Chap 20 Flashcards
1
Q
Pulmonary edema results from
A
excessive movement of fluid from the pulmonary vascular system to the extravascular system and air spaces of the lungs. The abundance of fluid in the interstitial spaces causes the lymphatic vessels to widen and the lymph flow to increase
2
Q
Fluid first seeps into
A
the perivascular and peribronchial interstitial spaces, depending on the degree of severity, fluid may progresively move into the alveoli, bronchioles, and bronchi. As a consequence of this fluid movement, the alveolar walls and interstitial spaces swell
3
Q
As the swelling intensifies,
A
the alveolar surface tension increases and causes alveolar shrinkage and atelectasis. Moreover, much of the fluid that accumulates in the tracheobronchial tree is churned into a frothy white (sometimes blood-tinged or pink) sputum as a result of air moving in and out of the lungs
4
Q
Pulmonary edema produces a what disorder
A
restrictive pulmonary disorder
5
Q
The major pathologic or structural changes of the lungs associated with pulmonary edema are as follows
A
- Interstitial edema, including fluid engorgement of the perivascular and peribronchial spaces and the alveolar wall interstitium
- Alveolar flooding
- Increased surface tension of alveolar fluids
- Alveolar shrinkage and atelectasis
- Frothy white (or pink) secretions throughout the tracheobronchial tree
6
Q
Most common cause of cardiac pulmonary edema is
A
Left sided heart failure- commonly called congestive heart failure
7
Q
Heart failure is most common in people over age of
A
65 years
8
Q
Cardiac pulmonary edema occurs when the
A
left ventricle is unable to pump out a sufficient amount of blood during each ventricular contracting. The ability can be determined by means of the left ventricular ejection fraction (LVEF)- a noninvasive imaging procedure Echocardiogram (systolic activity)
9
Q
Diastolic function
A
Poor ventricular function caused by an increased ventricular stiffness or impaired myocardial relaxation
10
Q
Ordinarily hydrostatic pressure of about what tends to move fluid out of the pulmonary capillaries into the interstitial space
A
10-15mmHg, normally offset by colloid osmotic forces of about 25-30 mmHg and tend to keep fluid in pulmonary capillaries
11
Q
Onconotic pressure
A
Colloid osmotic pressure and is produced by albumin and gobulin in the blood
12
Q
When the hydrostatic pressure within the pulmonary capillaries rises to more than 25-30mmHg, the onconic pressure
A
loses its holding force over the fluid within the pulmonary capillaries. Consequently fluid starts to spill into the interstitial and air spaces of the lungs
13
Q
Clinical side effects of Left ventricular failure
A
Activity tolerance, weight gain, anxiety, delirium, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, cough, fatigue,cardiac arrhythmia, adventitious breath sounds.
14
Q
Result of hypoperfusion
A
major organ failure of the brain and kidney
15
Q
Pulmonary edema may develop as a result of
A
increased capillary permeability stemming from infectious, inflammatory, and other processes.
16
Q
Causes of increased capillary permeability
A
Alveolar hypoxia, ARDS, Pulmonary infection-pneumonia, Therapeutic radiation of the lungs, acute head injury
17
Q
Should the normal lymphatic drainage of the lungs be decreased,
A
Intravascular and extravascular fluid begins to pool, and pulmonary, and pulmonary edema ensues. Lymphatic drainage may be slowed bc of obliteration or distortion of lymphatic be slowed because of obliteration or distortion of lymphatic vessels. Because the lymphatic vessels empty into systemic veins, increased systemic venous pressure may slow lymphatic drainage.
18
Q
Reduced intrapleural pressure may cause
A
pulmonary edema
19
Q
Decreased oncotic pressure may be caused by
A
- Overtransfusion and or rapid transfusion of intravenous fluids
- Uremia
- hypoproteinemia (malnutrition)
- Acute nephritis
- Polyarteritis nodosa
20
Q
The treatment for pulmonary edema is based on
A
- the cause-that is noncardiogenic versus cardiogenic pulmonary edema 2. severity
- Largely supportive and aimed at ensuring adequate ventilation and oxygenation
- No specific treatments, noncardiogenic pulmonary edema caused by severe infection is treted with antibiotics
- High altitude is treated with lower elevation or by positive pressure ventilation
21
Q
Therapeutic interventions to address the pts circulationry system has the following three main goals
A
Reduction of pulmonary venous return(preload reduction)
Reduction of systemic vascular resistance (afterload reduction)
Inotropic support
22
Q
Reduction of the preload
A
decreases pulmonary capillary hydrostatic pressure and reduces fluid transudation into the pulmonary interstitium and alveoli
23
Q
Reduction of the afterload
A
Increases cardiac output and improves renal perfusion, which in turn allows for diuresis in the pt with fluid overload
24
Q
Inotropic agents are used to treat
A
hypotension or signs of organ hypoperfusion
25
Preload reducers include
Nitroglycerin, Loop diuretics, Morphine sulfate
26
Nitroglycerin
Very effective, predictable, and rapid acting medication for preload
27
Loop diuretics
(Foresmide) Considered a cornerstone in the tx of cardiogenic pulmonary edema. Presumed to decrease preload through diuresis and direct vasodilation
28
Morphine sulfate
may be used in some cases to reduce preload. Adverse effects (nausea, vomiting or resp depression) may outweigh the potential benefit
29
Reduced systemic vascular resistance
increases cardiac output and improves renal perfusion, allowing for diuresis
30
Afterload reducers include
Dobutamine, Dopamine, Norephinephrine, Milrinone
31
Dobutamine
synthetic catecholamine that mainly has beta1 receptor activity, but also has some beta2- receptor and alpha receptor activity. Commonly used for pts with mild hypotension (systolic pressure 90-100)
32
Dopamine
naturally occuring catecholamine that acts as a precursor to norepinephrine.
Hemodynamic effect is dose dependent
Low dose is associated with dilation in renal and splanchnic vasculature , enhancing diuresis.
Moderate dose enhances cardiac contractility and heart rate.
A high dose increases afterload due to peripheral vasoconstriction.
GENERALLY RESERved FOR PTS WITH MODERATE HYPOTENSION (systolic 70-90)
33
Norepinephrine
Naturally occuring catecholamine with potent alpha receptor and mild beat receptor activity.
Stimulates beta1 adrenergic and alpha1 adrenergic receptors, increasing myocardial contractility, HR and vasoconstriction.
It increases BP and afterload. Is generally reserved for pts with SEVERE HYPOTENSION (<70 systolic)
34
Antidysrhythmic Agents
such as drugs to control bradycardia
35
Albumin or mannitol
sometimes administered to increase the pts oncotic pressure in an effort to offset the increased hydrostatic forces of cardiogenic pulmonary edema, if pts osmotic pressure is extremely low
36
Which of the following is an afterload reducer
Nitroprusside
37
What is the normal hydrostatic pressure in the pulmonary capillaries
10-15 mmHg
38
The normal oncotic pressure of the blood
25-30mmHg
39
Which of the following causes cardiogenic pulmonary edema?
Excessive fluid administration
Left ventricle failure
Mitral valve disease
Pulmonary embolus
40
As a result of pulmonary edema the pts
RV is decreased
FRC is Decreased
VC is decreased
TLC is decreased
41
LVEF norm
55-70%
42
Pneumonia or pneumonitis with consolidation is the result of an
inflammatory process that primarily effects the gas exchange area of the lung.
43
Effusion
process of fluid transfer.
44
Surface phagocytosis
Polymorphonuclear leukocytes move into the infected area to engulf and kill invading bacteria on the alveolar walls
45
When alveoli become filled with fluid, RBCs, polymorphonuclear leukocytes and macrophages the lungs are said to be
consolidated
46
Atelectasis is often associated with what kind of pneumonia
Aspiration pneumonia
47
Major pathologic or structural changes associated with pneumonia are
inflammation of the alveoli, alveoli consolidation, atelectasis
48
Causes of pneumonia include
bacteria, viruses, fungi, protozoa, parasites, TB, anerobic organisms, aspiration, and the inhalation of irritating chemicals such as chorine
49
Pneumonia is an ___ disease because its symptoms vary greatly
insidious
50
Bronchopneumonia
is characterized by a patchy pattern of infection that is limited to the segmental bronchi and surrounding lung parenchyma.
Usually involves both lungs and is seen more often in the lower lobe of the lung
51
Lobar pneumonia
is a widespread or diffuse alveolar inflammation and consolidation. Typically the end result of a severe or long term bronchopneumonia in which the infection has spread from one lung segment to another until the entire lung lobe is involved
52
Interstitial pneumonia
is usually diffuse and often bilateral inflammation that primarily involves the alveolar septa and interstitial space.
53
Mycoplasma pneumonia
cause interstitial pneumonias. Causing only minor permanent alveolar damage and usually resolve without consequences
54
When both lungs are involved the condition is called
double pneumonia or "walking pneumonia" often used to describe a mild case of pneumonia
55
CAP
pneumonia acquired from normal social contact
56
Streptococcal Pneumonia
accounts for 80% of all the bacterial pneumonias.
| Gram positive, nonmotile coccus that is found singly, in pairs and in short chains.
57
Streptococci Pneumonia are generally transmitted by
aerosol from a cough or sneeze of an infected individual . Commonly cultured from the sputum of patients having an acute exacerbation of chronic bronchitis
58
Staphylococcal Pneumonia 2 main groups
1. Staphylococcus aereus-"staph infections"
| 2. Stephylococcus albus and epidermidis -normal skin flora
59
Staphylococcus aereus is commonly transmitted by
aerosol from a cough of sneeze of an infected individual and indirectly via contact with contaminated floors, bedding, clothes, and the like
60
Staphylococcus are a common cause of
Hospital acquired pneumonia or nosocomial pneumonia and are becoming increasingly antibiotic resistant
61
MDRSA
Multiple drug resistant S. aureus
62
Haemophilus influenzae
is a common inhabitant of human pharyngeal flora. One of the smallest gram neg bacilli.
H. influenza type B- children age 1 month-6 years, cause of epiglottitis.
63
Legionella Pneumophila
severe pneumonia like disease outbreak occured at an american legion convention in philadelphia. Most of the species are free living in soil and water, where they act as decomposer organisms. Also multiply in standing water. Transmitted when it becomes airborne and enters the pts lungs as an aerosol.
Most commonly seen in middle aged men who smoke
64
Enterobacteriaceae (klebsiella pneumonia)
Associated with lobar pneumonia, particularly in men older than 40 years and in chronic alcoholics of both genders, It is a normal inhabitant of the human gastrointestinal tract. Transmitted directly by aerosol or indirectly by contact with freshly contaminated articles.
Common nosocomial, or hospital acquired disease
65
Pseudomonas aeruginosa
is a highly mobile, gram negative bacilus. Found in the gastrointestinal tract, burns, and catheterized urinary tract and is a contaminant in many aqueous solutions. LEADING CAUSe OF HOSPITAL ACQUIRED PNEUMONIA
66
Most common cause of an acquired atypical pneumonia
mycoplasma
67
common symptom of mycoplasma pneumonia
is a cough that tends to come in violent attacks, producing only a small amount of white mucus
68
Patients with M. pneumoniae are aften said to have
"walking pneumonia" because of the condition is mild
69
Chlamydia
is a type of bacteria that may be cound in the cervix, urethra, rectum, throat, and resp tract. Also of feces of variety of birds
70
Viruses account for what percent of pneumonias
50% and several are associated with community acquired atypical pneumonia. Although most viruses attack the upper airways some can produce pneumonias
71
Viral pneumonias tends to start with
flulike signs and symptoms. as the disease progreasses the pt may become SOB, cough, and produce a small amount of clear or whtie sputum.
72
Viral pneumonia always carries the risk of
development of a secondary bacterial pneumonia
73
Common viruses associated with CA atypical P include
Resp synctial virus, parainfluenza virus (children) , influenza A and B (adults), adenovirus (military recruits), and human metapneumovirus
74
There are five types of parainfluenza viruses
types 1, 2, 3, 4A, and 4B.
- Types 1,2,3 are major causes of infections in humans
- Type 1 is considered croup type of virus
- Type 2, 3 are associated with severe infections
- Type 3 common in infants
75
Influenza viruses A and B
most common causes of viral respiratory tract infections. During winter months. Transmitted from person to person by aerosol droplets.
First sign- increase in school absenteeism.
Incubation period of 1-3 days, usually cause upper resp tract infections
76
Common causes of hospital acquired pneumonias include
enterobacteriaceae, pseudomonas spp., and staphylcoccus aureus
77
VAP
Pneumonia that develops more than 48-72 hours after ET intubation.
-P.aeruginosa, Enterobacter, Klebsiella, and S. aureus
78
Common pathogenic agents associated with aspiration pneumonia include
anerobic oral flora admixed with aerobic bacteria such as S. pneumonia, S. aureus, H. influenza, and P aeruginosa
79
Aspiration of gastric fluid with a ph of ___ or less causes serious and often fatal form pf pneumonia
2.5. Aspirations of oropharyngeal secretions and gastric fluids are the major causes of anaerobic lung infections
80
Inflammatory reaction generally increases in severity for
12 to 26 hours and may progess to acute resp distress syndrom (ards)
81
Three distinctive forms of aspiration pneumonia
1. Toxic injury to the lung
2. obstruction
3. infection
82
Normal swelling mechanics has four phases...
1. oral preparatory
2. oral
3. pharygeal
4. esophageal
- First two phases are considered voluntary (cerebral)
- Pharyngeal phase (involuntary brain stem funtion) many steps
83
Resp is halted during pharyngeal phase for an approx
1 second apneic period
84
Also known as Friedlanders bacillus?
Klebsiella
85
Accounts for more than 80% of all the baterial pneumonias?
Streptococcal pneumonia
86
Associated with Q fever?
Rickettsia
87
Mendelsons syndrom is a term associated with what
Aspiration Pneumonia
88
Infects almost all children by age two?
Respiratory Synctial virus
89
Which of the following is almost always cause of acute epiglottitus
Haemophilus influenzae type B
90
Which of the following related to mumps, rubella, and RSV
Parainfluenza virus
91
In the absence of secondary bacterial infection, lung inflammation caused by the aspiration of gastric fluids usually becomes insignificant in approx how many days
3 days
92
Which of the following findings is/are associated with pneumonia?
1. Decreased tactile and vocal fremitus
2. Increased C(a-v)O2
3. Decreased functional residual capacity
4. Increased vital capacity
Decreased functional residual capacity
93
Lung abscess is defined as
a necrosis of lung tissue that in severe cases leads to a localized air and fluid filled cavity. Also known as "necrotizing pneumonia" or "lung gangrene"
94
The fluid in the cavity of a lung abscess is a collection of
purulent exudate that is composed of liquefied white blood cell remains, proteins, and tissue debris.
95
Pyogenic membrane
the air and fluid filled cavity encapsulated membrane that consists of a layer of fibrin, inflammatory cells, and granulation tissue
96
In severe cases the tissue necrosis in lung abscesses
ruptures into a bronchus and allows a partial or total drainage of the liquefied contents from the cavity. causes pleural effusion and empysema
97
The major pathologic or structural changes associated with a lung abcess are
- Alveolar Consolidation
- alveolar capillary and bronchial wall destruction
- tissue necrosis
- cavity formation
- fibrosis and calcification of the lung parenchyma
- bronchopleural fistulas and empysema
- atelectasis
- Excessive airway secretions
98
Lung abscesses most commonly occur as a
complication of aspiration pneumonia
99
flash burn
apsiration of acidic gastric fluids is associated with immediate injury to the tracheobronchial tree and lung parenchyma
100
Common anaerobic organisms found in the normal flora of the mouth, gingival crevice, upper resp tract, and gastrointestical tract
```
Anaerobic gram positive cocci
-Peptostreptococci
-Peptococci
Anaerobic gram negative bacilli
-Bacteroides fragilis
-Prevotella melaninogenica
-Fusobacterium species
```
101
Which of the following is or are anaerobic organisms?
1. Blastomyces
2. Peptococcus
3. Coccidioides immitis
4. Bacteroids
2. Peptococcus and 4. Bacteroids
102
Predisposing factors to the aspiration of GI fluids (and anaerobes?
1. Seizure disorders
2. Head trauma
3. Alcoholic binges
4. General anesthesia
all of the above
103
Associated with the formation of a lung abscess
(1) Bullae of cysts that become infected
(2) Interstitial lung disease with cavity formation
(3) Bronchial obstruction with secondary cavitating infection
(4) Penetrating chest wounds that lead to an infection
104
Anatomically a lung abscess most commonly forms in which parts of the lungs
Posterior segment of the upper lobe and Superior segment of the lower lobe
105
Which of the following pulmonary function findings may be associated witha severe and extensive lung abscess?
(1) Decreased FVC
(2) Increased PEFR
(3) Decreased RV
(4) Increased FRC
1. Decreased FVC
| 3. Decreased RV
106
TB
is a contagious chronic bacterial infection that primarily affects the lungs, although it may involve almost any part of the body
107
TB is classified as either
primary TB, Postprimary TB, or disseminated TB
108
Primary TB
follows the pts first exposure to the TB pathogen, mycobaterium TB. Begins when the inhaled bacilli implant in the alveoli. multiplies over 3-4 week period, intitial response of the lung is an inflammatory response.
-Clinically this phase coincides with a positive tuberculin reaction-PPD skin test result
109
Tubercle or granuloma
cell wall produced in TB pts. Encapsulate, or trap the TB bacilli in a nutshell like structure
110
Ghon nodules
TB on chest radiograph, lung lesions
| -lymph nodes in the hilar region
111
Dormant TB
pts do not feel sick or have any TB related symptoms. They are still infected iwth TB but do not have clinically active TB.
- Positive reaction to the tuberculin skin test (mantoux test), or TB blood test, chest residual scarrign or the radiograph.
- not infectious and cannot spread TB bacilli to others
112
Postprimary TB
Reactivation of TB months or even years after the initial infection has been controlled.
113
If the TB infection is uncontrolled,
further growth of the caseous granulomas tubercle develop
114
pt is highly contagious at this stage of TB
TB consumption
115
Disseminated TB
refers to infection from TB bacilli that escape from a tubercle and travel to other sites throughout the body by means of the bloodstream or lymphatic system
116
Most common location for TB is the
apex of the lungs. Other oxygen rich areas in the body include the regional lymph nodes, kidneys, long bones, genital tract, brain, and mininges
117
Genital TB in each gender
males damages the prostate gland, epididymis, seminal vesicles, and testes; in females, the fallopian tubes, ovaries, and uterus. The spine is a frequent site of tb Invfection, although hip knee wrist and elbow can be involved
118
Tubercular meningitis is caused
by an active brain lesion seeding TB bacilli into the meninges
119
TB complications include
hemoptysis, pneumothroax, bronchiectasis, extensive pulmonary destruction, malignancy, and chronic pulmonary aspergillosis.
120
TB primarily results in a what disorder
chronic restrictive pulmonary disorder
121
In humans, TB is primarily caused by
bacteria called Mycobacterium tuberculosis
122
Isolation procedures
used in acutely ill patients hospitalized and suspected of having active tuberculosis. Since it has been shown that in very fine aerosolized spray droplets (0.5 to 1.0um), the TB bacilli can remain suspended in the air for several hours after a cough or sneeze. When inhaled, some of the bacilli may be trapped in the mucus of the nasal passage and removed. The smaller bacilli, however, can easily be inhaled into the bronchioles and alveoli..
123
The TB bacilli are highly ___ and thrive best in areas of the body with ___
Aerobic organisms, high oxygen tension-especially in the apex of the lungs
124
Most frequently used diagnostic methods for TB are teh
mantoux tuberculin skin test, acid fast bacilli sputum, cultures, and chest radiographs. New test called QuantiFERON-TB Gold
125
Mantoux test
Most widely used TB test consisting of an intradermal injection of a small amount of purified protein derivative (PPD) of the TB bacillus.
-Skin is observed for induration (a wheal) after 48 hours and 72 hours, with results interpreted as follows
+Induration less than 5mm is a negative result
+5-9 mm is considered suspicious , and retesting required
+10mm or greater is considered a positive result.
126
Acid Fast Bacteria (AFB) test (sputum smear)
Frequently used test-Ziehl Neelsen stain= reveals bright red acid fast bacilli against a blue background
-Fluorescent acid-fast stain= reveals luminescent yellow green bacilli against a dark brown background. (becoming test of choice bc easier to read)
127
Sputum culture
Differentiate M.Tuberculosis from other acid-fast organisms. Common nontuberculous acid fast mycobacteria associated with COPD.
Can also identify drug resistant bacilli and their sensitivity to antibiotic therapy
-TB is caused by a bacterium and not a fungi
128
QFT-B test
is a whole blood test used for diagnosing M. Tuberculosis infection, including latent TB infection. Samples of blood are mixed with antigens. Incubated for 16-24 hours, measured for presence of interferon-gamma (IFN-gamma).- Elevated levels is diagnostic of TB
129
Standard pharmacologic agents used to treat M.tuberculosis consists of two to four drugs for 6-9 months. Examples of these protocols are as follows..
-Six month treatment protocol=First two months (induction phase) the pt takes a daily dose of INH, rifampin, pyraxinamide, and either ethambutol or streptomycin. for the next four months the pt taks INH and rifampin daily or twice weekly
-Nine month trreatment protocol= for the first 1-2 months the pt takes a daily dose of isoniazid and rifampin, followed by twice weekly isoniazid and rifampin until the full 9 month period has been complete
+when the TB bacterium is resistant to one or more of these agents, at least 3 or more antibiotics must be added to the tx regimen and the duration should be extended
130
Isoniazid (INH) and rifampin (Rifadin)
are first line agents prescribed for the entire 9 months of TB
Isoniazid- considered most effective first line antituberculosis agent
Rifampin-Bactericidal and is most commonly used with INH
131
Directly observed therapy (DOT)
Ingestion of medication is directly observed by a responsible individual in communities where DOT has been used, the rate of drug resistant TB and the rate of TB relapse have been shown to decrease
132
When fungal spores are inhaled
they may reach the lungs and germinate. Producing a frothy, yeast like substance that leads to an inflammatory response. Infected areas eventually become consolidated
133
Fungal diseases of the lung cause a what disorder?
Chronic restrictive pulmonary disorder
134
Changes of the lungs associated with fungal diseases of the lungs are as follows
- Alveolar consolidation
- Alveolar capillary destruction
- Caseous tubercles or granulomas
- Cavity formation
- Fibrosis and secondary calcification of the lungs parenchyma
- Bronchial secretions
135
Fungal spores of various types are widely distributed throughout
the air , soil, fomites, and animals, and even exist in the normal flora of humans
136
Histoplasmosis
most common fungal infection in the US, it is caused by the dimorphic fungus Histoplasma capsulatum.
- High along the major river valleys of Midwest and South "Ohio Valley fever"
- Found in soils enriched with bird exreta. (children playing in dirt)
137
Asymptomatic histoplasmosis
most common form of histoplasmosis. May just be a small, healed lesion of the lung parenchyma or calcified hilar lymph nodes
138
Chronic Pulmonary Histoplasmosis
characterized by infiltration and cavity formation in the upper lobes of one or both lungs. Effects pts with an underlying disease such as emphysema.
-Commonly seen in middle aged white men who smoke
139
Disseminated histoplasmosis
May follow either self limited histoplasmosis or chronic histoplasmosis. Seen in very young or very old pts with compromised immune systems
140
Screening and diagnosis of fungal disease-Histoplasmosis
Fungal culture-gold standard, disadvantage takes 4 weeks or longer, may prove fatal.
Fungal Stain-Tissue sample from sputum, bone marrow, lungs, or skin lesion, is dyed and examined uner a microscope. Obtaining sputum sample may be difficult, but 100% accurate
-Serology- Blood test checks blood serum for antigens and antibiodies (false negative)
141
Coccidioidomycosis Fungal disease
caused by inhalation of the spores of Coccidioides immitis, carried by wind borne dust particles.
- hot dry regions "california fever", "Desert rheumatism", "valley fever"
- Isolated in soils, plants, and a large numb of vertebrates
142
Spherules
when C.immitis spores are inhaled, they settle in the lugns, begin to germinate, and form round, thin walled cells
143
Screening and Diagnosising Coccidiodomycosis fungal disease
Direct visualization of distinctive spherules in microscopy of the pts sputum, tissue exudates, biopsies, or spinal fluid. Further supported by blood tests or from culture
144
Blastomycosis Fungal disease
"chicago diease, "north america blastomycosis" caused by blastomyces dermatitidis.
- Inhabits areas high in organic matter, such as forest soil, decaying wood, animal manure, and abandoned buildings. also found in dogs, cats, and horses
- Cough is frequently productive, and the sputum is purulent
- Skin lesions first sign of disease
- Diagnosed by direct visualization or culture
145
Opportunistic Pathogens
Candida albicans-thrush,
Cryptococcus neoformans- pigeon droplets high nitrogen content, and
aspergillus-most pervasive fungi in soil, vegetation, leaf, food, compost heaps (barns)
146
General management of fungal disease
- Amphotericin B= is the treatment of choice for most fungal infections= high incidence of nephrotoxicity associated,
- So the Azole antifungal agents=now serve an excellent alternative.
- Echinocandins
147
Most common fungal infection in the US
Histoplasmosis
148
Incidence of histoplasmosis is especially high in which of the following areas
1. Arizona
2. Mississippi
3. nevada
4. Texas
Mississippi
149
The condition called "desert bumps" "dessert arthritis" or "dessert rheumatism" is associated with which fungal disorder
Coccidiodomycosis
150
Which of the following is or are used to treat fungal disease
1. Streptomycin
2. Amphotericin B
3. Penicillin G
4. Iltraconazole
2. Amphotericin B
| 4. Iltraconazole
151
Form of histoplasmosis characterized by healed lesions in the hilar lymph nodes as well as a positive histoplasmin test response?
Latent asymptomatic disease
152
Pulmonary edema results from
excessive movement of fluid from the pulmonary vascular system to the extravascular system and air spaces of the lungs.
-Fluid first seeps into the perivascular and peribronchial interstitial spaces, may progress into the alveoli, bronchioles, and bronchi
153
Known as the first stage of TB
1. Reinfection TB
2. Primary TB
3. Secondary TB
4. Primary infection stage
Primary TB, Primary infection stage
154
What is the name of the protective wall that surrounds and encases lung tissue infected with TB
Granuloma and Tubercle
155
The tubercle bacillus is
1. High aerobic
2. Acid Fast
3. Capable of surviving for months outside of body
4. Rod-shaped
156
At which size wheal is a TB skin test considered to be positive
10mm
157
Often prescribed as a prophylactic daily dose for 1 year in individual who has been exposed to TB bacilli
Isoniazid
