Chronic Pulmonary Infections

Question 1

What are the risk factors for developing chronic pulmonary infections?

Answer 1

Abnormal host response
Abnormal innate host defence
Repeated Insult

Question 2

What type of immunodeficiency are IgA deficiency and Hypogammaglobulinaemia?

Answer 2

Immunoglobulin deficiencies

Question 3

What type of infection does an IgA deficiency increase risk of?

Answer 3

Acute infections

Question 4

What type of infection does Hypogammaglobulinaemia increase the risk of?

Answer 4

Acute and chronic infections

Question 5

What is the commonest cause of immunodeficiency and what type of infection does it predispose to?

Answer 5

Common Variable Immunodeficiency (CVID)

Recurrent infections

Question 6

What are the (defective) mechanisms of a defective innate host defence?

Answer 6

Damaged bronchial mucosa - smoking, pneumonia, ‘flu, malignancy.
Abnormal cilia - Kartagener’s and Young’s syndromes
Abnormal secretions - CF or channelopathies

Question 7

Examples of repeated insult which predispose to chronic pulmonary infections?

Answer 7

Recurrent aspiration - NG feeding / poor swallow / pharyngeal pouch
Indwelling material - NG tube in wrong place / chest drain / inhaled foreign body

Question 8

What is Kartagener’s syndrome?

Answer 8

Primary ciliary dyskinesia; internal organs on wrong side of body, neonatal respiratory distress

Question 9

What is Young’s syndrome?

Answer 9

Similar symptoms to CF (exclusion diagnosis and genetic testing)

Question 10

Weight loss, tiredness, a cough with sputum and recent history of pneumonia. CXR shows consolidated mass…?

Answer 10

intrapulmonary abscess

Question 11

‘Flu -> Staph Pneumonia -> Cavitating Pneumonia -> …?

Answer 11

Abscess

Question 12

How can aspiration pneumonia lead to an intrapulmonary abscess?

Answer 12

Vomiting, lowered level of consciousness; pharyngeal pouch

Question 13

How can hypogammaglobulinaemia lead to an intrapulmonary abscess?

Answer 13

Not enough gamma-globulins in blood; not enough antibodies exist; impaired immune system
Staph pneumonia -> Cavitating pneumonia -> abscess

Question 14

Which pathogens are likely to cause an intrapulmonary abscess?

Answer 14

Staphylococcus (post-flu)
Streptococcus
E. coli
Gram -ve bacteria

Aspergillus (fungi)

Question 15

Septicaemia, right sided endocarditis and infected DVT can all cause…?

Answer 15

Septic emboli

Question 16

How do PWIDs get intrapulmonary abscesses?

Answer 16

inject into groin
DVT
infection
PE + abscess

Question 17

Which bacteria is most common in PWIDs?

Answer 17

Staph aureus

Question 18

What is empyema?

Answer 18

Pus in the pleural space

Question 19

An exudate with what pH is indicative of empyema?

Answer 19

<7.2

Question 20

Empyema is caused by mostly aerobic or anaerobic bacteria?

Answer 20

Aerobic

Question 21

Which gram positives cause empyema?

Answer 21

Strep Milleri

Staph Aureus

Question 22

Which gram negatives are likely to cause empyema?

Answer 22

E coli
Pseudomonas
Haemophilus influenzae
Klebsiellae

Question 23

When would anaerobes cause empyema?

Answer 23

severe pneumonia or porr dental hygiene

Question 24

A patient who has just had a hip replacement and is recovering in hospital, has a pleural exudate of pH <7.2…what is diagnosis and what is the causative organism?

Answer 24

Empyema caused by staph aureus

Question 25

D sign on CXR is indicative of?

Answer 25

empyema

Question 26

What is used to differentiate between empyema and abscess?

Answer 26

CT

Question 27

Which chronic pulmonary infection is the localised, irreversible dilation of the bronchi?

Answer 27

bronchiectasis

Question 28

Is bronchiectasis a restrictive or obstructive condition?

Answer 28

obstructive

Question 29

A daily productive cough with lots of green sputum in a non-smoker with PMH of recurrent chest infections. ?

Answer 29

bronchiectasis

Question 30

Which radiological test is used to diagnose bronchiectasis?

Answer 30

HRCT (high res)

Question 31

What is the typical cause of abnormal fixed dilatation of the bronchial tree?

Answer 31

fibrous scarring following infection

Question 32

Which chronic infection has all the hallmarks or bronchiectasis but is differentiated using HRCT?

Answer 32

chronic bronchial sepsis

Question 33

Why is it important to remember the sinuses in a patient which chronic bronchial sepsis?

Answer 33

they are a reservoir of infection

Question 34

Young woman, working in a nursery who smokes,

Answer 34

chronic bronchial sepsis

Question 35

A low dose of macrolide antibiotics are shown to reduce exacerbation rates in which chronic infection?

Answer 35

bronchiectasis

Question 36

An individual colonised with a psuedomona should be given what as anti-inflammatory treatment?

Answer 36

Azithromycin 250mg 3 times a week (macrolide)

Question 37

How are patients with CF at a greater risk of infection?

Answer 37

have abnormally viscous mucous which can block the conducting airways and lungs also have abnormal cilia lining airways so reduced clearance and build-up of mucus

Question 38

What is a gram negative aerobic organism which is sensitive to Gentamicin?

Answer 38

Pseudomonas aerginosa