Pneumonia MCQs

The fluid is straw-colored and at times hemorrhagic; it is an exudate with a protein concentration >50% of that in serum (usually ~4&6 g/dL), a normal to low glucose concentration, a pH of ~7.3 (occasionally 45 IU/L) is the most sensitive test for pleural effusion. Reference: Harrison's principles of internal medicine 21th edition, ch: 178 Page no 1364

The differential diagnosis of acute monoarthritis includes- septic arthritis, crystal induced arthritis and hemarthrosis. The management of acute monoarthritis is always joint aspiration followed by appropriate therapy. In the context of an elderly male presenting with monoarthritis after a recent history of pneumonia should make us raise suspicion of a septic arthritis. Reference : Harrison's Principles of Internal Medicine, 21 st ed, Ch: 370, Pg: 2852 20th edition Ch:355 Pg:2570

Indicators of poor prognosis in pneumonia include: Age >65 Co-existing morbidity including diabetes mellitus, chronic renal failure, stroke, coronary artery disease. Respiratory rate>30 Mental impairment Biochemical/haematological markers which include white blood count 30,000/µL; hypoxia needing CPAP or FiO2>60%, positive blood culture and blood urea>7 mmol/L. Reference: Harrison's Principles of Internal medicine, 21st edition Ch:126Pg 1015

Staph aureus is the commonest organism (over 50%). Neisseria gonorrhoeae can occur in patients with sexually transmitted diseases. β-haemolytic streptococci can cause impetigo, sore throat and rheumatic fever. Moraxella is a gram negative coccus which can cause pneumonia in COPD patients. Reference : Harrison's Principles of Internal Medicine 21 st ed Ch: 130, Pg: 1040

The most common infectious complication of varicella is secondary bacterial superinfection of the skin, which is usually caused by Streptococcus pyogenes or Staphylococcus aureus, including strains that are methicillin-resistant Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 193, Pg: 1480

In Post-kala-azar dermal leishmaniasis (PKDL), Lymphocytes are the dominant cells; next most common are histiocytes and plasma cells. In about half of cases, epithelioid cells--scattered individually or forming compact granulomas are seen Reference : Harrison's Principles of Internal medicine, 21st edition Ch: 226Pg 1746 Reference : Harrison's Principles of Internal Medicine, 21 1746

All patients undergoing an elective splenectomy should be immunised with polyvalent pneumococcal vaccine (Pneumovax), which currently gives variable protection against 23 strains of Streptococcus pneumoniae. Where possible, it should be given at least 2 weeks and preferably at least 4 weeks prior to splenectomy to allow immunoglobulin G (gG) antibody production. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 146, Pg: 1177

Rare complications of viral hepatitis include pancreatitis,myocarditis, atypical pneumonia, aplastic anemia, transversemyelitis, and peripheral neuropathy. In children, hepatitis B may present rarely with anicteric hepatitis, a nonpruritic papular rash of the face, buttocks, and limbs, and lymphadenopathy (papular acrodermatitis of childhood or Gianotti-Crosti syndrome) Reference: Harrison's principles of internal medicine 21st Ed, Ch: 339 pg. 2565