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Pulmonology > Lung Abscess > Flashcards

Lung Abscess Flashcards

1
Q

Recommended initial IV dosage of clindamycin in the treatment of lung abscess caused by anaerobic infections. (Harrison’s 19th edition, pp 815)

A

600mg IV TID then 300mg PO QID after disappearance of fever and clinical improvement

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2
Q

Represents necrosis and cavitation of the lung following microbial infection. (Harrison’s 19th edition, pp 813)

A

Lung abscess

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3
Q

Size of the dominant cavity of a lung abscess in diameter. (Harrison’s 19th edition, pp 813)

A

> 2cm

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4
Q

Lung abscess that usually arise from aspiration. (Harrison’s 19th edition, pp 813)

A

Primary lung abscess

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5
Q

Lung abscess that is often caused by anaerobic bacteria. (Harrison’s 19th edition, pp 813)

A

Primary lung abscess

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6
Q

Duration for a lung abscess to be classified as acute. (Harrison’s 19th edition, pp 813)

A

< 4-6 weeks

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7
Q

Lung abscess that occur in the setting of an underlying condition. (Harrison’s 19th edition, pp 813)

A

Secondary lung abscess

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8
Q

Conditions that can cause secondary lung abscesses. (Harrison’s 19th edition, pp 813)

A 
Postobstructive process (bronchial foreign body or tumor)
Systemic process (HIV infection or another immunocompromising condition)
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9
Q

Proportion of lung abscess that are classified as chronic. (Harrison’s 19th edition, pp 813)

A

~40% of cases

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10
Q

Lung abscess that occur in the absence of an underlying pulmonary or systemic condition. (Harrison’s 19th edition, pp 813)

A

Primary lung abscess

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11
Q

Major risk factor for primary lung abscess. (Harrison’s 19th edition, pp 813)

A

Aspiration

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12
Q

Age and gender predilection for lung abscess. (Harrison’s 19th edition, pp 813)

A

Middle-aged men

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13
Q

Risk for aspiration. (Harrison’s 19th edition, pp 813)

A 
Altered mental status
Alcoholism
Drug over dose
Seizures
Bulbar dysfunction
Prior cerebrovascular events
Prior cardiovascular events
Neuromuscular disease
Esophageal dysmotility
Esophageal lesions (strictures or tumors)
Gastric distention
Gastroesophageal reflux
Substantial time on recumbent position
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14
Q

Important factor in the development of lung abscesses in combination with a risk of aspiration. (Harrison’s 19th edition, pp 813)

A

Colonization of the gingival cervices with anaerobic bacteria or microaerophilic streptococci (especially in patients with gingivitis and periodontal disease)

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15
Q

Pathogens involved in Primary lung abscess. (Harrison’s 19th edition, pp 814)

A

Anaerobes (Peptostreptococcus, Prevotella, Bacteroides and Streptococcus milleri)
microaerophilic streptococci

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16
Q

Duration in which the anaerobic bacteria produce parenchymal necrosis and cavitation. (Harrison’s 19th edition, pp 814)

A

7-14 days

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17
Q

Pathogens involved in secondary lung abscess. (Harrison’s 19th edition, pp 814)

A 
Staphylococcus areus
Gram negative rods (pseudomonas and enterobacteriaceae)
Nocardia
Aspergillus
Mucorales
Cryptococcus
Legionella
Rhodococcus
Pneumocystis jiroveci
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18
Q

Septic emboli lesions. (Harrison’s 19th edition, pp 814)

A

Tricuspid valve endocarditis (Staphylococcus aureus)

Lemierre’s syndrome (Fusobacterium necrophorum)

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19
Q

Infection that begins in the pharynx and then spreads to the neck and the carotid sheath to cause septic thrombophlebitis. (Harrison’s 19th edition, pp 814)

A

Lemierre’s syndrome

Fusobacterium – Jugular vein

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20
Q

Treatment for Lung abscess. (Harrison’s 19th edition, pp 815)

A

Clindamycin 600mg/IV TID then 300mg PO QID after disappearance of fever and clinical improvement
IV BLIC then oral co-amoxiclav once patient condition is stable

21
Q

Treatment duration for lung abscess. (Harrison’s 19th edition, pp 815)

A

Continued until imaging demonstrates that the lung abscess has cleared or regressed to a small scar. (3-4 weeks to 14 weeks)

22
Q

This agent is suggested to be as effective and well tolerated as ampicillin-sulbactam. (Harrison’s 19th edition, pp 815)

A

Moxifloxacin 400mg/PO

23
Q

Size of lung abscess that is less likely to respond to antibiotic therapy. (Harrison’s 19th edition, pp 815)

A

> 6-8cm in diameter

24
Q

Options for patients with lung abscess who do not respond to antibiotics. (Harrison’s 19th edition, pp 815)

A

Surgical resection

Percutaneous drainage

25
Q

Possible complications of percutaneous drainage. (Harrison’s 19th edition, pp 815)

A

Bacterial contamination of the pleural space
Pneumothorax
Hemothorax

26
Q

Most common location of primary lung abscess. (Harrison’s 19th edition, pp 814)

A

Dependent segments

  • posterior upper lobes
  • superior lower lobes
27
Q

Most common location of secondary lung abscess. (Harrison’s 19th edition, pp 814)

A

May vary with the underlying cause

28
Q

In primary lung abscess, which lung side is more commonly affected. (Harrison’s 19th edition, pp 814)

A

Right lung (due to less angulation of the right main bronchus)

29
Q

Most often microbiology of primary lung abscess. (Harrison’s 19th edition, pp 814)

A

Polymicrobial

30
Q

Term for the primary lung abscess when no pathogen is isolated. (Harrison’s 19th edition, pp 814)

A

Nonspecific lung abscess

31
Q

Refers to foul-smelling breath, sputum, or empyema and is essentially diagnostic of an anaerobic lung abscess. (Harrison’s 19th edition, pp 814)

A

Putrid lung abscess

32
Q

Percent of cases with no pathogen isolated. (Harrison’s 19th edition, pp 814)

A

~40%

33
Q

Physical findings in patients with lung abscess. (Harrison’s 19th edition, pp 814)

A 
Fever
Poor dentition
Gingival disease
Amphoric and/or cavernous breath sounds
Digital clubbing
Absence of gag reflex
34
Q

Initial clinical manifestations of patients with lung abscess. (Harrison’s 19th edition, pp 814)

A

Fever
Cough
Sputum production
Chest pain

35
Q

Clinical manifestations of patients with anaerobic lung abscess. (Harrison’s 19th edition, pp 814)

A 
More chronic
Indolent
Night sweats
Fatigue
Anemia
36
Q

Clinical manifestations of patients with putrid lung abscess. (Harrison’s 19th edition, pp 814)

A

Discolored phlegm

Foul tasting/smelling sputum

37
Q

Clinical manifestations of patients with non-aerobic lung abscess. (Harrison’s 19th edition, pp 814)

A

More fulminant course
High fever
Rapid progression

38
Q

Treatment for patients with lung abscess and a low likelihood of malignancy and with risk factors for aspiration. (Harrison’s 19th edition, pp 815)

A

Empirical treatment then further evaluation if unresponsive

39
Q

Treatment for patients with lung abscess and risk factors for malignancy or other underlying conditions. (Harrison’s 19th edition, pp 815)

A

Earlier diagnostics first (bronchoscopy with biopsy or CT-guided needle aspiration)
Sputum samples for areas endemic for TB

40
Q

Differential diagnosis for lung abscess. (Harrison’s 19th edition, pp 815)

A 
Lung infarction
Malignancy
Sequestration
Vasculitides (granulomatosis with polyangiitis)
Lung cysts
Bullae containing fluid
Septic emboli
41
Q

Complications of lung abscess. (Harrison’s 19th edition, pp 815)

A

Persistent cystic changes (pneumotoceles)
Bronchiectasis
Extension to pleural space with development of empyema
Life threatening hemoptysis
Massive aspiration of lung abscess contents

42
Q

Diagnostic modality used in determining of lung abscess. (Harrison’s 19th edition, pp 815)

A 
Chest radiograph – thick walled cavity with air fluid level
Computed tomography (CT) -  better definition and additional information regarding the possible cause of lung abscess
43
Q

Non invasive diagnostic modalities used in determining the pathogen of lung abscess. (Harrison’s 19th edition, pp 815)

A

Sputum GS/CS

Blood cultures

44
Q

Invasive diagnostic modalities used in determining the pathogen of lung abscess. (Harrison’s 19th edition, pp 815)

A

Bronchoscopy with bronchoalveolar lavage
Protected brush specimen collection
CT guided percutaneous needle aspiration

45
Q

Risk posed by invasive diagnostics for lung abscess. (Harrison’s 19th edition, pp 815)

A

Spillage of abscess contents (bronchoscopy)
Pneumothorax
Bronchopleural fistula (CT guided needle aspiration)

46
Q

Mortality rate for primary lung abscess. (Harrison’s 19th edition, pp 815)

A

2%

47
Q

Mortality rate for secondary lung abscess. (Harrison’s 19th edition, pp 815)

A

75%

48
Q

Poor prognostic factors for lung abscess. (Harrison’s 19th edition, pp 815)

A 
Age > 60
Presence of aerobic bacteria
Sepsis at presentation
Symptom duration > 8 weeks
Abscess size > 6cm
49
Q

Prevention strategies for lung abscess. (Harrison’s 19th edition, pp 815)

A 
Airway protection
Oral hygiene
Minimal sedation
Head elevation
Prophylaxis in high risk patients

Pulmonology (16 decks)

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