Lung Empyema And Abscess

Question 1

Predisposing factors for empyema

Answer 1

aspiration (altered swallowing),
respiratory disease impairing ciliary function, immunocompromise,
malignancy,
IV drug abuse,
alcoholism,
diabetes,
gastroesophageal reflux disease, and
poor oral hygiene

Question 2

Diagnostic criteria for empyema

Answer 2

aspiration of grossly purulent material on thoracentesis

and at least one:

A. thoracentesis fluid with a positive Gram stain or culture,
B. pleural fluid glucose <40 milligrams/dL,
C. pH <7.2
D. lactate dehydrogenase >1000 IU/L

Question 3

True or false

Pleural biopsy is diagnostic in 55% to 70% of patients, demonstrating a granuloma and/or being culture positive

Answer 3

True

Question 4

definitive treatment of an empyema

Answer 4

drainage and antibiotics

Question 5

Most antibiotics have adequate penetration into the pleural space with the exception of ________

Answer 5

aminoglycosides

Question 6

Choices for empiric therapy for ANAEROBES

Answer 6

β-lactam with β-lactamase activity, such as

piperacillin-tazobactam
ampicillin- sulbactam
carbapenem
clindamycin

Question 7

Therapy for GRAM NEGATIVE aerobic pathogens

Answer 7

second- or third-generation cephalosporin plus metronidazole
carbapenem
β-lactam aminopenicillin with β-lactamase activity (e.g., piperacillin-tazobactam or ampicillin- sulbactam)

Question 8

Therapy gram-positive

Answer 8

a β-lactam

Question 9

True or false

Video-assisted thoracoscopic surgery allows debriding of empyemas that fail tube thoracostomy drainage and antibiotic therapy

Answer 9

True

Question 10

True or false

Video-assisted thoracoscopic surgery can be followed by or converted to a thoracotomy if pleural fluid drainage remains insufficient.

Answer 10

True

Question 11

characterized by localized necrosis of the lung parenchyma and is typically caused by suppurative microbial infection

Answer 11

Lung abscess

Question 12

In lung abscess, Initial infection is usually caused by

Answer 12

aspiration of oral contents

Question 13

major causes of lung abscess

Answer 13

Type 3 Streptococcus pneumoniae and S. aureus

Question 14

Lung abscesses present for _________ are termed acute, and those present for__________ are chronic

Answer 14

<1 month

> 1 month

Question 15

True or false

Approximately 80% of lung abscesses are primary

Answer 15

True

Question 16

True or false

Secondary lung abscess is associated with malignancy, immunosuppression, extrapulmonary infection, sepsis, or complications of surgery.

Answer 16

True

Question 17

True or false

Lung abscess typically has an indolent course, with patients presenting after 2 to 4 weeks of symptoms. Symptoms include cough, fever, pleuritic chest pain, hemoptysis, weight loss, and night sweats

Answer 17

True

Question 18

Common Organisms in Empyema Pathology

Aspiration pneumonia

Answer 18

S. aureus

Question 19

Common Organisms in Empyema Pathology

Pneumonia (unimmunized with Haemophilus influenzae type B vaccine)

Answer 19

H. influenzae

Question 20

True or false

Chest radiograph may show an area of dense consolidation or an air- fluid level inside of a cavitary lesion, indicating that the abscess cavity communicated with a bronchiole. Bronchiole communication occurs in most patients with lung abscess

Answer 20

True

Question 21

Reasons for Medical Treatment Failure in Lung Abscess

Answer 21

Question 22

Antibiotic Lung abscess

Empiric therapy targets anaerobes and facultatively anaerobic streptococci

Answer 22

Ampicillin-sulbactam, 3 grams IV every 6 hours, or a carbapenem (imipenem, meropenem)