Suppurative Lung Diseases Overview
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Questions and Answers

What are suppurative lung diseases characterized by?

Acute destructive infections of the lungs and/or bronchi accompanied by the elaboration of pus.

What are the primary characteristics of lung diseases categorized by cough and expectoration of sputum?

  • Purulent yellow or green in color (correct)
  • Increased amount (more than one cup/day) (correct)
  • Related to posture (correct)
  • Bad odor (correct)

    • Which of the following is NOT a cause of a lung abscess?

  • Obstruction of a bronchus by a tumor with infection distal to the obstruction.
  • Pyemia through the bloodstream from an abscess in a remote (distant) area.
  • Pneumonia, if inadequately treated as in staphylococcal type.
  • Extension from subdiaphragmatic liver abscess.
  • Pneumothorax. (correct)
  • Foreign body inhalation with infection distal to the obstruction.

    • What is bronchiectasis?

    <p>Abnormal permanent dilatation of the distal bronchi with accumulation of pus.</p> Signup and view all the answers

    Which of the following is NOT a type of bronchiectasis?

    <p>Pulmonary Fibrosis</p> Signup and view all the answers

    Haemoptysis may occur in 50% of patients with bronchiectasis.

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

    What are the main purposes of bronchoscopy in treating bronchiectasis?

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

    What are obstructive lung diseases?

    <p>A heterogeneous group of pulmonary disorders that share in common obstruction of air flow and deranged gas exchange.</p> Signup and view all the answers

    What is the key characteristic of bronchial asthma?

    <p>Chronic inflammatory disease of the lung airways.</p> Signup and view all the answers

    The etiology of bronchial asthma is completely understood.

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

    What is the key difference between extrinsic and intrinsic asthma?

    <p>Extrinsic asthma has a known definite external cause, while intrinsic asthma does not</p> Signup and view all the answers

    Which of the following is NOT a common non-antigenic stimulus in intrinsic asthma?

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

    Explain the mechanism of bronchospasm in asthma.

    <p>Probably highly sensitive vagal receptors in the bronchial tree → stimulation of these receptors → release of mast cells mediators → bronchospasm.</p> Signup and view all the answers

    What are the four pathological changes that occur in bronchial asthma due to stimuli?

    <p>Bronchospasm (contraction of the small muscles), edema of bronchial mucosa, excessive mucous blocking the lumen, cellular infiltration in the submucosa (eosinophils, lymphocytes, mast cells).</p> Signup and view all the answers

    An asthma attack may last for days.

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

    What is a common complication of asthma?

    <p>Pneumothorax.</p> Signup and view all the answers

    What is status asthmaticus?

    <p>Asthma failed to resolve with therapy within 24 hours. Patient should be hospitalized to receive intensive therapy.</p> Signup and view all the answers

    Which of the following is NOT a symptom that patients with asthma may complain of?

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

    What does the peak flow meter measure?

    <p>Peak expiratory flow (PEF) which is the maximum speed of air that can be forcefully exhaled from the lungs.</p> Signup and view all the answers

    What is the main causative organism of tuberculosis?

    <p>Mycobacterium tuberculosis.</p> Signup and view all the answers

    Mycobacterium tuberculosis is acid-fast.

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

    Mycobacterium tuberculosis is highly resistant to antibiotics.

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

    How is tuberculosis primarily transmitted?

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

    What are the two types of Mycobacterium tuberculosis?

    <p>Human bacillus (98%) and bovine bacillus (2%).</p> Signup and view all the answers

    The human bacillus primarily affects the lungs.

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

    What is the term for the dormant TB bacteria present in the body?

    <p>TB Dormant.</p> Signup and view all the answers

    What are the potential reasons for clinical progression of TB in some individuals?

    <p>Depressed host defense mechanisms.</p> Signup and view all the answers

    What is infective endocarditis?

    <p>A serious infection of the endocardium, including heart valves.</p> Signup and view all the answers

    Infective endocarditis is caused by colonization and invasion of the heart by a microbe.

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

    What are the two main factors contributing to infective endocarditis?

    <p>Bacteremia and underlying cardiac disease</p> Signup and view all the answers

    Which of the following is NOT a typical clinical manifestation of infective endocarditis?

    <p>Swollen lymph nodes</p> Signup and view all the answers

    Osler’s nodes are painless erythematous macules on the tips of fingers and toes.

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

    Roth spots are retinal hemorrhages with pale centers.

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

    Infective endocarditis commonly results in the precipitation of heart failure.

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

    What are the two main categories of treatment for infective endocarditis?

    <p>Prophylactic and therapeutic</p> Signup and view all the answers

    Prophylactic antibiotics are recommended before procedures that pose a high risk for infective endocarditis.

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

    Which of the following is NOT a common antibiotic used for the treatment of infective endocarditis?

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

    What is hypertension?

    <p>A long-term medical condition in which the blood pressure in the arteries is persistently elevated.</p> Signup and view all the answers

    Hypertension is often referred to as a 'silent killer' because it often has no symptoms.

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

    What are the two major categories of hypertension?

    <p>Primary (essential) and secondary</p> Signup and view all the answers

    Which of the following is NOT a common risk factor for primary hypertension?

    <p>Genetic predisposition</p> Signup and view all the answers

    What is the primary cause of secondary hypertension?

    <p>An underlying medical condition or disease.</p> Signup and view all the answers

    What is the most common complication of hypertension?

    <p>Heart disease</p> Signup and view all the answers

    What is the name for the type of stroke caused by hypertension?

    <p>Cerebrovascular stroke (infarction).</p> Signup and view all the answers

    What is the term for the damage to the kidneys caused by hypertension?

    <p>Hypertensive nephropathy.</p> Signup and view all the answers

    Which of the following is NOT a recommended lifestyle modification for preventing hypertension?

    <p>Taking supplements</p> Signup and view all the answers

    What is the primary action of diuretics in treating hypertension?

    <p>Reducing blood volume</p> Signup and view all the answers

    What is the mechanism of action of beta-blockers in hypertension?

    <p>Reduce the workload of the heart and causing the heart to beat slowly and with less force.</p> Signup and view all the answers

    What is the main effect of alpha-blockers on blood vessels?

    <p>Peripheral vasodilation.</p> Signup and view all the answers

    Calcium channel blockers primarily act by increasing heart rate.

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

    What are the two main types of coronary artery disease?

    <p>Angina pectoris and myocardial infarction.</p> Signup and view all the answers

    Angina pectoris is a form of myocardial infarction.

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

    What is the main risk factor for coronary artery disease?

    <p>Atherosclerosis.</p> Signup and view all the answers

    Hypertension is a risk factor for coronary artery disease.

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

    Which of the following is NOT a typical clinical presentation of coronary artery disease?

    <p>Loss of appetite</p> Signup and view all the answers

    What is the key characteristic of angina pectoris?

    <p>Transient myocardial ischemia resulting in chest pain.</p> Signup and view all the answers

    The pain of angina pectoris is usually relieved by rest and taking nitroglycerin.

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

    Which of the following is NOT a recommended treatment for angina pectoris?

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

    What is the medical term for a heart attack?

    <p>Myocardial infarction.</p> Signup and view all the answers

    The pain of a myocardial infarction is typically more severe and prolonged compared to angina pectoris.

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

    Which of the following is NOT a common investigation performed in the emergency room for suspected myocardial infarction?

    <p>CT scan of the heart</p> Signup and view all the answers

    Thrombolytic agents can dissolve blood clots in the coronary arteries.

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

    Which of the following is NOT a common procedure for treating coronary artery disease?

    <p>Heart valve replacement</p> Signup and view all the answers

    Study Notes

    Suppurative Lung Diseases

    • Suppurative lung diseases are acute infections of the lungs and/or bronchi, accompanied by pus formation.
    • Examples include lung abscess (primary and secondary), bronchiectasis, and mucoviscidosis.

    Lung Abscess

    • Definition: A cavity filled with pus in the lung, that ruptures into a bronchus.
    • Causes:
      • Foreign body inhalation with infection distal to the obstruction.
      • Untreated pneumonia (e.g., staphylococcal).
      • Tumor obstructing a bronchus, leading to infection distal to the obstruction.
      • Extension from a subdiaphragmatic liver abscess.
      • Pulmonary infarction infection.
      • Pyemia (blood spread) from a distant abscess.
    • Symptoms:
      • Suppurative syndrome with expectoration increases when lying over the healthy side.
      • Hemoptysis (coughing up blood).
      • Fever.
      • Clubbing of fingers.
      • Rupture of abscess into the pleural sac causing empyema (pus in the pleural cavity).

    Bronchiectasis

    • Definition: Abnormal permanent dilation of the distal bronchi with pus accumulation.
    • Types:
      • Congenital (immotile cilia syndrome).
      • Acquired: Severe recurrent infections leading to destruction of bronchial muscles and elastic fibers, fibrosis and weakened lung walls, resulting in dilation of the lumen (e.g., chronic bronchitis).
    • Clinical picture:
      • Recurrent coughing with large amounts of purulent sputum, related to posture.
      • Chronic toxemia symptoms (e.g., recurrent fever, weight loss, pallor, clubbing of fingers).
      • Halitosis (bad breath).
      • Hemoptysis in 50% of patients.
    • Investigations:
      • Chest X-ray.
      • Chest CT scan.
      • Sputum culture and sensitivity.
      • Bronchoscopy (to diagnose the cause and drain the pus, and inject antibiotics).
    • Treatment:
      • Postural drainage with the help of a physiotherapist.
      • Antibiotics for exacerbations.
      • Mucolytics, expectorants, and bronchodilators.
      • Surgery for complicated cases.

    Obstructive Lung Diseases

    • A heterogeneous group of disorders that commonly involve obstruction of airflow and deranged gas exchange.
    • Examples include: Emphysema, Chronic bronchitis, Chronic obstructive pulmonary disease (COPD), Bronchial Asthma, and Cystic fibrosis.

    Bronchial Asthma

    • Definition: Chronic inflammatory disease of the lung airways.
    • Characterized by:
      • Paroxysmal attacks of dyspnea (difficulty breathing) that resolve spontaneously or with therapy.
      • Cough.
      • Wheezing.
      • Chest tightness due to airway obstruction.
    • Etiology: Incompletely understood.
    • Types & Pathophysiology:
      • Extrinsic asthma: known definite external cause. Involves exposure to allergens in atopic individuals, resulting in IgE antibody production and mast cell degranulation.
      • Intrinsic asthma: No causative agent identified. Includes non-antigenic stimuli like infections, emotional stress, exercise and environmental triggers.
    • Pathology:
      • Bronchospasm (contraction of small muscles).
      • Edema of bronchial mucosa.
      • Excessive mucous blocking the lumen.
      • Cellular infiltration in the submucosa (e.g., eosinophils, lymphocytes, mast cells).
    • Clinical picture:
      • Recurrent attacks of cough and expectoration of large amounts of purulent sputum related to posture.
      • Chronic toxemia symptoms (e.g., fever, weight loss, pallor, clubbing of fingers).
      • Halitosis.
      • Hemoptysis in 50%.
    • Investigations:
      • Pulmonary function tests (to estimate obstruction).
      • Chest X-ray.
      • Chest CT scan.
      • Sputum and blood eosinophilia.
      • Elevated serum IgE levels.
    • Treatment:
      • Prophylaxis (avoidance of allergens).
      • Inhaled agents (e.g., rapid-acting β2-agonists, inhaled corticosteroids, long-acting β2-agonists).
      • Inhaled anticholinergic drugs.
      • Mast cell stabilizers (e.g., cromolyn, ketotifen, and leukotriene modifiers).
      • Oral steroids.
      • Biologics (e.g., omalizumab).
      • Status asthmaticus treatment, if necessary (e.g. theophylline or IV steroids).

    Tuberculosis (TB)

    • Causative organism: Mycobacterium tuberculosis – acid-fast, alcohol-fast aerobic bacillus, highly resistant to antibiotics.

    • Mode of Transmission: Droplet infection from patients with open pulmonary TB.

    • Types:

      • Human bacillus (98%): inhalation of infected droplets. Affects lungs, bones, genitourinary system, and joints.
      • Bovine bacillus (2%): Intake of infected milk. Affects tonsils, and cervical lymph nodes, causing intestinal TB.

    • TB is Not Spread by: Sharing toothbrushes, saliva from kissing, touching bed linens or toilets, or sharing food, drink, or utensils.

    • Epidemiology: Prevalent in developing countries with low socioeconomic standards, poor nutrition, and bad ventilation; increasing in developed countries due to AIDS, malignancies, and immunosuppressive drugs.

    • Factors that increase the risk of TB: immunocompromised patients (HIV, malignancy, steroid therapy); Diabetes mellitus; chronic renal failure; malnutrition; and close contact with a patient who is sputum smear positive.

    Primary TB (Childhood)

    • The first infection with M. Tuberculosis
    • Usually affects the upper to middle zones of the lungs..
    • The classic primary pathology is: Ghon's focus, lymphangitis, lymphadenitis.
    • Ghon's focus: disease-specific granuloma, surrounded by macrophages and foamy giant cells.
    • Fate:
      • 80% heal by fibrosis and calcification (dormant).
      • 20% due to depressed host defense mechanisms (clinical progression)

    Primary TB (Childhood) Clinical Picture

    • Usually asymptomatic in most individuals
    • In minority of immune-suppressed patients, it can manifest as:
    • TB Pneumonia
    • Pleural effusion
    • Blood spread to other organs
    • Enlarged lymph nodes causing compression of bronchus causing lung collapse

    Secondary TB (Adulthood)

    • Source of infection is either endogenous (reactivation of dormant primary disease) or exogenous (reinfection by an open TB case).
    • More common due to decreased immunity (e.g., AIDS, immunosuppressive drugs, malnutrition, uncontrolled diabetes).
    • Clinical Manifestations
    • Post-primary TB is characterized by TB toxemia, cough, and pleural effusion.
    • Asymptomatic cases might only be diagnosed through routine chest X-rays.
    • Extra-pulmonary TB can also manifest with cervical lymphadenopathy and the formation of cold abscesses in some cases affecting other organ systems

    Infective Endocarditis

    • Definition: A serious infection of the endocardium, including heart valves, caused by microbe colonization. This often leads to large friable vegetations composed of thrombotic debris (fibrin + platelets) and organisms, potentially disrupting the tissues.

    • Etiology: A combination of bacteremia and underlying cardiac disease.

      • Bacteremia: Infectious agents such as Staphylococcus aureus, Viridans streptococci, Enterococci, and others originate in contaminated sources like infected needles, dental procedures, etc.
      • Underlying cardiac disease: Damaged valves (native or prosthetic), congenital heart defects, etc., which create ideal starting points for colonization.

    • Pathogenesis:

      • Endothelial injury -> Uninfected Platelet-Fibrin thrombus (NBTE)->Transient bacteremia and attachment to NBTE -> Proliferation and pro-coagulant state -> Infected, friable, bulky vegetation

    • Clinical Picture:

      • General manifestations: fever, anorexia, weight loss, marked pallor, toxic facies, tachycardia or absent pulse and complications like sudden blindness, conjunctival petechiae, Roth spots, splinter hemorrhage, pallor, Osler's nodules, hand clubbing, and Janeway lesions.
      • Embolization: Involvement of other organs, causing issues in the kidneys, brain, or lungs.
      • Immune processes: Complications potentially involving the kidneys or joints.

    • Investigations: Blood culture (highly important), bone marrow culture, complete blood count, ESR (Erythrocyte sedimentation rate), CRP, urine analysis (microscopic or macroscopic hematuria), proteinuria, casts, immunological tests (e.g., increased gamma globulins), echocardiography, and chest X-ray & ECG.

    • Treatment: Prophylactic (antibiotics before procedures) and Therapeutic (antibiotics, correction of predisposing factors, and potential surgical intervention)

    • Prophylactic antibiotics: Amoxicillin, Erythromycin

    • Complications: Embolization, heart failure, renal failure, mycotic aneurysms, and treatment side effects.

    Hypertension

    • Definition: A long-term medical condition characterized by persistently elevated blood pressure in arteries.

    • Physiology: Blood pressure (BP) is the force exerted by blood against the arterial walls. It depends on cardiac output (CO) and systemic vascular resistance (SVR). Systolic pressure depends on CO and diastolic pressure on SVR.

    • Physiology 2: BP is regulated by four mechanisms: sympathetic nervous system, vascular endothelium, renal system, and endocrine system.

    • Classification: -Primary (essential): No specific underlying cause. -Secondary: Resulting from another medical condition or disease (e.g., renal disease).

    • Risk Factors: Age, ethnicity, alcohol, cigarette smoking, diabetes mellitus, elevated serum lipids, excess dietary sodium, gender, family history, obesity, sedentary lifestyle, and stress.

    • Secondary Hypertension (Causes):

      • Renal disorders: glomerulonephritis, and renal artery stenosis result in ischemia reducing blood flow to the kidney which in turn release renin leading to increased blood pressure.

      • Endocrinal causes: Cushing syndrome (increased cortisol) and Conn's disease (increased aldosterone) result in increased sodium and water retention.

      • Other Causes: Drugs, neurological disorders, and congenital narrowing of the aorta (coarctation of aorta).

    • Clinical Picture:

      • Early symptoms are often absent until complications develop
      • Signs and symptoms of complications include headache, dizziness, vertigo, epistaxis, blurred vision, nausea, vomiting and chest tightness.

    • Clinical Picture 2:

      • Cardiac problems: Left ventricular hypertrophy, coronary artery disease, heart failure, peripheral vascular disease
      • Cerebral problems: Cerebrovascular stroke, brain hemorrhage, brain edema
      • Renal problems: Nephrosclerosis, renal failure
      • Retinal problems: Retinopathy

    Treatment: Lifestyle modifications (healthy weight, reduced salt/sodium intake, increased physical exercise, cessation of smoking, limited alcohol consumption, controlled diabetes, stress relieving techniques) and medications.

    Ischemic Heart Diseases

    • Myocardial ischemia (imbalance between blood supply and heart demand for oxygen and nutrients).
    • Atherosclerosis: Leading cause of IHD.
    • Other rare causes include vasculitis and vasospasm.

    Angina Pectoris

    • Transient myocardial ischemia resulting in chest pain, characteristically retrosternal.
    • Symptoms often spread to shoulders, lower jaw, and left arm.
    • Aggravated by emotional stress, exertion, heavy meals, or smoking.
    • Relieved by rest and nitroglycerin inhalers.

    Myocardial Infarction (Heart Attack)

    • Definition: Ischemic necrosis of a part of the heart muscle due to complete blockage of blood supply.
    • Usually caused by thrombosis on top of coronary atheroma.
    • Common symptoms include severe chest pain, often unlike typical angina. Other findings may include shock, cold and pale skin, heart failure, arrhythmia, or sudden death.
    • Investigations: ECG, serum enzyme levels, elevated LDH, AST, CK, Troponin, ER admission and oxygen.
    • Management: Immediate ER admission, Oxygen and support, sublingual nitrates or IV nitroglycerin, analgesics, thrombolytic therapy within 6 hours of symptoms, and follow-up with anticoagulants, PCI (percutaneous coronary intervention) procedures.

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    Explore the various suppurative lung diseases, including lung abscess and bronchiectasis. This quiz covers definitions, causes, symptoms, and complications associated with these acute infections of the lungs. Test your knowledge on the critical aspects of these conditions.

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