Lung infections

Question 1

Pneumonia

Answer 1

Inflammation in alveoli
Bacteria, viruses, fungi

Aspiration:

• alcoholics
• NG tubes
• Intubation
• Obtunded states

Question 2

Typical pneumonia

Answer 2

Fever, cough, malaise, purulent sputum
CP, SOB

CXR: lobar infiltrate
MC: S. pneumo
S. aureas, H. flu, Grp B strep

Question 3

Atypical pneumonia

Answer 3

Nonproductive cough
HA
Fatigue
“walking pneumonia”

CXR: diffuse, patchy infiltrate

Mycoplasma pneumoniae
Legionella pneumophila
Chlamydophila pneumoniae

Question 4

Lung Abscess

Answer 4

Necrosis of pulmonary parenchyma
Collection of pus in lung
Complication of aspiration pneumonia
Caused by anaerobes – found in gingival crevaces

At risk: altered consciousness: alcoholics, drug users, general anesthesia

Bronchial obstruction

CXR: air fluid level in cavitation

Tx: empirically: clindamycin to cover gram -

Question 5

Common bacteria assoc w/ lung abscesses

Answer 5

Peptostreptococcus
Prevotella
Bacteroides
Fusobacterium
s. aureas
Klebsiella pneumoniae
Gram – bacteria

Question 6

Pleural effusion – transudate

Answer 6

Low protein, high electrolytes
CHF – high hydrostatic pressure
Cirrhosis – low oncotic pressure
Nephrotic sn – low oncotic pressure
Fluid overload

Question 7

Pleural effusion – exudate

Answer 7

High protein – increased pleural and lung inflammation -> increased membrane permeability

Cancer
Pneumonia, infection, TB
Uremia
Connection tissue dz

Drain – risk of increased infection

Question 8

Pleural effusion

Answer 8

Fluid accumulate between two lyers
Impairs breathing – limit expansion of lungs

XR: airspace looks obliterated – big white out if large
-layer according to gravity, depends on viscosity

Question 9

Lymphatic pleural effusion

Answer 9

Milky – Chylothorax

Obstruction of thoracic duct
-> fluid backing up

can go into pleural space

Question 10

Central sleep apnea

Answer 10

No respiratory effort
Premature infant

Tx:
CPAP
BIPAP
Adaptive servo ventilation (ASV)
-synchronize w/ pt breaths

supplemental O2
Respiratory stimulates
Acetazolamide

Question 11

Obstructive sleep apnea

Answer 11

Airway obstruction – soft palate falls back, tonsils swollen (kids)

Abnormal respiratory patterns – ceases to breath for 20-40s

Assoc:
Obesity
Loud snoring
Excessive day time fatigue
Decreased concentration 
2-3 x more likely to have MVA

hypoxemia in sleep
untreated -> htn, pulm htn, stroke, CAD

Dx: polysomography >5 episodes/hr

Tx:
Wt loss
CPAP
Surgery – tonsils and adenoid

Severe: soft palate and uvula removed as last resort

Modafinil – wake up during day

Worse with sleep aids, etOH

Obese male w/ short neck