Medicine Marrow Pg 281-290 (Pulmonology)
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Medicine Marrow Pg 281-290 (Pulmonology)

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What is the most common site for lung abscesses associated with necrotizing pneumonia?

  • Right upper lobe (correct)
  • Left lower lobe
  • Right lower lobe
  • Left upper lobe

    • Clubbing is a sign associated with acute abscesses in necrotizing pneumonia.

    False

    Which of the following is NOT a thick-walled cavity cause for lung cavities?

  • Blastomycosis
  • Asthma (correct)
  • Abscess
  • Necrotising SCC

    • What organisms are most commonly responsible for lung abscesses in necrotizing pneumonia?

    <p>Anaerobes</p> Signup and view all the answers

    Squamous Cell Carcinoma is the most common cause for lung cavities.

    <p>True</p> Signup and view all the answers

    The pathogenesis of necrotizing pneumonia includes consolidation and suppuration leading to _______.

    <p>necrosis</p> Signup and view all the answers

    Name two types of infections that can cause lung cavities.

    <p>Staphylococcus aureus, Klebsiella</p> Signup and view all the answers

    The mnemonic for causes of lung cavities is _____

    <p>CAVITY</p> Signup and view all the answers

    Match the following clinical features with their descriptions:

    <p>Fever = A common systemic sign of infection Cough with purulent sputum = A symptom indicating lung infection Tachypnoea = Increased respiratory rate Impaired percussion = A physical exam finding indicating lung pathology</p> Signup and view all the answers

    Match the following causes of lung cavities with their respective categories:

    <p>Cancer = C Infection = I Tuberculosis = T Fungus = F</p> Signup and view all the answers

    Which of the following is NOT a clinical feature of atypical infection?

    <p>High grade fever</p> Signup and view all the answers

    Pontiac fever is classified as a mild form of infection.

    <p>True</p> Signup and view all the answers

    What is the drug of choice (DOC) for treating the infection discussed?

    <p>Azithromycin</p> Signup and view all the answers

    Respiratory secretions will typically show ____ cells and neutrophils during Gram staining.

    <p>pus</p> Signup and view all the answers

    Match the following tests to their respective characteristics:

    <p>DFAT = High specificity Urinary antigen testing = High specificity Sputum/aspiration testing = Not done Gram staining = Microorganisms visualized in samples</p> Signup and view all the answers

    Which of the following is characteristic of Mycoplasma pneumonia?

    <p>Resistant to beta-lactams</p> Signup and view all the answers

    Mycoplasma can cause pneumonia in immunocompromised patients.

    <p>True</p> Signup and view all the answers

    What is the first-line treatment (DOC) for Mycoplasma pneumonia?

    <p>Azithromycin</p> Signup and view all the answers

    Mycoplasma pneumonia is primarily transmitted through __________ infection.

    <p>droplet</p> Signup and view all the answers

    Match the extrapulmonary manifestations of Mycoplasma pneumonia with their descriptions:

    <p>Cold antibody autoimmune hemolytic anemia = A condition where the body's immune system attacks its own red blood cells Steven Johnson syndrome = A serious skin reaction that causes blistering and lesions Guillain Barre Syndrome = A condition that causes the body's immune system to attack the nerves Myocarditis = An inflammation of the heart muscle</p> Signup and view all the answers

    Which of the following is NOT a characteristic feature of empyema?

    <p>Irregular wall appearance</p> Signup and view all the answers

    Lung abscess treatment includes Vancomycin and Meropenem.

    <p>True</p> Signup and view all the answers

    What is the typical radiological finding in a lung cavity?

    <p>Air fluid level</p> Signup and view all the answers

    Empyema is associated with ________ protein levels in pleural fluid.

    <p>increased</p> Signup and view all the answers

    Match the following characteristics with empyema and lung abscess:

    <p>Smooth wall = Empyema Lentiform appearance on X-ray = Empyema Irregular wall = Lung Abscess Rounded appearance on X-ray = Lung Abscess</p> Signup and view all the answers

    Which of the following statements about Chlamydia is false?

    <p>Chlamydia has peptidoglycan in its cell wall.</p> Signup and view all the answers

    Legionella is known for its ability to thrive in biofilms in aquatic bodies.

    <p>True</p> Signup and view all the answers

    What is the gold standard for serological investigation to diagnose Chlamydia infections?

    <p>Microimmunofluorescence</p> Signup and view all the answers

    Which imaging finding is characterized by a hazy, translucent area in the lungs?

    <p>Ground glass opacity</p> Signup and view all the answers

    The primary treatment for Legionella infections often includes __________.

    <p>azithromycin</p> Signup and view all the answers

    Match the bacterial characteristics with the correct organism:

    <p>Chlamydia = Elementary body infectious form Legionella = Type 4 secretion system</p> Signup and view all the answers

    AA amyloidosis is frequently seen in patients with tuberculosis, bronchiectasis, and lung abscess.

    <p>True</p> Signup and view all the answers

    What is the recommended duration of antibiotic therapy for the treatment discussed?

    <p>6-8 weeks</p> Signup and view all the answers

    Accumulation of fluid in the pleural space surrounding the lungs is referred to as _______.

    <p>pleural effusion</p> Signup and view all the answers

    Match the following complications with their descriptions:

    <p>Metastatic infection = Spread of infection from one body part to another Pyopneumothorax = Accumulation of pus in the pleural cavity Bronchopleural fistula = Abnormal connection between the bronchial tubes and pleura AA amyloidosis = Protein deposition due to chronic inflammatory disease</p> Signup and view all the answers

    Which of the following is a potential extrapulmonary manifestation of community-acquired pneumonia?

    <p>Steven Johnson's syndrome</p> Signup and view all the answers

    Air bronchograms are a specific finding only observed in pneumonia.

    <p>False</p> Signup and view all the answers

    What is indicated by the consolidation observed in the left lower lobe?

    <p>Fluid or inflammatory processes</p> Signup and view all the answers

    The presence of ___ filling is described as a non-specific radiological finding.

    <p>air</p> Signup and view all the answers

    Match the following findings with their descriptions:

    <p>Loss of Left Heart Silhouette = Loss of definition of the heart shape on the X-ray Collapse of Right Upper Lobe = Area appears collapsed in the image Golden S Sign = Indicates shifting of the mediastinum In tact Diaphragm Silhouette = Diaphragm appears as expected on imaging</p> Signup and view all the answers

    What finding suggests a possible Klebsiella infection?

    <p>Golden S Sign</p> Signup and view all the answers

    A loss of the ascending aorta silhouette is a normal finding in community-acquired pneumonia.

    <p>False</p> Signup and view all the answers

    Name one possible diagnosis based on the radiological findings associated with community-acquired pneumonia.

    <p>Klebsiella infection</p> Signup and view all the answers

    What is a classic sign found in a focal suppurative lung abscess?

    <p>Air-fluid levels</p> Signup and view all the answers

    Pneumatoceles are commonly observed in IV drug users.

    <p>True</p> Signup and view all the answers

    What type of pneumonia is associated with bilateral dense consolidation on chest X-ray?

    <p>Legionella pneumonia</p> Signup and view all the answers

    Necrotizing pneumonia may be associated with _________, a bacterium that can lead to severe lung infection.

    <p>Klebsiella</p> Signup and view all the answers

    Match the following pneumonia types with their key characteristics:

    <p>Mycoplasma = Minimal interstitial infiltrates Bronchopneumonia = Air space opacification Pneumatocele = Cyst that may progress post viral infection Legionella = Bilateral dense consolidation</p> Signup and view all the answers

    What does the 'C' in the CURB-65 scoring system stand for?

    <p>Confusion</p> Signup and view all the answers

    A urea level greater than 7 mmol/L contributes to the CURB-65 scoring system.

    <p>True</p> Signup and view all the answers

    What is one of the criteria used in the CURB-65 scoring system to indicate respiratory distress?

    <p>Respiratory rate greater than 30/min</p> Signup and view all the answers

    The CURB-65 scoring system is primarily used to assess the ______________ of pneumonia.

    <p>severity</p> Signup and view all the answers

    Match the CURB-65 criteria to their corresponding indicators:

    <p>C = Confusion u = Urea &gt; 7 mmol/L R = Respiratory rate &gt; 30/min B = Blood pressure low</p> Signup and view all the answers

    Study Notes

    Lung Abscess

    • Common causes: Aspiration pneumonia, necrotizing SCC, Wegener's granulomatosis, blastomycosis
    • Aspiration Pneumonia: Chronic symptoms, often anaerobes, usually in posterior segment of right upper lobe
    • Pathogenesis: Lung consolidation, suppuration, necrosis, rupture of abscess, purulent expectoration, abscess with air-fluid level

    Causes of Lung Cavities

    • Mnemonic: CAVITY
      • Cancer (Squamous cell carcinoma, most common), Aspergillosis, Autoimmune (Wegener's granulomatosis), Abscess
      • Aspergillosis, Autoimmune (Wegener's granulomatosis), Abscess
      • Vascular (Emboli)
      • Infection (Staphylococcus aureus, Klebsiella)
      • Tuberculosis (TB)
      • Young patients (congenital abnormality)
      • Fungus (Cryptococcus, Aspergillus, Coccidioidomycosis)

    Necrotizing Pneumonia

    • Mode of transmission: Microaspiration, aerosolization
    • Culture: Buffered charcoal yeast extract (BCYE) medium
    • Gram staining: Pus cells, neutrophils present, no organisms seen
    • Clinical features: Rapidly progressive, high fever, dense bronchial consolidation, leucocytosis
    • Atypical features: Non-productive cough, GI symptoms, hyponatremia, elevated LFTs, thrombocytopenia, hematuria
    • Diagnosis:
      • "Mild" - Pontiac fever
      • "Severe" - Legionnaires' disease
      • Direct fluorescence antibody test (DFAT) - high specificity, urinary antigen testing - high specificity, sputum/aspiration testing - not usually done
    • Risk factors: Poor cellular immunity (CMI), cigarette smoking, immunosuppression, hairy cell leukemia
    • Treatment: Azithromycin (DOC) + Rifampicin, quinolones

    Complications of Necrotizing Pneumonia

    • Empyema: Macroscopic pus in pleural cavity, thickened parietal & visceral pleura, increased protein & LDH, decreased glucose, treated with intercostal drainage
    • Lung abscess: Destruction of lung parenchyma, cavity formation, treated with vancomycin + meropenem + clindamycin for 6-8 weeks
    • ARDS with MDR:
    • Metastatic Infection (rare)
    • Lung cavity: Gas-filled space, often caused by expulsion of necrotic debris via bronchial tree, air fluid level, thickening of wall after sealing of cavity

    Mycoplasma

    • Characteristics: Smallest free-living organism capable of replication, no cell wall, beta-lactams ineffective, sterols present, no flagella
      • Diseases: Tracheobronchitis/pharyngitis, Pneumonia (10%)
      • Extrapulmonary manifestations: Cold antibody autoimmune hemolytic anemia, Steven Johnson Syndrome (SJS)/erythema multiforme, Guillain Barre Syndrome (GBS), encephalitis, bullous myringitis, myocarditis/pericarditis, arthralgia, adenopathy
    • Transmission: Droplet infection
    • Investigations: X-ray, CT, reticulonodular/patchy consolidation, interstitial involvement, ground glass appearance, tree in bud appearance, serology, PCR (rapid and most sensitive)
    • Culture: PPLO agar (Dienes' method), biphasic with fried-egg appearance
    • Treatment: Azithromycin, doxycycline, respiratory quinolones
    • Prognosis: Good
    • Pathogen: Hydrogen peroxide and superoxide produced by organism leading to epithelial cell injury

    Chlamydia Pneumoniae

    • Characteristics: Obligate intracellular bacteria, lack of peptidoglycan, human-to-human transmission
    • Elementary body: Extracellular, metabolically inactive, infectious form
    • Clinical Features: Prolonged asymptomatic upper respiratory tract infection, atypical pneumonia (10%), "walking pneumonia", low-grade fever, minimal sputum, dry cough
    • Investigation: Isolation by HEP-2 cells, serology (microimmunofluorescence- gold standard), absence of lobar consolidation
    • Treatment: Resistant to sulfonamides, azithromycin, doxycycline

    Legionella

    • Characteristics: Gram-negative, predominantly intracellular, strict aerobes, motile, partially acid-fast
    • Locations: Aquatic bodies (contaminated water), microcolonies within biofilms
    • Virulence: Type 1 serovar - most pathogenic, pathogenic factor - Type 4 secretion system
    • Extrapulmonary manifestations: Cold antibody autoimmune hemolysis, Steven Johnson's syndrome, Guillain Barre syndrome

    Community Acquired Pneumonia (CAP) - Radiologic Findings

    • Air Bronchogram: May be observed in pneumonia, can be present in cardiogenic pulmonary edema
    • Consolidation: Opacification on x-ray, suggests fluid/inflammation, left lower lobe consolidation, right upper lobe consolidation, lobar consolidation
    • Loss of left heart silhouette: Loss of normal heart shape on x-ray/CT
    • Intact diaphragm silhouette
    • Loss of ascending aorta silhouette
    • Collapse of right upper lobe
    • Golden S/Reverse S sign & Bulging Fissure Sign: Suggestive of Klebsiella infection
    • Shifting of mediastinum to same side
    • Non-specific air filling: Air-filled spaces, suggestive of potential illness

    CAP - Possible Diagnoses

    • Klebsiella infection

    Imaging Findings:

    • Ground glass opacity: Hazy, translucent areas in the lungs.
    • Pleural effusion: Fluid accumulation in the space surrounding the lungs.
    • Consolidation: Lung tissue filled with fluid or inflammatory material.
    • Thick-walled cavity: Localized collection of pus or material surrounded by a dense wall.
    • Air-fluid levels: Air and fluid in the same space within a cavity.

    CAP - Complications

    • Metastatic infection
    • Pyopneumothorax
    • Bronchopleural fistula
    • AA amyloidosis (secondary amyloidosis)

    Differential Diagnosis of AA Amyloidosis:

    • Tuberculosis (TB)
    • Malignancy
    • Nocardia
    • Actinomycetes

    CAP - Treatment:

    • Antibiotics with postural drainage
      • Vancomycin + Piptaz + Clindamycin (anaerobes)
      • 6-8 weeks of therapy
    • Response: Fever resolution in 7-10 days
    • Surgery: For MDR organisms if unresponsive to treatment

    Pneumonia with Multiple Pneumatocele

    • Pathogenesis: Dense white opacity on x-ray representing mass, consolidation, or nodule.
    • Focal Supurative Lung Abscess: Necrosis and destruction of lung parenchyma, bursts into bronchus, air entry into abscess, gas within consolidation surrounded by wall (minimum 4mm thick), air-fluid levels present (classic sign), cavity formation (thick walled or thin walled).
    • Myoplasma/Chlamydia: Minimal interstitial infiltrates, often misdiagnosed as normal.
    • Legionella: Bilateral dense consolidation.
    • Bronchopneumonia: Air space opacification, consolidation.
    • Fibrosis:
    • Fibrocalcific scar post TB: (Description likely refers to a healed Tuberculosis infection)
    • Necrotizing Klebsiella: Upper lobe involvement, bulging fissure sign.
    • Pneumatocele, cyst, bulla: Often seen in IV drug abusers, post viral infection, may progress to cavity, associated with MRSA, size greater than 4mm.

    Scoring of Pneumonia

    • CURB-65: Assessment of severity
      • Confusion
      • Urea greater than 7 mmol/L
      • Respiratory rate greater than 30/min
      • Blood pressure less than 90 mmHg systolic or 60 mmHg diastolic
      • Age 65 years or older

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    Test your knowledge on lung abscesses and cavities with this informative quiz. Explore common causes, pathogenesis, and the intricacies of necrotizing pneumonia. Enhance your understanding of lung conditions and their implications.

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