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Пульмонология, гематология (англ,рус)

 

Examples of tests

 

  1. How can you confirm broncyiectasis?
  1. Bronchographic examination
  2. X-Ray examination
  3. Laboratory findings
  4. Clinical findings
  5. None
  1. Dosing regimen of Amoxicillin|clavulanic acid:
  1. 1,0g 8-12 hurly i.v
  2. 1,2g 8-12 hurly i.v
  3. 1,4g 8-12 hurly i.v
  4. 1,6g 8-12 hurly i.v
  5. 1,8g 8-12 hurly i.v
  1. Main way of medicine introduction for abscess is:
  1. Orally
  2. Intramuscular
  3. Intravenous
  4. Aerosol
  5. All named above
  1. What does Kartageners syndrom include, except:
  1. Sinusitis
  2. Situs in versus
  3. Bronchiectasis
  4. Osteoporosis
  5. All named above

 

Answers to tests:

1.      A

2.      B

3.      C

4.      D

 

References.

 

1.     Therapy: Manual. The course of lectures/V. M. Fedosyeyeva, A. A. Chrenov. – Simferopol, 2003. – 17 - 19 p.

2.     Davidson’s Principles and practice of medicine (nineteenth         edition)/Christopher Haslett, Edvin R. Chilvers and others. – Edinburgh, 2002. – 501-508 p.

3.     Harrisons Principle if internal medicine (seventeenth Edition)/Fauci, Braunwald, Hasper and other. – Part 10, section 2, Chapter 252.

4.     The Merck Manual of Diagnosis and Therapy (seventeenth Edition)/ Robert Berkow, Andrew J. Fletcher and others. – published by Merck Research Laboratories, 1999.

 

 

Short theoretic material

LUNG ABSCESS

Essentials of Diagnosis

• Development of pulmonary symptoms about 1-2 weeks after possible aspiration, bronchial obstruction, or previous pneumonia.

• Septic fever and sweats, and periodic sudden ex­pectoration of large amounts of purulent, foul-smelling, or "musty" sputum. Hemoptysis may occur.

• X-ray density with central radiolucency and fluid level.

General Considerations

Lung abscess develops when necrosis and liquefaction occur in an area where necrotizing pneumonia is present. Symptoms and signs occur 1-2 weeks after the following events: (1) massive-aspira­tion of upper respiratory tract secretions and microbial flora, especially during profound suppression of cough reflex (eg, with alcohol, drugs, unconsciousness, anesthesia, brain trauma); (2) bronchial obstruction (eg, by atelectasis, foreign body, neoplasm); (3) pres­ence of pneumonias, especially those caused by gram-negative bacteria or staphylococci; or (4) forma­tion of septic emboli from other foci of infection, or, during bacteremia, with pulmonary infarcts. Abscess is more commonly in the lower dependent portions of the lung. The main etiologic organisms are related to the underlying condition, but a dense mixed anaerobic flora is often prominent, particularly when aspiration has occurred.

Clinical Findings

      A. Symptoms and Signs: Onset may be abrupt or gradual. Symptoms include septic fever, sweats,  cough, and chest pain. Cough is often nonproductive at onset. Expectoration of foul-smelling brown or gray sputum (anaerobic flora) or of purulent sputum without odor (pyogenic organism) may occur abruptly and  in large quantity. Blood-streaked sputum is also common.

 Pleural pain, especially with coughing, is common because the abscess is often subpleural.     Weight loss, anemia, and pulmonary osteoarthropathy  may appear when the abscess becomes chronic (8-12 weeks after onset).

Physical findings may be minimal. Consolidation due to pneumonitis surrounding the abscess is the most frequent finding. Rupture into the pleural space produces signs of fluid or pneumothorax.

B. Laboratory Findings: Sputum cultures are usually inadequate in determining the bacterial cause of a lung abscess. Transtracheal aspirates should be obtained with the proper technique employed to cul­ture anaerobic organisms in addition to the usual aerobic cultures. Special methods of transporting specimens are required for anaerobic organisms, and appropriate culture media and methods must be employed.

Smear and cultures for the tubercle bacilli are required, especially in lesions of the upper lobe and in chronic abscess.

C. X-Ray Findings: A dense shadow is the initial finding. A central radiolucency, often with a visible fluid level, appears as surrounding densities subside. Computerized tomography can supply the detailed lo­calization of the abscess and may also reveal primary lesions (eg, bronchogenic carcinoma) and provide guidance for contemplated surgery. Various x-ray pro­cedures also permit localization of pleural involvement to facilitate drainage.

D. Instrumental Examination: Fiberoptic bronchoscopy may help to 'diagnose location and na­ture of obstructions (foreign body, tumor), obtain specimens for microbiologic and pathologic examina­tion, and, occasionally, aid drainage.

Differential Diagnosis

Differentiate from other causes of pulmonary cavitation: tuberculosis, bronchogenic carcinoma, mycotic infections, and staphylococcal or gram-nega­tive bacterial pneumonia.

Treatment

Postural drainage and bronchoscopy are impor­tant to promote drainage of secretions.

A. Acute Abscess: Intensive antibacterial ther­apy is necessary to prevent further destruction of lung tissue. While cultures and sensitivity tests are pending, treatment should be started with penicillin G, 2-6 million units daily. In penicillin hypersensitivity clindamycin and chloramphenicol are alternatives. If the patient improves on antimicrobial drugs (and postural drainage),

 

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