Bronchiectasis and Lung Abscess MCQs

Bronchiectasis is most likely due to the extensive amounts of sputum production. In a young person, cystic fibrosis and hypogammaglobulinemia should be considered. Reference : Harrison's Principles of Internal medicine, 21st edition Ch: 290 Pg 2173

Extraintestinal infection by E. histolytica Most often involves the liver. Of travelers who develop an amebic liver abscess after leaving an endemic area, 95% do so within 5 months. Young patients with an amebic liver abscess are more likely than older patients to present in the acute phase with prominent symptoms of Reference : Harrison's Principles of Internal medicine, 21st edition Ch: 223Pg 1716

Pleuropulmonary involvement, which is reported in 20-30% of patients, is the most frequent complication of amebic liver abscess. Rupture into the pericardium, usually from abscesses of the left lobe of the liver, carries the gravest prognosis; it can occur during medical therapy and requires surgical drainage. Reference : Harrison's Principles of Internal medicine, 21st edition Ch: 223Pg 1717

Meconium Ileus is the earliest clinical manifestation of cystic fibrosis (CF) and occurs in approximately 16% of patients with CF. Contents of the intestinal lumen are often difficult to excrete, leading to meconium ileus (a presentation in 10–20% of newborns with CF) or distal intestinal obstructive syndrome in older individual. Signs of peritonitis include tenderness, abdominal wall edema, distension, and clinical evidence of sepsis. A palpable mass may indicate pseudocyst formation. Surgical exploration is indicated for patients with progressive distension, signs of peritonitis, or clinical deterioration. Complicated Meconium Ileus requires resection more often than simple cases and always requires temporary stomas. Reference: Harrison's Principles of Internal Medicine, 21 st Ed, Ch:291 Pg: 2176

Lung abscesses are usually characterized as either primary (~80% of cases) or secondary. Primary lung abscesses usually arise from aspiration, are often caused principally by anaerobic bacteria, and occur in the absence of an underlying pulmonary or systemic condition. Secondary lung abscesses arise in the setting of an underlying condition, such as a post obstructive process (e.g., a bronchial foreign body or tumor) or a systemic process (e.g., HIV infection or another immunocompromising condition). Lung abscesses can also be characterized as acute ( Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 127, Pg: 1020

In a patient who has recently had antibiotics, Clostridium difficile is the most likely infective organism. Clindamycin, ampicillin, and cephalosporins are the implicated drugs. Discontinuation of the offending antibiotic is important (not always easy if an infection such as a dental abscess persists). Oral administration of fidaxomicin or vancomycin is the treatment. Reference : Harrison's Principles of Internal Medicine, 21 st ed, Ch: 134, Pg: 1068

Clindamycin, doxycycline, minocycline, and trimethoprim-sulfamethoxazole are active in vitro against both MRSA and MSSA strains and have been recommended and used to treat skin and soft tissue infections in areas with high prevalence of MRSA. Many MRSA strains and some MSSA strains are fluoroquinolone resistant, and therefore fluoroquinolones should not be used in the absence of documented in vitro susceptibility Reference : Harrison's Principles of Internal Medicine, 21 st Ed, Ch: 129 Pg: 1039

Ans. B i.e. Terminal pulp space infection a painful abscess of the deep tissues of the palmar surface of the fingertip that is typically caused by bacterial infection (as with a staphylococcus) and is marked by swelling and pain