Lung Abscess Flashcards

1
Q

Represents necrosis and cavitation of the lung following microbial infection.

A

Lung abscess

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2
Q

Lung abscesses can be single or multiple but usually are marked by a single dominant cavity ___

A

> 2 cm in diameter.

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3
Q

Primary lung abscesses generally arise from aspiration, often are caused principally by ______, and occur in the absence of an underlying pulmonary or systemic condition.

A

anaerobic bacteria

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4
Q

Acute Lung Abscess

A

<4-6 weeks

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5
Q

Major risk factor for Lung abscess is __

A

Aspiration

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6
Q

Patients at risk for Lung Abscess

A
  1. Altered mental status
  2. Alcoholism
  3. Drug overdose
  4. Seizures
  5. Bulbar dysfunction
  6. Prior cerebrovascular or cardiovascular events
  7. Neuromuscular disease

Additional Risk factors:
-esophageal dysmotility or esophageal lesions (strictures or tumors)
-gastric distention
-gastroesophageal reflux
-spend substantial time in the recumbent position

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7
Q

Pathogens: Primary Lung Abscess

A

Anaerobes
Microaerophilic streptococci

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8
Q

Pathogens: Secondary lung abscess

A

Staphylococcus aureus
Gram-negative rods

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9
Q

Pathogens: Embolic lesions

A

Staphylococcus aureus (Tricuspid valve endocarditis)
Fusobacterium necrophorum (Lemierre’s syndrome)

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10
Q

Endemic infections

A

Mycobacterium tuberculosis
Coccidioides spp.
Histoplasma capsulatum
Blastomyces spp.
Parasites

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11
Q

An infection that begins in the pharynx and then spreads to the neck and the carotid sheath to cause septic thrombophlebitis

A

Lemierre’s syndrome

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12
Q

Most common locations of primary lung abscesses

A

Posterior Upper Lobe
Superior Lower Lobe

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13
Q

When no pathogen is isolated from a primary lung abscess

A

Nonspecific lung abscess
(presence of anaerobes is often presumed)

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14
Q

Cases with foul-smelling breath, sputum, or empyema

A

Putrid Lung Abscess

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15
Q

Recommended regimen for Primary Lung Abscess

A

(1) Clindamycin (600 mg IV three times daily; then, with the disappearance of fever and clinical improvement, 300 mg PO four times daily)

(2) an IV-administered β-lactam/β-lactamase combination, followed—once the patient’s condition is stable—by orally administered amoxicillin-clavulanate.

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16
Q

An abscess _______ is less likely to respond to antibiotic therapy without additional interventions.

A

> 6–8 cm in diameter

17
Q

Alternative procedure if patient is a poor surgical candidate

A

Percutaneous drainage of the abscess

18
Q

Mortality rate of Primary Lung Abscess

A

<2%

18
Q

Possible complications of percutaneous drainage include :

A
  1. Bacterial contamination of the pleural
  2. Pneumothorax
  3. Hemothorax
19
Q

Mortality rate of Secondary Lung abscess

A

as high as 75%

20
Q

Poor prognostic Factors for Lung Abscess

A
  1. Age >60 years old
  2. Presence of aerobic bacteria
  3. Sepsis at presentation
  4. Symptom duration >8 weeks
  5. Abscess size >6 cm
21
Q

Presents with a more fulminant course characterized by high fevers and rapid progression.

A

Non-anaerobic organisms (S. aureus)

22
Q

It takes ____ days before defervescence during treatment

A

7 days

23
Q

Duration of treatment for Lung Abscess

A

3-4 weeks, can extend to 14 weeks, until imaging has cleared/regressed to a small scar