EMQs in Clinical Medicine.pdf - Peshawar Medical College

50 Respiratory medicine
continued
• Non-specific, e.g. fever, nightsweats, TB [13, 97]
anorexia, haemoptysis
Ziehl–Neelsen staining shows acid-fast
bacilli (AFBs)
• Swinging fever, copious foul-smelling Lung abscess
sputum
Usually patient has persistent, worsening
pneumonia
An EMQ may require you to identify the most likely infecting organism in a
patient with pneumonia (Box 5).
Box 5 Causative agents in patients with pneumonia
Cause
Organism
• Positive cold agglutinins Mycoplasma infection [12, 20]
• Occupation involving water systems Legionella infection [12]
• Cavitating lung(s)
Staphylococcal/klebsiella infection
• Contact with birds Chlamydia psittaci infection [12, 19]
• HIV ve, bilateral hilar shadowing Pneumocystis carinii pneumonia [12,
19, 87]
In examination EMQs certain drugs for respiratory conditions tend to be
associated with particular side effects (Box 6).
Box 6 Side effects of drugs
Side effect
Peripheral neuropathy, hepatitis
Orange-coloured tears/urine
Deranged liver function tests (LFTs),
hepatitis
Retrobulbar neuritis (pain, loss of vision)
Gout
Tremor, tachycardia
Candidiasis mouth/pharynx
Drug
Isoniazid
Rifampicin
Ethambutol
Pyrazinamide
Salbutamol
Inhaled high-dose corticosteroid