Chronic Pulmonary Infection Flashcards Preview

Respiratory > Chronic Pulmonary Infection > Flashcards

Flashcards in Chronic Pulmonary Infection Deck (33):
1

What's the diff. diagnosis of:
Shadow on CXR
Weight loss
Persistent sputum production
Chest pain
Increasing SOB

Lung Cancer
Intrapulmonary abscess
Empyema
Bronchiectasis
CF

2

What are the risk factors for developing chronic pulmonary infection?

Abnormal host response- immunodeficiency/ immunosuppression

Abnormal innate host defence- Damaged bronchial mucosa/ abnormal cillia/ abnormal secreation

Repeated insult- aspiration/ indwelling material (eg NG or ET tube)

3

What immunoglobulin deficiencies are associated with chronic pulmonary infection?

IgA deficiency- more accute
Hypogammaglobulinaemia
CVID- common cause, recurrent infections
Specific Polysaccharide Antibody Deficiency

4

What are other causes of immunodeficiency?

Hypo-splenism
Immune paresis- myeloma, lymphoma, metastatic malignancy
HIV

5

What are some common causes of immunosuppression?

Steroids
Azathioprine
METHOTREXATE
Cyclophosphamide
Monoclonal antibodies (Infliximab, etanercept, TNFa/ rituximab/ leflunamide)
Chemo

6

What causes defective innate host defence?

Damaged bronchial mucosa
Abnormal cillia ( Kartenager's syndrome, Young's syndrome
Abnormal secretions (CF, channelopathies)

7

What causes repeated insult?

Recurrent aspiration (NG feeding, poor swallow, pharyngeal pouch)
Indwelling material (NG tube, chest drain, inhaled foreign body?

8

What's an intrapulmonary abscess?

Indolent presentation (quietly growing)
Weight loss
Lethargy, tiredness, weakness
Cough sometimes sputum
high mortality if untreated
usually a preceding illness of some sort (pneumonic, post viral, foreign body)

9

what bacteria is very good at causing abscesses?

Staph Pneumonia

10

What can cause aspiration pneumonia?

Vomiting
Lowered conscious level
Pharyngeal pouch

11

what poor immune response is associated with pulmonary abscess?

hypogammaglobulinaemia

12

What pathogens are common of lung abscess?

Streptococci
Staphylococci
E-coli
Gram negatives
fungi- aspergillus

13

What are three main causes of septic emboli?

Right sided endocarditis
Infected DVT
Septicaemia

14

How does IV drug use lead to septic emboli?

Inject into groin,
DVT
Infection
PE + abscesses

15

What is empyema?

Pus in pleural space- infected pleural effusion

16

What is pleural effusion?

fluid in pleural space

17

what does empyema look like on a CT scan?

C- shaped
like a banana

18

What are signs of simple parapneumonic effusion?

Clear fluid
pH > 7.2
LDH < 1000
Glucose > 2.2

19

what are signs of complicated parapneumonic effusion/

pH < 7.2
LDH >1000
Glucose < 2.2
NEEDS CHEST TUBE DRAINING

20

what are signs of empyema?

frank pus

21

How would you diagnose empyema?

Clinical suspiscion
CXR
USS
CT

22

What does a D shape on CXR indicate?

Empyema

23

Empyema treatments other than chest drain?

IV antibiotics
- broad spectrum
- amoxicillin and metronidazole initially

Oral antibiotics

24

How should you tap an empyema?

with a USS

25

What is bronchiectasis?

Localises, irreversible dilation of bronchial tree

26

What is the presentation of bronchiectasis?

Recurrent "chest infections"
Recurrent antibiotic prescriptions
No response to antibiotics
Short lived response to antibiotics
Persistent sputum production

27

How to diagnose bronchiectasis?

Cough productive of sputum
chest pain
recurrent LRTIs
Radiological- HRCT

28

What would be characteristic on a brochiectasis CT?

Cygnet rings

29

What causes bronchiectasis?

Bronchial obstruction
CF
Young's and Kartanager's syndrome
ABPA
Immunodeficiency
Rheumatoid arthritis
bronchopulmonary sequestration
Monier-Khum syndrom (lack of tracheal cartillage)
Yellow Nail syndrome
ABOUT 50% IDIOPATHIC

30

What is chronic bronchial sepsis?

hallmarks of bronchiectasis but no radiological signs

31

Who are likely to get chronic bronchial sepsis?

Young women working with children
Older people with COPD or airways disease

32

How to treat chronic bronchial sepsis?

Stop smoking
Flu vaccine
reactive antibiotics: sputum sample, antibiotics appropriate to most recent positive culture

33

What are some anti-inflammatory treatments for bronchiectasis?

clarithromycin 250mg OD
Azithromycin 250mg three times a week