Flashcards in Pneumonia, Fungal Infections and Tuberculosis Deck (85):
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
Community acquired pneumonia (CAP) can be ___ or ___
What is acute CAP?
A sudden onset over a few hours to several days
What is chronic CAP?
Gradual escalating symptoms over days, weeks or even months
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
More than ___ individuals develop HAP each year
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
What are some aerosolized infectious particles that one can get from inhalation?
What kinds of pneumonia can one get from aspiration of organisms colonizing in the oropharynx?
-subtopic aspiration pneumonia
What are some populations that are at risk for large volume aspiration?
-Impaired gag reflexes from narcotic use
Intubated patients with chronic aspiration are at risk of what?
What are the major pathologic or structural changes associated with pneumonia?
-Inflammation of the alveoli
Bacterial pneumonia often occurs after an individual has had an upper respiratory tract infection such as a ____ or ____
What are some early signs and symptoms of bacterial pneumonia?
-Cough producing yellow/green sputum
Streptococcus pneumonia (gram positive) accounts for more than ___ of all bacterial pneumonias
____ pneumonia often follows a predisposing virus infection and is seen most often in children and immunosuppressed adults
Staphylococci (gram positive) are a common cause of ____ and are becoming increasingly antibiotic resistant
The major gram-negative organisms responsible for pneumonia are rod-shaped microorganisms called ____
A typical symptom of ____ pneumonia is a cough that tends to come in violent attacks, producing only a small amount of white mucus
____ 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
____ of oropharyngeal secretions and gastric fluids are the major causes of anaerobic lung infections
What are the symptoms of viral pneumonia?
-Dry (nonproductive) cough
What are some examples of gram negative pneumonia?
What are some viral causes of pneumonia?
-Influenza A & B
What are some other causes of pneumonia?
What are the three distinctive forms of aspiration pneumonia?
-Toxic injury to the lung (gastric acid)
In pneumonia, Vt does what?
Normal or decrease
In pneumonia, FRC, RV, IC, IRV, ERV, VC, and TLC do what?
In pneumonia, RV/TLC does what?
In general, how do you treat pneumonia?
It depends on the specific cause and the severity of symptoms demonstrated by the patient
How do you begin treatment for bacterial pneumonia?
In pneumonia, oxygen therapy is used to treat ____, ____ the work of breathing and ____ myocardial work
Hypoxemia; decrease; decrease
____ TB is called the primary infection stage and follows the patient's first exposure to the TB pathogen
When does primary TB begin?
When the inhaled bacilli implant in the alveoli
The lung tissue that surrounds the infected area of TB slowly produces a protective cell wall called a ____
Tubercle or granuloma
____ TB is a term used to describe the reactivation of TB months or even years after the initial infection has been controlled
TB can become reactivated at any time, especially in patients with ____
Depressed immune systems
Most new TB cases are associated with what risk factors?
-People in institutional housing
-People living in overcrowded conditions
____ 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)
Where do TB bacilli that enter the bloodstream usually gather and multiply?
-Apex of the lungs
-Regional lymph nodes
TB is primarily a chronic _____ pulmonary disorder
The major pathologic or structural changes of the lungs associated with TB are ____, ____, ____ and ____
Alveolar-capillary membrane destruction;
Caseous tubercles or granulomas;
Most TB infections are contracted via the ____ route
When stained, the hard outer layer of the tubercle bacilli resists decolorization by acid or alcohol; therefore the bacilli are called ____
Acid fast bacilli
What are the most frequently used diagnostic methods for TB?
-Mantoux tuberculin skin test (PPD)
With a PPD test, the skin is observed for induration after ___ hours and ___ hours
An induration of less than 5 mm is a ___ result
An induration of 5-9 mm is a ___ result
Suspicious; retesting is required
An induration of 10+ mm is a ___ result
In tuberculosis, Vt does what?
Normal or decrease
In tuberculosis, IRV, ERV, RV, VC, IC, FRC and TLC do what?
In tuberculosis, the RV/TLC ratio is what?
The standard pharmacologic agents used to treat TB consist of ___-___ drugs for ___-___ months
What are the first line agents prescribed for the entire 9 months of TB treatment?
Isoniazid (INH) and Rifampin (Rifadin)
Oxygen therapy is used to treat ____, ____ the work of breathing and ____ myocardial work
Hypoxemia; decrease; decrease
Because ____ is occasionally associated with TB, mechanical ventilation may be required to maintain adequate ventilatory status
Acute ventilatory failure
What clinical findings are typically associated with Pneumonia, TB and fungal infections?
-Increased HR and BP
-Cough, dull percussion, bronchial breath sounds
What are the major pathologic or structural changes of the lungs associated with fungal diseases?
-Fibrosis and secondary calcification
-Bronchial airway secretions
What is the most common fungal infection in the US?
Where in the US histoplasmosis typically found?
Major river valleys of the midwest (Ohio, Michigan, Illinois, Mississippi, Missouri, Kentucky, Tennessee, Georgia and Arkansas)
What is histoplasmosis frequently called?
Ohio Valley fever
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
What is the most common form of histoplasmosis?
Acute symptomatic pulmonary histoplasmosis symptoms may range from ___ to ___ depending on the number of spores inhaled
Mild; serious illness
___ histoplasmosis is characterized by infiltration and cavity formation in the upper lobes or one or both lungs
What are the three diagnostic tests used for fungal infections?
Fungal culture, fungal stain and serology
What test is considered the gold standard for detecting histoplasmosis?
In the ___ test, a small amount of blood, sputum or tissue from the lymph node, lung or bone marrow is cultured
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
A ____ test checks blood serum for antigens and antibodies to histoplasmosis
______ is caused by the inhalation of the spores of coccidioides immitis, which are spheric fungi carried by the windborne dust particles
In the US, coccidiodomycosis is especially preventalent in what states?
California, Arizona, Nevada, New Mexico, Texas and Utah
____ occurs in the south-central and midwestern United States and Canada
Blastomycosis inhabits areas high in what?
Organic matter such as forrest soil, decaying wood, animal manure and abandoned buildings
Blastomycosis is most common amount what populations and is also found in dogs, cats and horses?
Pregnant women and middle-aged African-American men
What are the three opportunistic pathogens?
Candida albicans, cryptococcus neoformans and aspergillus
What is aspergillus found in?
Soil, vegetation, leaf detritus, food and compost heaps
Who are at greatest risk of getting aspergillus?
Persons breathing the air of granaries, barns and silos
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
In fungal infections, Vt does what?
Normal or decrease
In fungal infections, IRV, ERV, RV, VC, IC, FRC, and TLC do what?
In fungal infections, the RV/TLC ratio is what?
In general, the drug of choice for most fungal infections is intravenously administered polyene ____
Amphotericin B (fungizone)
What are two other drugs used to treat fungal infections?
Fluconazole and itraconazole