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foundations pulm exam > histococci (fungal PNA) > Flashcards

histococci (fungal PNA) Flashcards

1
Q

what is the etiology of histoplasma capsulatum?

A

soil contaminated with bird/bat droppings

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2
Q

what are the different forms of histoplasmosis?

A 
asymptomatic primary histoplasmosis
acute diffuse pulmonary disease
acute localized pulmonary disease
chronic cavitary pulmonary histoplasmosis
disseminated histoplasmosis
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3
Q

which form of histoplasmosis is the most common?

A

asymptomatic primary histoplasmosis (may see residual granuloma on CXR)

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4
Q

which form of histoplasmosis lasts 1 week - 6 months?

A

acute diffuse pulmonary disease (can occur in healthy people, few complaints, can have fever and marked fatigue)

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5
Q

which form of histoplasmosis presents like PNA?

A

acute localized pulmonary disease (cough, fever, possible dyspnea and local infiltrates)

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6
Q

which form of histoplasmosis usually occurs in older COPD pts?

A

chronic cavitary pulmonary histoplasmosis (lungs show apical cavities)

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7
Q

which form of histoplasmosis is often fatal?

A

disseminated histoplasmosis (fever, marked fatigue and cough, dyspnea, and weight loss)

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8
Q

what does CXR show in histoplasmosis?

A

hilar adenopathy, patchy or nodular infiltrates in lower lung fields

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9
Q

when are cultures useful in histoplasmosis?

A

chronic disease

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10
Q

can you treat asymptomatic pts with histoplasmosis?

A

no

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11
Q

does acute pulmonary infection need treatment?

A

usually not but you could use ORAL itraconazole or ketoconazole

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12
Q

how to treat severe histoplasmosis infection?

A

amphotericin B IV

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13
Q

how to treat chronic histoplasmosis infection?

A

amphtericin B or itraconazole

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14
Q

how to treat AIDS pt with histoplasmosis?

A

amphotericin B

maintenance therapy with itraconazole

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15
Q

what is the etiology of coccidioidomycosis?

A

coccidioides immitis or coccidioides posadasii

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16
Q

what is the incubation period for coccidioidomycosis?

A

7-21 days

17
Q

what is the clinical presentation of coccidioidomycosis?

A 
fever
cough
pleuritic chest pain
H/A
arthralgias
marked fatigue
rash
18
Q

what types of pts are at increased risk for disseminated cocci?

A

HIV/immunocompromised
African Americans
Asians
women in 3rd trimester of pregnancy

19
Q

immunocompromised due to?

A 
pt with solid organ transplant
high-dose glucocorticoids
chemotherapy
immunosuppresant meds
pre-existing cardiopulmonary conditions
frail eldery
20
Q

what might you find on CXR for pt with coccidioidomycosis?

A

hilar adenopathy
patchy, nodular pulmonary infiltrates
miliary infiltrates
thin-walled cavities

21
Q

what might you find in lab findings for pt with coccidioidomycosis?

A

eosinophilia/high WBC count

22
Q

when treating a pt with coccidioidomycosis, what must you not give?

A

steroids

23
Q

majority of coccidioidomycosis cases will resolve ______ antifungal therapy

A

without

24
Q

what are indications for treating pt with coccidioidomycosis?

A 
> 10% loss of body weight
night sweats > 3 weeks
infiltrates involving more than half of one lung or portions of both lungs
prominent or persistent hilar adenopathy
inability to work
symptoms > 2 months
25
Q

what medication would you give to a pt with coccidioidomycosis for 3-6 months

A

fluconazole

26
Q

severe cases of coccidioidomycosis or pregnancy, what medication do you give?

A

amphotericin B IV

27
Q

how often do you monitor a pt with coccidioidomycosis?

A

everyone for 1 year, initially q2-4weeks

28
Q

what are common ADR with antifungal meds?

A

GI upset

hepatotoxicity

29
Q

what are ADR of amphotericin B IV?

A 
encephalopathy
seizures
cardiomyopathy
Ventricular arrhythmias
renal failure
cardiac arrest
pulmonary edema
electrolyte imbalance
hepatotoxicity
agranulocytosis
30
Q

what disease must you be careful with when giving itraconazole?

A

CHF

31
Q

what symptoms associated with both cocci & histo?

A

arthralgias
erythema nodosum
erythema multiforme

32
Q

think cocci when pt has pulmonary complaints and one or more of the 3 Es

A

erythema nodosum
erythema multiforme
eosinophilia

33
Q

what organism is most commonly associated with AIDS?

A

pneumocystis jiroveci (airborne fungus)

34
Q

what is the clinical presentation of pneumocystis jiroveci?

A

pneumoia (severe SOB)
severe hypoxemia
CXR shows diffuse perihilar infiltrates

35
Q

when to think “maybe fungal PNA?”

A

pneumonia with hilar or mediastinal lymphadenopathy or masses
pulmonary nodules suggestive of malignancy
cavitary lung disease that looks like TB
presentation looks like sarcoidosis

foundations pulm exam (10 decks)

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