Pneumonia, Fungal Infections and Tuberculosis Flashcards Preview

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Flashcards in Pneumonia, Fungal Infections and Tuberculosis Deck (85):
1

What is the definition of pneumonia?

An infection of the lower respiratory tract, in the alveolar level and small airways. It is the result of an inflammatory process that primarily affects the gas exchange area of the lung

2

Community acquired pneumonia (CAP) can be ___ or ___

Acute; chronic

3

What is acute CAP?

A sudden onset over a few hours to several days

4

What is chronic CAP?

Gradual escalating symptoms over days, weeks or even months

5

What is hospital acquired pneumonia (HAP or nosocomial pneumonia)?

A lower respiratory tract infection that develops in the hospitalized patients more than 48 hours after admission

6

More than ___ individuals develop HAP each year

250,000

7

Selected patient populations such as patients in the ICU and bone marrow transplant recipients, the mortality rate can be as high as ___ (especially those with organisms such as ____)?

70%; pseudomonas aeruginosa

8

What are some aerosolized infectious particles that one can get from inhalation?

-Tuberculosis
-Histoplasmosis
-Cryptococcosis
-Blastomycosis
-Q fever
-Legionellosis

9

What kinds of pneumonia can one get from aspiration of organisms colonizing in the oropharynx?

-CAP
-subtopic aspiration pneumonia
-subtopic HAP

10

What are some populations that are at risk for large volume aspiration?

-Impaired gag reflexes from narcotic use
-Alcohol intoxication
-Prior stroke
-Seizure disorder
-Cardiac arrest
-Syncope

11

Intubated patients with chronic aspiration are at risk of what?

-Mixed aerobic
-Anaerobic gram-negative
-Staphylococcal pneumonias

12

What are the major pathologic or structural changes associated with pneumonia?

-Inflammation of the alveoli
-Alveolar consolidation
-Atelectasis

13

Bacterial pneumonia often occurs after an individual has had an upper respiratory tract infection such as a ____ or ____

Cold; flu

14

What are some early signs and symptoms of bacterial pneumonia?

-Shaking chills
-Shaking
-High fever
-Sweating
-Chest pain
-Increased RR
-Cough producing yellow/green sputum

15

Streptococcus pneumonia (gram positive) accounts for more than ___ of all bacterial pneumonias

80%

16

____ pneumonia often follows a predisposing virus infection and is seen most often in children and immunosuppressed adults

Staphylococcal

17

Staphylococci (gram positive) are a common cause of ____ and are becoming increasingly antibiotic resistant

HAP

18

The major gram-negative organisms responsible for pneumonia are rod-shaped microorganisms called ____

Bacilli

19

A typical symptom of ____ pneumonia is a cough that tends to come in violent attacks, producing only a small amount of white mucus

Mycoplasma

20

____ multiplies in standing mud puddles, large air-conditioning systems and water tanks, and is transmitted when it becomes airborne and enters the patient's lungs as an aerosol

Legionella

21

____ of oropharyngeal secretions and gastric fluids are the major causes of anaerobic lung infections

Aspiration

22

What are the symptoms of viral pneumonia?

-Dry (nonproductive) cough
-Headache
-Muscle pain
-Fatigue
-Fever

23

What are some examples of gram negative pneumonia?

-Klebsiella
-E Coli
-Enterobacter species
-Serratia species

24

What are some viral causes of pneumonia?

-Parainfluenza
-Adenovirus
-Influenza A & B
-RSV
-SARS

25

What are some other causes of pneumonia?

-Rickettsiae
-Rubella
-Varicella
-Aspiration

26

What are the three distinctive forms of aspiration pneumonia?

-Toxic injury to the lung (gastric acid)
-Obstruction
-Infection

27

In pneumonia, Vt does what?

Normal or decrease

28

In pneumonia, FRC, RV, IC, IRV, ERV, VC, and TLC do what?

Decrease

29

In pneumonia, RV/TLC does what?

Normal

30

In general, how do you treat pneumonia?

It depends on the specific cause and the severity of symptoms demonstrated by the patient

31

How do you begin treatment for bacterial pneumonia?

Antibiotics

32

In pneumonia, oxygen therapy is used to treat ____, ____ the work of breathing and ____ myocardial work

Hypoxemia; decrease; decrease

33

____ TB is called the primary infection stage and follows the patient's first exposure to the TB pathogen

Primary

34

When does primary TB begin?

When the inhaled bacilli implant in the alveoli

35

The lung tissue that surrounds the infected area of TB slowly produces a protective cell wall called a ____

Tubercle or granuloma

36

____ TB is a term used to describe the reactivation of TB months or even years after the initial infection has been controlled

Postprimary

37

TB can become reactivated at any time, especially in patients with ____

Depressed immune systems

38

Most new TB cases are associated with what risk factors?

-HIV patients
-Immunosuppressed patients
-People in institutional housing
-People living in overcrowded conditions
-Alcoholism
-Malnourished individuals

39

____ TB refers to infection from TB bacilli that escape from a tubercle and travel to sites other throughout the body by means of bloodstream of lymphatic system

Disseminated (aka miliary TB)

40

Where do TB bacilli that enter the bloodstream usually gather and multiply?

-Long bones
-Genital tract
-Meninges
-Brain
-Apex of the lungs
-Regional lymph nodes
-Kidneys

41

TB is primarily a chronic _____ pulmonary disorder

Restrictive

42

The major pathologic or structural changes of the lungs associated with TB are ____, ____, ____ and ____

Alveolar consolidation;
Alveolar-capillary membrane destruction;
Caseous tubercles or granulomas;
Cavity formation;

43

Most TB infections are contracted via the ____ route

Airborne

44

When stained, the hard outer layer of the tubercle bacilli resists decolorization by acid or alcohol; therefore the bacilli are called ____

Acid fast bacilli

45

What are the most frequently used diagnostic methods for TB?

-Mantoux tuberculin skin test (PPD)
-Acid-fast staining
-Chest radiographs
-Sputum cultures

46

With a PPD test, the skin is observed for induration after ___ hours and ___ hours

48; 72

47

An induration of less than 5 mm is a ___ result

Negative

48

An induration of 5-9 mm is a ___ result

Suspicious; retesting is required

49

An induration of 10+ mm is a ___ result

Positive

50

In tuberculosis, Vt does what?

Normal or decrease

51

In tuberculosis, IRV, ERV, RV, VC, IC, FRC and TLC do what?

Decrease

52

In tuberculosis, the RV/TLC ratio is what?

Normal

53

The standard pharmacologic agents used to treat TB consist of ___-___ drugs for ___-___ months

2-4; 6-9

54

What are the first line agents prescribed for the entire 9 months of TB treatment?

Isoniazid (INH) and Rifampin (Rifadin)

55

Oxygen therapy is used to treat ____, ____ the work of breathing and ____ myocardial work

Hypoxemia; decrease; decrease

56

Because ____ is occasionally associated with TB, mechanical ventilation may be required to maintain adequate ventilatory status

Acute ventilatory failure

57

What clinical findings are typically associated with Pneumonia, TB and fungal infections?

-Tachypnea
-Increased HR and BP
-Chest pain
-Cyanosis
-Digital Clubbing
-Peripheral Edema
-Cough, dull percussion, bronchial breath sounds

58

What are the major pathologic or structural changes of the lungs associated with fungal diseases?

-Alveolar consolidation
-Alveolar-capillary destruction
-Caseous tubercles
-Cavity formation
-Fibrosis and secondary calcification
-Bronchial airway secretions

59

What is the most common fungal infection in the US?

Histoplasmosis

60

Where in the US histoplasmosis typically found?

Major river valleys of the midwest (Ohio, Michigan, Illinois, Mississippi, Missouri, Kentucky, Tennessee, Georgia and Arkansas)

61

What is histoplasmosis frequently called?

Ohio Valley fever

62

What is histoplasmosis commonly found in?

Soils enriched with bird excreta, such as soil near chicken houses, pigeon lofts, barns and trees where starlings and blackbirds roost

63

What is the most common form of histoplasmosis?

Asymptomatic histoplasmosis

64

Acute symptomatic pulmonary histoplasmosis symptoms may range from ___ to ___ depending on the number of spores inhaled

Mild; serious illness

65

___ histoplasmosis is characterized by infiltration and cavity formation in the upper lobes or one or both lungs

Chronic pulmonary

66

What are the three diagnostic tests used for fungal infections?

Fungal culture, fungal stain and serology

67

What test is considered the gold standard for detecting histoplasmosis?

Fungal culture

68

In the ___ test, a small amount of blood, sputum or tissue from the lymph node, lung or bone marrow is cultured

Fungal culture

69

In the ___ test, a tissue sample, which may be obtained from sputum, bone marrow, lungs or a skin lesion, is stained with dye and examined under a microscope

Fungal stain

70

A ____ test checks blood serum for antigens and antibodies to histoplasmosis

Blood serology

71

______ is caused by the inhalation of the spores of coccidioides immitis, which are spheric fungi carried by the windborne dust particles

Coccidiodomycosis

72

In the US, coccidiodomycosis is especially preventalent in what states?

California, Arizona, Nevada, New Mexico, Texas and Utah

73

____ occurs in the south-central and midwestern United States and Canada

Blastomycosis

74

Blastomycosis inhabits areas high in what?

Organic matter such as forrest soil, decaying wood, animal manure and abandoned buildings

75

Blastomycosis is most common amount what populations and is also found in dogs, cats and horses?

Pregnant women and middle-aged African-American men

76

What are the three opportunistic pathogens?

Candida albicans, cryptococcus neoformans and aspergillus

77

What is aspergillus found in?

Soil, vegetation, leaf detritus, food and compost heaps

78

Who are at greatest risk of getting aspergillus?

Persons breathing the air of granaries, barns and silos

79

Aspergillus infection usually occurs in the ____ and poses a serious threat to patients with ____ infection because it is almost alway an ____ infection

Lungs; HIV; opportunistic

80

In fungal infections, Vt does what?

Normal or decrease

81

In fungal infections, IRV, ERV, RV, VC, IC, FRC, and TLC do what?

Decrease

82

In fungal infections, the RV/TLC ratio is what?

Normal

83

In general, the drug of choice for most fungal infections is intravenously administered polyene ____

Amphotericin B (fungizone)

84

What are two other drugs used to treat fungal infections?

Fluconazole and itraconazole

85

Oxygen therapy in fungal infections is used to treat ____, ____ the work of breathing and ____ the myocardial work

Hypoxemia; decrease; decrease