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Flashcards in Chronic Pulmonary Infection Deck (38):
1

What does a shadow on a CXR indicate?

Cancer or infection

2

Clinical signs of lung infection (5)

Shadow on CXR
Weight loss
persistent sputum production
chest pain
increase SOB

3

What are some risk factors for developing chronic pulmonary infection (4)

Immunodeficiency
Immunosupresson
Abnormal innate host defence (mucosa, cilia and secretions damaged)
Aspiration

4

How can immunodeficiency occur?

Immunoglobulin deficiency

Hyposplenism

Immune paresis

HIV

5

How can immunosuppression occur? (4)

Steroids
Chemo
Immunosuppressor drugs (Azathioprine, Methotrexate, Cyclophosphamide)
Monoclonal antibodies (infliximab, rituximab)

6

How can the bronchial mucosa be damaged? (4)

From smoking, recent pneumonia, viral infection or malignancy

7

How can cilia be damaged? (3)

Smoking, Kartenager's syndrome, Young's syndrome

8

How can secretions become abnormal? (2)

CF, Channelopathies

9

Why does damaging the bronchial mucosa cause problems?

It damages the wall, letting bacteria in as the 2nd infection can now get through the wall


e/g/ staphylococcal empyema

10

How can Aspiration occur (3)

- Nasogastric tube feeding
- Poor swallowing
- Pharyngeal pouch

11

Name the 5 forms of chronic infection

- intrapulmonary access
- empyema
- chronic bronchial sepsis
- bronchiectasis
- cystic fibrosis

12

What is the clinical presentation of an intrapulmonary abscess?

It has an indolent presentation - isn't obvious, doesn't cause any pain

however, weight loss, lethargy, tiredness, cough with/out sputum can be common

often preceding an illness e.g. post viral, post having pneumonia

13

What bacteria can cause chronic pulmonary infections? (4)

streptococcus
staphylococcus
E-coli
Gram -ve's

14

what fungi can cause chronic pulmonary lung infections?

aspergillus

15

What kinds of people tend to become affected by Aspergillus?

immunosuppressed e.g. on high doses of Chemo or have HIV

16

What could be a cause of multiple abscesses?

Bacteraemia (bacteria in bloodstream)

17

What 4 ways can septic emboli occur

1. Right sided endocarditis
2. Infected DVT
3. Septicemia
4. Intravenous drug users

18

What is Empyema?

Pus in the pleural space (infected fluid)

19

If fluid in the pleural space is not infected, what is it called?

Pleural effusion

20

What pH is a Simple Parapneumonic Effusion?

Over 7.2; alkali

21

What pH is Complicated Parapneumonic Effusion?

Under 7.2; acidic

22

What kind of bacteria cause Empyema; anaerobic or aerobic?

Aerobic (usually)

23

Name 2 Gram +ve organisms that can cause Empyema

Strep milleri and Staph aureus

24

Name 4 Gram -ve organisms that can cause Empyema

E-Coli
Pseudomonas
Haemophilus Influenzae
Kelbsiellae

25

In what cases can anaerobic bacteria cause Empyema

in severe pneumonia or poor dental hygiene

26

What does Empyema appear like clinically?

As a 'slow to resolve' pneumonia

27

What does Empyema look like on a CXR

persisting effusion, look for a 'D' sign as empyema is sticky so sticks to side of chest wall

28

What is the best investigation for Empyema

USS (ultrasound) (blackness on ultrasound is fluid = empyema)

29

How can Empyema be treated

IV or Oral antibiotics

30

Name 2 IV antibiotics for Empyema

Amoxicillin and Metronidazole

31

What is Bronchiectasis?

Localized, irreversible dilation of the bronchial tree

32

What does Bronchiectasis result in for the patient?

Airflow obstruction
Impaired clearance of secretions

33

How does Bronchiectasis present clinically?

Recurrent chest infections, persistent sputum and no response/short lived response to antibiotics

34

What are the clinical signs of Chronic Bronchial Sepsis?

Has all the hallmarks of bronchiectasis but none shown on HRCT

35

Treatment for Bronchiectasis

Stop smoking
Flu vaccine
Pneumococcal vaccine
reactive antibiotics

36

Name 2 antibiotics used for bronchiectasis

Clarithromycin and Azithromycin

37

What is the mortality from abscess?

10%

38

What is the mortality from empyema?

20%