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Respiratory > Chronic Lung Infections > Flashcards

Chronic Lung Infections Flashcards

1
Q

d: cachexia

A

weakness and wasting of the body muscles due to severe chronic illness

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2
Q

give some reasons for developing chronic pulmonary infection

A 
Immunodeficiency
 -Congenital
- Acquired
Immunosuppression
 -Drugs
 -Malignancy
Abnormal innate host defence
-Damaged bronchial mucosa
-Abnormal cillia
-Abnormal secretions
Repeated insult
-Aspiration
-Indwelling material
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3
Q

name some types of immunodeficiency

A

Immunoglobulin deficiency
IgA Deficiency

Hypogammaglobulinaemia: rarer, increased risk of acute, and chronic infections
CVID: commonest cause of immunodeficiency, recurrent infections

Specific Polysaccharide Antibody Deficiency (SPAD), streptococcal infections
Hypo-splenism
Immune paresis
Myeloma, lymphoma, metastatic malignancy
HIV
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4
Q

name some forms of immunosuppression

A 
Steroids
Azathioprine
Methotrexate
Cyclophosphamide
Monoclonal antibodies
Infliximab, etanercept: TNFa 
Rituximab: CD20
Leflunamide
Chemotherapy
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5
Q

how may the bronchial mucosa become damaged?

A

smoking
recent pneumonia
malignacy

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6
Q

why may cilia be abnormal?

A

kartenager’s syndrome

Youngs Syndrome

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7
Q

why may you have abnormal secretions?

A

CF

Channelopathies

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8
Q

d: situs inversus

A

all the organs are the other way round

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9
Q

what causes situs inversus?

A

abnormal cilial function

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10
Q

What are symptoms of recurrent aspiration?

A

NG feeding
Poor Swallow
Pharyngeal Pouch

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11
Q

Give some egs of indwelling material?

A

NG tube in the wrong place…
Chest drain
Inhaled foreign body (peanut, chicken bone, piece of coal, cockroach…)

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12
Q

Name some Chronic Infections

A 
Intrapulmonary abscess
Empyema
Chronic Bronchial Sepsis
Bronchiectasis
Cystic Fibrosis and other oddities
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13
Q

what type of necrosis is a lung abscess?

A

liquefactive

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14
Q

Name symptoms of an intrapulmonary abscess

A 
unwilling to do exercise/lazy
Weight loss common
Lethargy, tiredness, weakness
Cough ± sputum
High mortality if not treated
Usually a preceding illness of some sort
-Pneumonic infection
-Post viral
-Foreign body
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15
Q

name some preceding illnesses for intrapleural abscess

A

pneumonia
aspiration pneumonia
hypogammaglobulinaemia

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16
Q

what pathogens cause abscesses?

A 
Bacteria
Streptococcus
Staphylococcus (Particularly post ‘flu)
E-Coli
Gram Negatives
Fungi
Aspergillus
17
Q

Name some causes of septic emboli

A

Right sided endocarditis
Infected DVT
Septicaemia

Intravenous drug users

18
Q

Name the organisms that typical cause empyema

A
  • Gram +ve (strep milleri, Staph aureus)

- Gram –ve (Ecoli, Pseudomonas, Haem Influenzae, Klebsiella)

19
Q

aerobic/anaerobic organisms frequently cause empyema

A

aerobic

20
Q

How would you diagnose empyema

A 
Clinical suspicion
The slow to resolve pneumonia
Don’t forget the lateral chest film
CXR
Persisting effusion, particularly if loculations visible
USS
The preferred investigation
Simple, bedside test
Targetted sampling
CT
Differentiation between Empyema and Abscess
21
Q

what other treatments are given in empyema?

A

IV antibiotics
amoxicillin and metronidazole
Oral antibiotics
co-amoxiclav

22
Q

d:bronchiectasis

A

Localised, irreversible dilation of the bronchial tree
Involved bronchi are dilated, inflamed and easily collapsible
Airflow obstruction
Impaired clearance of secretions

23
Q

Name some of the pathophysiology of bronchiectasis

A 
Bronchial obstruction
Cystic Fibrosis
Young’s Syndrome
Kartanager’s Syndrome
ABPA
Immunodeficiency
Rheumatoid Arthritis
Bronchopulmonary sequestration
Mounier-Khun Syndrome
Yellow Nail Syndrome
Traction bronchiectasis associated with pulmonary fibrosis
24
Q

Clinical presentations of chronic bronchial sepsis

A

All the hallmarks of bronchiectasis
No bronchiectasis on the HRCT
Confirmed positive sputum results
Often younger patients, mainly women, often involved in childcare
Others are older, usually with COPD, or airways disease
Same work-up as bronchiectasis
Remember the sinuses - reservoir of infection

25
Q

treatment of chronic bronchial sepsis

A 
Stop smoking
‘Flu vaccine
Pneumococcal vaccine
Reactive antibiotics
Send sputum sample
Give antibiotics appropriate to most recent positive culture
26
Q

what has been shown to reduce exacerbation rates in bronchiectasis?

A

low dose macrolide antibiotics

27
Q

How do you treat acute exacerbations of bronchiectasis?

A

2 weeks of antibiotics appropriate to the most recent positive sputum sample
Send sputum every time
Alter antibiotics if the sputum culture shows resistant organisms
Aggressively eradicate Pseudomonas Aeriginosa

Respiratory (27 decks)

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