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Pediatric > Supprative lung disease 11\11 > Flashcards

Supprative lung disease 11\11 Flashcards

1
Q

Enumerate suppurative lung disease

A
  1. purulent pleurisy ( empyema
  2. lung abscess
  3. bronchiactsis
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2
Q

Define empyema

A

accumulation of pus in the pleural spaces

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3
Q

causes of empyema:4

A
  1. complication of bacterial pneumonias: pneumococci, staph, H.influenza
  2. contamination introduced from chest trauma or surgery
  3. mediastinitis
  4. rupture of lung abscess or sub diaphragmatic abscess
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4
Q

keyword of causes of empyema

A

bacterial pneumonias
chest trauma or sugery برا
mediastinits جوه
rupture abscess جوه

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5
Q

CP: what are the symptoms of empyema 4

A
  1. fever 2. dyspnea 3. chest pain: +++ exaggerated by what?? de breath, cough, straining
    4.. the child often lies on the affected side
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6
Q

IN which side does the child with empyema will lie

A

affected

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7
Q

CP: signs of empyema:3 inspection palpation, percussion , auscultation

A
  1. Diminished movement of affected side, inspection
    shift of trachea and mediastinum to the opposite side, palpation
  2. Dullness on percussion
  3. Diminished breath sounds
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8
Q

complications of empyema2

A

bronchopleural fistula
pleural fibrosis:chronicity

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9
Q

investigations of empyema2

A

1.chest X ray : uni or bi Massive homogenous opacity ,,
obliterated costophrenic angle
mediastinal shift of the opposite side
2. Thoracocentesis and culture of pus

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10
Q

what is the treatment of empyema3

A
  1. Immediate closed drainage of pus by an underwater seal or continuous suction
  2. systemic antibiotic : 3-4 weeks according to culture and sensitivity
  3. surgical decortication: of chronic cases
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11
Q

Define lung abscess

A

it is a suppurative process resulting in destruction of the pulmonary parenchyma with formation of a cavity containing purulent material.
may be acute less than 6 weeks or chronic more than 6 weeks

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12
Q

what is the duration to differentiate of acute and chronic lung abscess

A

6 weeks

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13
Q

what is the etiology or causes of lung abscess:AB:4

A

A: aspiration of infected material or foreign body
B: secondary: 1. pueumonia 2. TB and bronchiectasis
3. Amebic abscess: rare in child 4. metastatic abscess: uncommon as from septic emboli
or thrombophlebitis

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14
Q

CP:symptoms of lung abscess5

A

dyspnea and pain
1. insidious onset of fever 2. anorexia 3. weight loss
4. cough often with hemoptysis and copious amounts of foul smelling purulent sputum
5. followed by marked relief of symptoms

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15
Q

what are the signs of lung abscess:3 auscultation

A
  1. respiratory distress 2.diminshied air entry 3. localizing bronchial breathing
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16
Q

what are the complications of lung abscess3
the other topics of the lecture

A
  1. empyema or pneumothorax
  2. bronchiectasis
  3. spread of infection local or systemic
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17
Q

what are the investigations for lung abscess 3

A
  1. chest x ray or CT BETTER: a cavity with or without air fluid level surrounded by consolidation
  2. sputum culture and sensitivity
  3. bronchoscopy and BAl culture
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18
Q

what is the treatment of lung abscesse3

A
  1. prolonged antibiotic therapy : for 6 weeks: 3 IV and then 3 oral according to culture and
  2. bronchscopy : only to identify and remove a foreign body
    3, resection of the affected lobe : in children with recurrent severe hemoptysis or chronic
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19
Q

Define Broncheicatasis

A

obstruction + chronic inflammation
it is a condition characterized by dilatation of the bronchi with destruction of the bronchial and peribronchial tissues and accumulation of exudative material inside bronchi

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20
Q

etiology of bronchiatsis AB

A

A: congenital
B; acquired : usually due to chronic pulmonary infection as:
1.foreigh body 2. enlarged broncho-pulmonary nodes due to TB
3. lung abscess or localized cysts 4, immotile cilia syndrome
5. cystic fibrosis 6. asthma 7. immunodeficiency
8. gastroesophageal reflux.

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21
Q

what are the affected lobs parts of bronchiectasis

A

bassal segments of the lower lobes……… right middle lobe……. lingular segment of left upper lob

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22
Q

what is the classification of bronchiectasis

A

Anatomical: localized or diffuse
Etiological: cystic fibrosis and Non- cystic

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23
Q

CP: symptoms of bronchiectasis3

A
  1. fever, anorexia, poor weight gain are common
  2. chronic cough : with expectoration of copious fetid mucopurulent sputum, usually changing with posture
  3. hemoptysis may occur
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24
Q

what are the signs of bronchiectasis3

A
  1. chest signs: musical rales may heard over the affected area as well signs of consolidation and fibrosis
  2. clubbing of fingers is usually seen
    3, if extensive there is : persistent dyspnea and delayed physical growth
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25
Q

what are the complications of bronchiectasis2

A
  1. pulmonary hypertension may comp…. cor-pulmonale
  2. respiratory failure
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26
Q

what are the investigations of bronchietasis2

A
  1. chest x ray: may show honeycomb or soap bubble appearance
  2. CT scan of the chest confirms the diagnosis. GOLD STAND: DIAGNOSTIC
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27
Q

what is the treatment of bronchiectasis 4

A
  1. Effective postural drainage and chest physiotherapy
  2. antibiotic accordign to culture
  3. bronchodilators and symptomatic
  4. in localized cases : lobar resection
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28
Q

what is the primary infection with TB 3

A
  1. the lung is the portal for 98% of cases
  2. the local infection constitutes the primary complex: gohns foucs, lymphang, lymphadeni
  3. most lesions heal slowly by fibrosis and may calcify
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29
Q

what are the TB complications5: spread ……. pleura

A
  1. local spread 2. bronchial spread 3. hematogenous causing miliary TB
  2. pleural effusion : in older children as hypersensitivity reaction
  3. empyema , caseation and cavitation : more in malnourished children
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30
Q

pleural effusion common in which children……older

A
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31
Q

empyema as compl of tb common in which child ……. malnutri

A
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32
Q

tell about secondary infection of TB

A

mostly seem in adults as a reactivation or reinfection

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33
Q

CP; of pulmonary TB3

A
  1. general : loss of appetite , weight , night sweat , night fever
  2. chronic cough: MAIN SYMPTOM
    A.sputum may be mucoid , purulent or blood B. may complain of localized wheezing
    C. recurrent colds or pneumonia for months before diagnosis, with response to routine treatment
  3. chest signs:
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34
Q

what is the main symptom of pulmonary TB

A

chronic cough

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35
Q

what are the chest signs of TB4 : according to the lesion

A
  1. IN pneumonic : may be signs of consolidation
  2. IN pleural effusion : physical signs of effusion may be detected
  3. IN fibrosis : deviation if the trachea and mediastinum to the same side
  4. IN compression of the trachea and bronchi by tb lymph nodes: wheezes may be noticed
    Should be differentiated from asthma
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36
Q

what are the diagnostic investigations :8

A
  1. CBC: lymphocytois 3. Tuberclin test: Mantoux test MOST important diagnostic tool
  2. esr: very high above 100 4, culture: sputum or gastric aspirate, directZN, on LS media 4 weeks, bactic 10 days
    5, quantiferon tb test: GOOD negative : IFN release from T cell
    6, biopsy of nodes or pleura 7. radiology: x ray or CT
  3. ELISA and PCR
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37
Q

other name of tuberculin test

A

mantoux

38
Q

what is the most important diagnostic tool for TB

A

Tuberculin test

39
Q

what is an 5mm induration

A

Negative tuberclin

40
Q

5-9 mm induration

A

doutful repeat

41
Q

10 mm induration or more

A

positive

42
Q

false positive tuberclin

A

BCG vaccin
infection with atypical myobacteria

43
Q

false negative test tuberclin5

A

subcutaneous injection or outdated
recent use fo corticosteroids or immunosuppressives
intercurrent viral infections
recent antiviral vaccines; measles and mumps
advanced disseminated TB………..

44
Q

prevention of TB2

A
  1. general :
  2. BCG : early in 1st month, live attenuated , left deltoid muscle , intradermaly, reaction after 3-6 weeks, subsides 2-6 mon, booster 6 year
    chemoprophylaxis: isoniazid 15mg\kg\day for 6 months
45
Q

what is the treatment of TB

A

it usually consists of combined drug therapy to delay the emergence of drug resistant strains

46
Q

what are the 1st line antituberculous drugs and their doses

A

isioniazid , rifampicin , pyrazinamide, ethambutol orallllllll

47
Q

dose of isonazide

A

10-15mg\kg\day oral

48
Q

rifampicin dose

A

10-20 mg\ kg\day oralllll

49
Q

pyrazinamide

A

20-40 mg oral

50
Q

ethambuto

A

15-20 oralllllllllll

51
Q

alterative drugs

A

strptomycin , thionamide, other as kanamycin amikacin para amion

52
Q

streptomycin dose

A

20 -40 IMMMMMMMMMMM

53
Q

ethionamide

A

15-20 aoral

54
Q

allll drugs of TB oral ex

A

strepto

55
Q

what is the antitubirculas regimen

A

1st 2 mont : all the 1st line
next 4mot: isoniazid and rifampicin only

56
Q

what are the indications of corticosteroids in TB 5

A
  1. Allergy to antituberculous drugs
  2. TB serositis: pleurisy, pericarditis , asictic pertiontis
    3, miliary TB affect the suprarenal
    4, endobronchial TB after removal of the glands to avoid postoperative stricute
  3. after surgical removal of cervical TB lymph nods to avoid fibrous tissue formation
57
Q

what are the areas of extra TB5

A
  1. lymphadenitis 2. skeletal : potts disease… arthritis
  2. abdominal: enteritis……peritonitis………tabes mesentrica of the mesentry…..urogenital
  3. TB of cns: meningitis …..tuberculoma
  4. other: pericardittis ….. skin lupus vulgarus…………….eye and ear as chronic otitis media and mastoiditis
58
Q

Define cystic fibrosis

A

Autosomal recessive mutation …..of cystic fibrosis transbembrane regulator CFTR gene……..
leading to abnormal ion transport across the epithelial cells of the exocrine glands……………
resulting in increased viscosity if secretions.

59
Q

what are the most common affected lymphnodes in lymphadenitis

A

cervical…..intialy …then ….with cold abscess formation

60
Q

what are the characters of potts or TB of spine

A

more in lower thoracic and descends less in cervical
pain , kyphosis, compression paraplegia
x ray: rarefaction and destruction of vertebrae

61
Q

TB arthirits

A

affect large joints from ankle to elbow
limitation of movements and pain

62
Q

what is the most unique thing when examining urine of TB patient

A

sterile pyuria

63
Q

TB meningitis

A

headache , irritability , disorientatiion due to ++ICT
convulsions, CSF: ++protein and lymphocytes……..— glucose

64
Q

what is the pathogenesis of cystic fibrosis

A

LUNGS…Panceriase….Sweat glands

65
Q

pathogenesis of CF the 1st one

A
  1. viscid mucus in the smaller airways predisposes to chronic infection. initially with staph and H influenza and subsequently with pseudomonas aeruginosa.
    leads to damage of the bronchial wall. bronchiectasis and abscess
66
Q

2nd pathogenesis of CF and 3

A

over 90 of children have malabsorption and failure to thrive from birth ….because of pancreatic insufficiency exocrine
abnormal function of the sweat glands results in excessive concentrations of Na and Cl in sweat
reach 60-125ml mol\L

67
Q

what is the normal concentrations of Na and Cl in children

A

10-30 mmol\L

68
Q

clinical presentation of CF in newborn

A

can be diagnosed through screening

69
Q

CP of CF in infancy 4

A
  1. meconium ileus in newborns is delayed up to 72 h
  2. failure to thrive
  3. recurrent chest infections
    4, malabsorption, steatorrha
70
Q

CP in young child of CF 4

A
  1. bronchiectasis 2. sinusitis 3, nasal polyp
  2. rectal prolapse
71
Q

CP of older child and adolescent of CF 7

A
  1. Allergic bronchopulmonary aspergillosis ABPA
  2. diabetes mellitus often not insulin dependent
  3. liver or biliary cirrhosis and portal hypertension
  4. distal intestinal obstruction
  5. pneumthorax or recurrent hemoptysis
  6. sterility in males
  7. psychological problems
72
Q

symptoms of CF : chest , Git

A

recurrent or persistent chest infection with purulent sputum
frequent large pale very offensive and greasy stools steatorrhea

73
Q

signs o f CF 5

A
  1. hyperinflation o f the chest due to air trappign
  2. coarse inspiratory crepitations and expiratiory wheeze
  3. finger clubbing
  4. failure tto thrive
  5. ultimately 95 of patients with CF will die of respiratory failure
74
Q

diagnositc investigations of CF 1

A

sweat chloride test

75
Q

how to confirm the diagnosis of CF

A

by testing for gene abnormalities in the CFTR protein where AF508 is the commonest gene mutation

76
Q

what is the commonest gene mutation in CF

A

AF508

77
Q

what is the aim of CF management 2

A

prevent progression
maintain adequate nutrition and growth

78
Q

what are the systems that are involved in CF management 4

A

1.respiratory 2. nutrition, git and hepatic
3. psychological 4. gene therapy

79
Q

what is the major problem with CF

A

recurrent and persistent chest infection

80
Q

enumerate the respiratory management of CF 6

A
  1. anti inflammatory : appear to be beneficial 2. antibiotcs: prophylactic oral are recommended
    usually flucloxacillin hg
81
Q

what is the usually used prophylactic anibiotic in CF

A

flucloxacillin

82
Q

4 rest respiratory ttt of CF

A
  1. physiotherapy: at least twice a day aiming to clear airway
  2. bronchodilators: may reverse the obstruction
  3. lung transplant: in end stage
83
Q

what are the nutritional , git….management 6

A

regular assess of nutri
High calorie diet is essential
oral enteric coated pancreatic enzymes replacement therapy taken with meals and snacks
4, oral bile acid therapy may improve biliary secretion
5. fat soluble vitamin supplements
6. supplement with salt staring at diagnosis as oral rehydration is essential

84
Q

what is gene therapy

A

CFTR potentiators and correctors may improve
high cost …. not yet proven

85
Q

what are the pediatric allery 5..1…2 =7

A

asthma, allergic rhivitis, conjunctivitis, eczema
5, urticaria and hypersensitivity to food , drugs and insects

86
Q

allergy is common 40 of asth… 8 of food

A
87
Q

increasing in prevlance throughout developed world

A
88
Q

are majore cause of emergency and morbidity and can be fetal aller

A
89
Q

in which age does eczema and food allergy present

A

infancy

90
Q

in which age dose the asthma and allergic rhinitis present

A

toddler and chilhood

91
Q

whaat do you called the progression from eczema , food in infancy and then asthma which is predictive and allergic rhinitis in later chilhood

A

allergic march

92
Q

what are the possible preventations of allergy under trial 4

A

pre and pro biotics 1. prebiotics: microorganisms
2. pro: active oligosaccaride
3, environmental and 4. nutritional

Pediatric (6 decks)

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