Lung Abcess

Question 1

 What is lung abscess

Answer 1

Necrosis of the pulmonary parenchyma caused by microbial infection or localized collection of pus in a large cavity lined by chronic inflammatory tissue

Question 2

What is the most common group of bacteria that causes lung abscess

Answer 2

Anaerobes 90%

Question 3

What are the most common anaerobes involved in lung abscess

Answer 3

1. Pepto Streptococcus
2. Provotella
3. fusobacterium

Question 4

What are the frequently involved aerobic bacteria that cause lung abscess

Answer 4

1. S aureus
2. E. coli
3. klebsiella
4. pseudomonas

Question 5

85 to 95% of cases of lung abscess have a clear association with what

Answer 5

1. Periodontal disease
2. predisposition to aspiration

Question 6

What are the aetiological causes of lung abscess

Answer 6

1. Aspiration pneumonia
2. supportive pneumonia
3. poor dental hygiene and periodontal disease
4. spread from amoebic liver abscess
5. swallowing defect, paralysis
6. pre-existing cavities
7. infective endocarditis
8. inhalation of oral pharyngeal Content GERD
9. Brachial obstruction

Question 7

What are the signs and symptoms of lung abscess

Answer 7

1. Fever, weight loss, copious sputum
2. Purulent cough
3. High fever with rigor and sweating
4. large amounts of sputum which has an odor/foul smell or bloodstained
5. plural chest
6. pain clubbing within 10 to 14 days
7. signs of consolidation
8. pleural rub
9. Poor dental hygiene
10. Increased heart rate

Question 8

What is the common type of organism present in patients who are diabetic or alcoholics

Answer 8

Klebsiella

Question 9

 How can we tell that klebsiella is the causing organism of lung abscess by looking at the sputum

Answer 9

Thick mucoid sputum thick cell wall of klebsiella

Question 10

What are the investigations for lung abscess

Answer 10

1. Chest x-ray
2. ultrasound chest
3. sputum D/R
4. Blood CBC

Question 11

What are the clinical findings of chest x-ray for a patient who has lung abscess

Answer 11

Single thick walled cavity with air fluid level surrounded by chronic inflammatory tissue and consolidation

Question 12

In which long does abscess usually develop and why

Answer 12

Develops in the right lung because the right bronchus is larger

Question 13

What are the D/DS Of lung abscess

Answer 13

1. TB
2. Bronchogenic carcinoma
3. fungal infection
4. pulmonary infarction
5. Wagners granulomatosis
6. infected bullae and cyst 

Question 14

What will ultrasound chest reveal In lung abscess

Answer 14

Reveal pleural loculation‘s

Question 15

What will blood CBC show for lung abscess

Answer 15

neutrophil leukocytosis

Question 16

What are the complications of lung abscess

Answer 16

1. Bronchiectasis
2. residual fibrosis
3. empyema
4. internal haemorrhage
5. brain abscess
6. pneumothorax

Question 17

What type of management is best for lung abscess and why

Answer 17

Medical management instead of surgical management because antibiotics treat the problem

Question 18

What is the common side of aspiration in the upright position for lung abscess

Answer 18

Lower lobes

Question 19

What is the most common site for aspiration in supine position for lung abscess

Answer 19

Posterior segment of right upper lobe

Question 20

What is the empirical treatment for lung abscess

Answer 20

Clindamycin or penicillin

Question 21

What is The specific antibiotic therapy for lung abscess

Answer 21

1. Clindamycin 600 mg IV eight hourly. After improvement clindamycin 300 mg oral six hourly or Augmentin 625 mg 8- hourly

OR

2. Injection Augmentin 1.2 g eight hourly plus metronidazole injection 500 mg 8- hourly

Question 22

How long should antibiotics be taken for a lung abscess

Answer 22

Continue until chest x-ray shows improvement

Question 23

 what is the management of lung abscess

Answer 23

1. Antibiotic therapy
2. chest tube drainage required of the patient develops empyema
3. postural drainage to expel secretions from the cavity