florescent antibody staining was
positive for the organism. AFB pending. The most likely diagnosis is:
a. Hospital acquired ventilator associated pneumonia
b. Legionella pneumophilia pneumonia from contaminated ventilator tubing by an aquatic
protozoan which happens to be parasites of the fresh water amoebae Hartmanella and
Acanthamoeba. It grows on specialized media having an absolute requirement for L-
cysteine. Optimal growth is on buffered charcoal yeast medium supplemented with iron, L-
cysteine, and alpha-ketoglutarate
c. Aspiration pneumonia due to loss of protective gag reflex in a intubated individual
d. TB
Ans. 1.-d, 2.-d, 3.-b, 4.-c 5.-e, 6.-b, 7.e, 8-b

You might also like