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Resp JL > Chronic Pulmonary Infection > Flashcards

Chronic Pulmonary Infection Flashcards

1
Q

What are 5 other differential diagnosises for chronic pulmonary infection?

A 
Lung cancer
Intrapulmonary abscess
Empyema
Bronchiectasis
Cystic Fibrosis
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2
Q

What are three broad risk factors for developing chronic pulmonary infection?

A

Abnormal host response
Abnormal innate host defence
Repeated insult

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3
Q

What are two risk factors under the heading abnormal host response, for developing chronic pulmonary infection?

A

Immunodeficiency - congenital or aquired

Immunosuppresion - drugs/malignancy

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4
Q

What are three risk factors under the heading abnormal innate host defence for chronic pulmonary infection?

A
  1. Damaged bronchial mucosa
  2. Abnormal cillia
  3. Abnormal secretions
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5
Q

What are two features that come under the risk factor “repeated insult” for chronic pulmonary infection?

A

Aspiration

Indwelling material

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6
Q

What are 4 immunoglobulin deficiencies which can lead to chronic pulmonary infection?

A
  1. IgA deficiency - increased risk of acute infection
  2. Hypogammaglobulinaemia - increased risk of acute/chronic infection
  3. CVID - commonest cause of immunodeficiency, recurrent infecitons
  4. Specific Polysaccharide Antibody Deficiency
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7
Q

What three things can cause immune paresis?

A

Myeloma, lymphoma, metastatic malignancy

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8
Q

Name two other factors which can cause immunodeficiency, leading to the development of chronic pulmonary infection?

A

Hypo-splenism

HIV

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9
Q

What can the use of steroids, azathioprine, methotrexate, cyclophosphamide, monoclonal antibodies and chemotherapy cause?

A

Immunosuppression leading to the development of chronic pulmnary infections

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10
Q

What are Infliximab, Rituximab and Leflunamide all?

A

Monoclonal antibodies

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11
Q

What can cause abnormal cillia, causing a defective innate host defence, which can lead to the development of chronic pulmonary infections?

A

Kartenager’s syndrome

Youngs syndrome

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12
Q

What two conditions can cause abnormal secretions, leading to defective innate host defence, which can cause development of chronic pulmonary infections?

A

Cystic Fibrosis

Channelopathies

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13
Q

What 3 factors can cause recurrent aspiration, leading to repeated insult and chronic pulmonary infection?

A

NG feeding
Poor swallow
Pharyngeal pouch

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14
Q

What three things can be indwelling material, leading to repeated insult and eventually chronic pulmonary infection?

A

NG tube in wrong place
Chest drain
Inhaled foreign body

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15
Q

Name 5 forms of chronic infection?

A 
Intrapulmonary abscess
Empyema
Chronic bronchial sepsis
Bronchiectasis
CF
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16
Q

What condition is described: indolent presentation, weight loss, lethargy, tiredness, weakness, cough +/- sputum, high mortality if not treated and usually preceding illness of sort (pneumonic infection, post viral or foreign body)?

A

Intrapulmonary abscess

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17
Q

What are three preceding illness of intrapulmonary abcsess?

A

Pneumonia
Aspiration pneumonia
Poor host immune response

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18
Q

What conditions does this occur in: Flu -> Staph Pneumonia -> cavitating pneumonia -> abscess?

A

Pneumonia

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19
Q

Name 4 bacterial pathogens that cause intrapulmonary abscesses?

A

Streptococcus
Staphylococcus
E.Coli
Gram negative

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20
Q

Name a fungal pathogen that can cause intrapulmonary abscesses?

A

Aspergillus

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21
Q

What three things are related to septic emboli?

A

Right sided endocarditis
Infected DVT
Septicaemia

22
Q

What does this occur in: inject into groin, DVT, infection, PE + abscesses?

A

Intravenous drug useres

23
Q

What is empyema?

A

Pus in the pleural space

24
Q

What do these results suggest?
Clear fluid
pH > 7.2
LDH 2.2

A

Simple parapneumonic effusion

25
Q

What do these results suggest?
pH 1000
Glucose

A

Complicated parapneumonic effusion

26
Q

What type of organisms are found most requently in bacteriology of empyema?

A

Aerobic organisms

27
Q

What are gram positive organisms Strep milleri and Staph aureus found in bacteriology a cause of?

A

Empyema

28
Q

Name 4 gram negatives found in bacteriology of empyema?

A

E.Coli
Pseudomonas
Haemophilus influenzae
Klebsiellae

29
Q

What does a slow to resolve pneumonia suggest?

A

Empyema

30
Q

In empyema, what can be seen on CXR?

A

Persisting effusion, particularly if loculations visible

31
Q

What is the preferred investigation for empyema?

A

Ultrasound

32
Q

What investigation can be used to differentiate between empyema and abscess?

A

CT

33
Q

What sign are you looking for in CXR to diagnose empyema?

A

D sign

34
Q

Descirbe the antibiotic treatment of empyema?

A

IV antibiotics - broad spectrum, amoxicillin and metronidazole initially
Oral antibiotics - directed towards cultured bacteria, at least 14 days

35
Q

What drains are preferred to initially treat empyema?

A

Small bore seldinger type

36
Q

What name is given to localised, irreversible dilation of the bronchial tree?

A

Bronchiectasis

37
Q

What 4 features can bronchiectasis patients present with?

A
  1. Recurrent chest infections
  2. Recurrent antibiotic prescriptions, no response to them
  3. Short lived response to antibiotics
  4. Persistent sputum production
38
Q

What investigation can be used to diagnose bronchiecatsis?

A

HRCT

39
Q

In relation to the pathophysiology of bronchiectasis, what 4 syndromes are mentioned?

A
  1. Young’s syndrome
  2. Kartanager’s syndrome
  3. Mounier-Khun syndrome
  4. Yellow nail syndrome
40
Q

What can CF, bronchial obstruction, ABPA, immunodeficiency, rheumatoid arthritis, bronchopulmonary sequestration and traction bronchiectasis associated with pulmonary fibrosis all lead to?

A

Bronchiectasis

41
Q

What condition can be suspected with all the hallmarks of bronchiectasis but no bronchiectasis on the HRCT?

A

Chronic bronchial sepsis

42
Q

How is chronic bronchial sepsis confirmed?

A

Positive sputum results

43
Q

What is the treatment for chronic bronchial sepsis when colonised with persistent bacteria?

A

Prophylactic antibiotics
Nebulised gentamicin, colomycin
Pulsed IV abx
Alternating oral antibiotics

44
Q

What have been shown to reduce exacerbation rates in bronchiectasis?

A

Low dose macrolides

45
Q

What three features make up the prognosis of chronic bronchial sepsis?

A

Recurrent infection
Abscesses and empyema
Colonisation

46
Q

What is a congenital cause of bronchiectasis?

A

Cystic fibrosis

47
Q

What complication relating to fertility can there be from CF?

A

Male infertility

48
Q

What pancreatic dysfunctions can result from CF?

A

Endocrine - CFRDM

Exocrine - steatorrhoea

49
Q

What biliary tree related complications are there of CF?

A

Biliary obstruction

Obstructive hepatitis

50
Q

What are shadow on CXR, weight loss, persistent sputum production, chest pain and increasing SOB all lead to the diagnosis of?

A

Chronic pulmonary infection

Resp JL (27 decks)

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