Pulm. aspiration+abscess+nocardia (10-27) (2)

Question 1

Aspiration. pneumonia. pathophysiology? 2

Answer 1

Lung parenchyma INFECTION

Aspiration of upper airway or stomach MICROBES (anaerobes)

Question 2

Aspiration. what 2 syndromes?

Answer 2

pneumonia and pneumonitis

Question 3

Aspiration. pneumonitis pathophysiology? 2

Answer 3

Lung parenchyma INFLAMMATION

Aspiration of GASTRIC ACID with direct tissue injury

Question 4

Aspiration. pneumonia. clinical features? 4

Answer 4

Present DAYS after aspiration event
FEVER, cough, incr. sputum
xray infiltrate in dependent lung segment (clasically RLL)
Can progress to abscess

Question 5

Aspiration. pneumonitis. clinical features? 3

Answer 5

Presents HOURS after aspiration event
Range from no symptoms to nonproductive cough, decr. O2, respiratory distress
xray infiltrates (one or both lobes) resolve without antibiotics

Question 6

Aspiration. pneumonia. treatment?

Answer 6

Abs: clindamycim or beta-lactam and beta-lactamase inhibitor

Question 7

Aspiration. pneumonits. treatment?

Answer 7

Supportive (no abs)

Question 8

aspiration. Location of the infiltrate is gravity-dependent and differs according to the patient’s position at the time of aspiration.

Answer 8

In supine: posterior segments of the upper lobes and superior segments of the
lower lobes of the right lung are most affected.

Question 9

Aspiration. Treatment:
Broad-spectrum antibiotics; clindamycin or amoxiclav.

Answer 9

.

Question 10

Aspiration prophylaxis?

Answer 10

Oral care.
Diet modification for patients with dysphagia.
Elevate the head of the bed 30 to 45 degrees.

Question 11

Predisposing conditions for aspiration pneumonia. consciousness?

Answer 11

Altered consciousness impairing cough reflex/glottic closure (eg dementia, drug intoxication)

Question 12

Predisposing conditions for aspiration pneumonia. dysphagia?

Answer 12

dysphagia due to neurologic deficits (stroke, neurodegenerative disease)

Question 13

Predisposing conditions for aspiration pneumonia. GI?

Answer 13

Upper GI disorders (eg GERD)

Question 14

Predisposing conditions for aspiration pneumonia. mechanical compromise?

Answer 14

mechanical compromise of aspiration defenses (eg nasogastric and endotracheal tubes)

Question 15

Predisposing conditions for aspiration pneumonia.
Protracted vomiting. nothing

Answer 15

.

Question 16

Predisposing conditions for aspiration pneumonia. feeding?

Answer 16

Large-volume tube feedings in recumbent position

Question 17

Predisposing conditions for aspiration pneumonia.

Parkinson disease mechanism on swallowing?

Answer 17

Parkinson disease lose dopaminergic neurons that control the striated muscles in the oral cavity, pharynx, and esophgaus –> swallowing dysfunction.

Question 18

Aspiration (chemical) pneumonitis. table. risk factors? 5

Answer 18

Gastric reflux (eg. decr. esophageal sphincter tone)

Delayed gastric emptying

Incr. intraabdominal pressure

Altered consciousness or sedation (anesthesia)

Endotracheal intubation, nasogastric tube

Question 19

Aspiration (chemical) pneumonitis. table. pathophysiology?2

Answer 19

Aspiration of gastric acid with direct tissue injury

Lung parenchymal inflammation

Question 20

Aspiration (chemical) pneumonitis. table. clinical? 4

Answer 20

within hours of aspiration event
Acute onset dyspnea, low grade fever, hypoxemia

Diffuse crackles on lung examination

Xray infiltrates (dependent lung segments)

Question 21

Aspiration (chemical) pneumonitis. table. treatment?

Answer 21

supportive (no abs)

Question 22

Lung abscess. pathophysiology?

Answer 22

Aspiration of oropharyngeal/gingival anaerobes (poor dentition, gingival disease)

Question 23

Lung abscess. risk factors?

Answer 23

dysphagia, substance abuse, seizures

Question 24

Lung abscess. sequence of events?

Answer 24

pneumonitis –> pneumonia –> ebscess/empyema

Question 25

Lung abscess. manifestation? 2

Answer 25

Subacute fever, night sweats, weight loss

cough with putrid sputum

Question 26

Lung abscess. diagnosis? 2

Answer 26

thick walled cavitary infiltrates with air-fluid levels

Culture rarely used

Question 27

Lung abscess. treatment?
first line? abs

Answer 27

ampicillin-sulbactam, imipenem, mropenem

Question 28

Lung abscess. treatment?
alternate? abs

Answer 28

clindamycin

Question 29

Norcardiosis. what gram?

Answer 29

gram positive rod (beaded or branching)

Question 30

Norcardiosis. what oxygen and what other characteristic?

Answer 30

partially acid-fast
Aerobic

Question 31

Norcardiosis. epidemiology? 3

Answer 31

Endemic in soil
Contracted via inhalation or skin puncture

Immunocompromised or elderly

Question 32

Norcardiosis. clinical?3

Answer 32

Pneumonia - similar to TBC
CNS involvement - brain abscess
Cutaneous involvement

Question 33

Norcardiosis. treatment? 2

Answer 33

abs: TMP-SMX
Surgical drainage of abscesses

Question 34

Norcardiosis. diagnosis. xray?

Answer 34

nodular or cavitary lesions in the upper lobes of the lung. Can be confused with malignancy and TBC

Question 35

Norcardiosis. diagnosis. sputum cultures?

Answer 35

Sputum cultures are negative

Question 36

Norcardiosis. diagnosis. BAL?

Answer 36

BAL provides an adequate sample for diagnosis: filamentous gram-positive rods that are weakly acid-fast.

Question 37

Norcardiosis. diagnosis. why important cultures from BAL?

Answer 37

Culture and susceptibility testing are important as many strains are antibiotic resistant.

Question 38

Norcardiosis. how long treatment?

Answer 38

6-12 months.