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1st Year Medicine > Chronic Lung Sepsis. > Flashcards

Chronic Lung Sepsis. Flashcards

1
Q

What are the risk factors for developing chronic lung sepsis?

A

Congenital or acquired immunodeficiency. Immunosuppression, abnormal innate host defence e.g. Abnormal cilia and repeated insult e.g. Foreign object or aspiration.

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2
Q

What is the most common cause of immunodeficiency in adults? what does it cause?

A

CVID- common variant immunodeficiency.

Recurrent infections.

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3
Q

How common is IgA deficiency and what does it cause?

A

Common. Causes increased risk of acute infections but rarely chronic ones.

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4
Q

What is hypogammaglobinaemia?

What does it cause?

A

It is a decreased level of gamma globulin in the blood. This consists mainly of antibodies.
Causes increased risk of both acute and chronic infections.
It is rare than IgA deficiency.

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5
Q

What are some other causes of immunodeficiency?

A

Specific polysaccharide antibody syndrome.
Hyposplenism
HIV
Immune paresis caused by myeloma, lymphoma and metastatic malignancy.

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6
Q

What kinds of drugs cause immunosuppression?

A

Steroids, apathioprine, methotrexate, cyclophosamide.
Monoclonal antibodies: infliximab, TNFa, rituximab and leflunamide.
Chemo drugs.

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7
Q

What can cause damaged bronchial mucosa?

A

Smoking, recent pneumonia, viral infections and malignancy.

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8
Q

What can cause abnormal cilia?

A

Kartenagers syndrome.

Youngs syndrome - normal lung function but abnormally thick mucus.

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9
Q

What different froms of chronic lung infection do we get?

A

Intrapulmonary abscess, empyema, chronic bronchial sepsis, bronchiectasis and cystic fibrosis.

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10
Q

What signs and symptoms do we get of pulmonary abcesses?

A

Indolent (failing to heal) presentation.

Weight loss common, lethargy, tiredness, weakness, cough +/- sputum.

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11
Q

What types of illnesses can precede chronic lung abscesses?

A

Pneumonia, aspiration and hypogammaglobinaemia.

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12
Q

How do get from flu to an abscess?

A

Flu ==> staph pneumonia ==> cavitation pneumonia ==> abscess.

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13
Q

What can increases the chances of aspiration?

A

NG feeding, lowered consciousness, pharyngeal pouch, alcoholism, neurological issues. Vomiting.

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14
Q

What is immune paresis?

A

Muscular weakness caused by a disease of the neuro system.

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15
Q

What pathogens can cause a chronic lung abscess?

A

Streptococcus, staphylococcus, E. coli, gram negatives and fungi like aspergillus.

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16
Q

What can cause septic emboli?

A

Right sided endocarditis, infected DVT, septicaemia and IVDU causing infected DVT.

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17
Q

What is empyema?

What commonly causes it?

A

Pus in the pleural space.

Pneumonia but the rest are primary form idiopathic or iatrogenic causes.

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18
Q

How deadly in empyema?

A

20 % of all people that have it die.

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19
Q

How does pleural effusion progress to empyema?

A

Simple parapneumonic effusion to complicated to empyema.

20
Q

What are the features of a simple parapneumonic effusion?

A

Clear fluid
Ph > 7.2
LDH 2.2

21
Q

What are the features of a complicated parapneumonic effusion?

A

Ph 1000

Glucose

22
Q

What is LDH and when is it released?

A

Lactate dehydrogenase enzyme. Released during tissue damage.

23
Q

What will empyema look like on aspiration?

A

Frank pus.

24
Q

What do we see on CXR for empyema?

A

D sign.

25
Q

What type of organisms most commonly cause empyema?

A

Aerobic.

26
Q

What gram positive organisms cause empyema?

A

Strep milleri and staph aureus.

27
Q

What gram negative organisms cause empyema?

A

E.coli, haemophilus influenzae and Klebsiella.

28
Q

What patients should we be suspicious may have developed empyema?

A

Slow to resolve pneumonia.

29
Q

What test should we do for empyema?

A

Front and lateral CXR.
USS.
CT.

30
Q

When is a lateral CXR particularly useful in empyema?

A

When there are small retro diaphragmatic collections.

31
Q

What IV antibiotics do we use for empyema?

A

Amoxicillin and metronidazole.

32
Q

What oral antibiotics do we use for empyema? When do we give them?

A

Given after broad spectrum IV antibiotics for 14 days.

Dictated by culture of aspirate.

33
Q

How do we avoid empyema?

A

By detecting and sampling complicated effusion.

34
Q

What is bronchiectasis? What can it cause?

A

Localised irreversible dilation of the bronchial tree. Involved bronchi can easily collapse, which can cause airflow obstruction and decreased clearance of secretions. The dilated airways usually accumulate purulent secretions.

35
Q

What is the presentation of the type of patient that gets bronchiectasis?

A

Recurrent chest infections, with recurrent antibiotics. No or short lived response to antibiotics. Persistent sputum production.

36
Q

What are the signs and symptoms of bronchiectasis?

A

Cough productive of sputum, chest pain, recurrent LRTI.

37
Q

What tests do we do to look for bronchiectasis?

A

Radiography and high resolution commuted tomography.

38
Q

What usually cause bronchiectasis?

A

Usually due to fibrous scarring following infection e.g. Pneumonia or TB.
Also seen in chronic obstructions like a tumour.

39
Q

What is bilateral pulmonary oedema usually always caused by?

A

Heart failure.

40
Q

What are the three main causes of pleural effusion?

A

Malignancy, heart failure and infection.

41
Q

What is bronchial sepsis?

A

All the hallmarks of bronchiectasis but none seen on HRCT.

42
Q

Who does chronic bronchial sepsis commonly affect?

A

Often younger women involved in childcare.

Or older people with COPD or other airway diseases.

43
Q

What is the treatment for bronchiectasis and chronic bronchial sepsis?

A

When colonised with persistent bacteria give prophylactic antibiotics.
Nebuliser gentamicin or colomycin.
Alternating oral antibiotics.

Anti inflammatory treatment: low dose macrolides have been shown to reduce exacerbations.
Clarithromycin 250mg once a day.
Azithromycin 250mg three times a week.

44
Q

What is the prognosis for bronchiectasis and bronchial sepsis?

A

Recurrent infection, colonisation, abscesses and empyema.

45
Q

What signs and symptoms do we find with someone with chronic lung sepsis?

A

Shadow on X-ray, weight loss, persistent sputum production, chest pain and increasing shortness of breath.

1st Year Medicine (64 decks)

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