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Pathophysiology > Chap 20 > Flashcards

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

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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

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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

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4
Q

Pulmonary edema produces a what disorder

A

restrictive pulmonary disorder

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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
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6
Q

Most common cause of cardiac pulmonary edema is

A

Left sided heart failure- commonly called congestive heart failure

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7
Q

Heart failure is most common in people over age of

A

65 years

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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)

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9
Q

Diastolic function

A

Poor ventricular function caused by an increased ventricular stiffness or impaired myocardial relaxation

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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

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11
Q

Onconotic pressure

A

Colloid osmotic pressure and is produced by albumin and gobulin in the blood

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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

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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.

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14
Q

Result of hypoperfusion

A

major organ failure of the brain and kidney

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15
Q

Pulmonary edema may develop as a result of

A

increased capillary permeability stemming from infectious, inflammatory, and other processes.

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16
Q

Causes of increased capillary permeability

A

Alveolar hypoxia, ARDS, Pulmonary infection-pneumonia, Therapeutic radiation of the lungs, acute head injury

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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.

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18
Q

Reduced intrapleural pressure may cause

A

pulmonary edema

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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
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20
Q

The treatment for pulmonary edema is based on

A
  1. 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
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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

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22
Q

Reduction of the preload

A

decreases pulmonary capillary hydrostatic pressure and reduces fluid transudation into the pulmonary interstitium and alveoli

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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

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24
Q

Inotropic agents are used to treat

A

hypotension or signs of organ hypoperfusion

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25
Q

Preload reducers include

A

Nitroglycerin, Loop diuretics, Morphine sulfate

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26
Q

Nitroglycerin

A

Very effective, predictable, and rapid acting medication for preload

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27
Q

Loop diuretics

A

(Foresmide) Considered a cornerstone in the tx of cardiogenic pulmonary edema. Presumed to decrease preload through diuresis and direct vasodilation

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28
Q

Morphine sulfate

A

may be used in some cases to reduce preload. Adverse effects (nausea, vomiting or resp depression) may outweigh the potential benefit

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29
Q

Reduced systemic vascular resistance

A

increases cardiac output and improves renal perfusion, allowing for diuresis

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30
Q

Afterload reducers include

A

Dobutamine, Dopamine, Norephinephrine, Milrinone

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31
Q

Dobutamine

A

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)

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32
Q

Dopamine

A

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)

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33
Q

Norepinephrine

A

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)

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34
Q

Antidysrhythmic Agents

A

such as drugs to control bradycardia

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35
Q

Albumin or mannitol

A

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

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36
Q

Which of the following is an afterload reducer

A

Nitroprusside

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37
Q

What is the normal hydrostatic pressure in the pulmonary capillaries

A

10-15 mmHg

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38
Q

The normal oncotic pressure of the blood

A

25-30mmHg

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39
Q

Which of the following causes cardiogenic pulmonary edema?

A

Excessive fluid administration
Left ventricle failure
Mitral valve disease
Pulmonary embolus

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40
Q

As a result of pulmonary edema the pts

A

RV is decreased
FRC is Decreased
VC is decreased
TLC is decreased

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41
Q

LVEF norm

A

55-70%

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42
Q

Pneumonia or pneumonitis with consolidation is the result of an

A

inflammatory process that primarily effects the gas exchange area of the lung.

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43
Q

Effusion

A

process of fluid transfer.

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44
Q

Surface phagocytosis

A

Polymorphonuclear leukocytes move into the infected area to engulf and kill invading bacteria on the alveolar walls

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45
Q

When alveoli become filled with fluid, RBCs, polymorphonuclear leukocytes and macrophages the lungs are said to be

A

consolidated

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46
Q

Atelectasis is often associated with what kind of pneumonia

A

Aspiration pneumonia

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47
Q

Major pathologic or structural changes associated with pneumonia are

A

inflammation of the alveoli, alveoli consolidation, atelectasis

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48
Q

Causes of pneumonia include

A

bacteria, viruses, fungi, protozoa, parasites, TB, anerobic organisms, aspiration, and the inhalation of irritating chemicals such as chorine

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49
Q

Pneumonia is an ___ disease because its symptoms vary greatly

A

insidious

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50
Q

Bronchopneumonia

A

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

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51
Q

Lobar pneumonia

A

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

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52
Q

Interstitial pneumonia

A

is usually diffuse and often bilateral inflammation that primarily involves the alveolar septa and interstitial space.

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53
Q

Mycoplasma pneumonia

A

cause interstitial pneumonias. Causing only minor permanent alveolar damage and usually resolve without consequences

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54
Q

When both lungs are involved the condition is called

A

double pneumonia or “walking pneumonia” often used to describe a mild case of pneumonia

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55
Q

CAP

A

pneumonia acquired from normal social contact

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56
Q

Streptococcal Pneumonia

A

accounts for 80% of all the bacterial pneumonias.

Gram positive, nonmotile coccus that is found singly, in pairs and in short chains.

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57
Q

Streptococci Pneumonia are generally transmitted by

A

aerosol from a cough or sneeze of an infected individual . Commonly cultured from the sputum of patients having an acute exacerbation of chronic bronchitis

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58
Q

Staphylococcal Pneumonia 2 main groups

A
  1. Staphylococcus aereus-“staph infections”

2. Stephylococcus albus and epidermidis -normal skin flora

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59
Q

Staphylococcus aereus is commonly transmitted by

A

aerosol from a cough of sneeze of an infected individual and indirectly via contact with contaminated floors, bedding, clothes, and the like

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60
Q

Staphylococcus are a common cause of

A

Hospital acquired pneumonia or nosocomial pneumonia and are becoming increasingly antibiotic resistant

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61
Q

MDRSA

A

Multiple drug resistant S. aureus

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62
Q

Haemophilus influenzae

A

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.

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63
Q

Legionella Pneumophila

A

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
Q

Enterobacteriaceae (klebsiella pneumonia)

A

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
Q

Pseudomonas aeruginosa

A

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
Q

Most common cause of an acquired atypical pneumonia

A

mycoplasma

67
Q

common symptom of mycoplasma pneumonia

A

is a cough that tends to come in violent attacks, producing only a small amount of white mucus

68
Q

Patients with M. pneumoniae are aften said to have

A

“walking pneumonia” because of the condition is mild

69
Q

Chlamydia

A

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
Q

Viruses account for what percent of pneumonias

A

50% and several are associated with community acquired atypical pneumonia. Although most viruses attack the upper airways some can produce pneumonias

71
Q

Viral pneumonias tends to start with

A

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
Q

Viral pneumonia always carries the risk of

A

development of a secondary bacterial pneumonia

73
Q

Common viruses associated with CA atypical P include

A

Resp synctial virus, parainfluenza virus (children) , influenza A and B (adults), adenovirus (military recruits), and human metapneumovirus

74
Q

There are five types of parainfluenza viruses

A

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
Q

Influenza viruses A and B

A

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
Q

Common causes of hospital acquired pneumonias include

A

enterobacteriaceae, pseudomonas spp., and staphylcoccus aureus

77
Q

VAP

A

Pneumonia that develops more than 48-72 hours after ET intubation.
-P.aeruginosa, Enterobacter, Klebsiella, and S. aureus

78
Q

Common pathogenic agents associated with aspiration pneumonia include

A

anerobic oral flora admixed with aerobic bacteria such as S. pneumonia, S. aureus, H. influenza, and P aeruginosa

79
Q

Aspiration of gastric fluid with a ph of ___ or less causes serious and often fatal form pf pneumonia

A

2.5. Aspirations of oropharyngeal secretions and gastric fluids are the major causes of anaerobic lung infections

80
Q

Inflammatory reaction generally increases in severity for

A

12 to 26 hours and may progess to acute resp distress syndrom (ards)

81
Q

Three distinctive forms of aspiration pneumonia

A
  1. Toxic injury to the lung
  2. obstruction
  3. infection
82
Q

Normal swelling mechanics has four phases…

A
  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
Q

Resp is halted during pharyngeal phase for an approx

A

1 second apneic period

84
Q

Also known as Friedlanders bacillus?

A

Klebsiella

85
Q

Accounts for more than 80% of all the baterial pneumonias?

A

Streptococcal pneumonia

86
Q

Associated with Q fever?

A

Rickettsia

87
Q

Mendelsons syndrom is a term associated with what

A

Aspiration Pneumonia

88
Q

Infects almost all children by age two?

A

Respiratory Synctial virus

89
Q

Which of the following is almost always cause of acute epiglottitus

A

Haemophilus influenzae type B

90
Q

Which of the following related to mumps, rubella, and RSV

A

Parainfluenza virus

91
Q

In the absence of secondary bacterial infection, lung inflammation caused by the aspiration of gastric fluids usually becomes insignificant in approx how many days

A

3 days

92
Q

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
A

Decreased functional residual capacity

93
Q

Lung abscess is defined as

A

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
Q

The fluid in the cavity of a lung abscess is a collection of

A

purulent exudate that is composed of liquefied white blood cell remains, proteins, and tissue debris.

95
Q

Pyogenic membrane

A

the air and fluid filled cavity encapsulated membrane that consists of a layer of fibrin, inflammatory cells, and granulation tissue

96
Q

In severe cases the tissue necrosis in lung abscesses

A

ruptures into a bronchus and allows a partial or total drainage of the liquefied contents from the cavity. causes pleural effusion and empysema

97
Q

The major pathologic or structural changes associated with a lung abcess are

A
  • 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
Q

Lung abscesses most commonly occur as a

A

complication of aspiration pneumonia

99
Q

flash burn

A

apsiration of acidic gastric fluids is associated with immediate injury to the tracheobronchial tree and lung parenchyma

100
Q

Common anaerobic organisms found in the normal flora of the mouth, gingival crevice, upper resp tract, and gastrointestical tract

A 
Anaerobic gram positive cocci
-Peptostreptococci
-Peptococci
Anaerobic gram negative bacilli
-Bacteroides fragilis
-Prevotella melaninogenica
-Fusobacterium species
101
Q

Which of the following is or are anaerobic organisms?

  1. Blastomyces
  2. Peptococcus
  3. Coccidioides immitis
  4. Bacteroids
A
  1. Peptococcus and 4. Bacteroids
102
Q

Predisposing factors to the aspiration of GI fluids (and anaerobes?

  1. Seizure disorders
  2. Head trauma
  3. Alcoholic binges
  4. General anesthesia
A

all of the above

103
Q

Associated with the formation of a lung abscess

A

(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
Q

Anatomically a lung abscess most commonly forms in which parts of the lungs

A

Posterior segment of the upper lobe and Superior segment of the lower lobe

105
Q

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

A
  1. Decreased FVC

3. Decreased RV

106
Q

TB

A

is a contagious chronic bacterial infection that primarily affects the lungs, although it may involve almost any part of the body

107
Q

TB is classified as either

A

primary TB, Postprimary TB, or disseminated TB

108
Q

Primary TB

A

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
Q

Tubercle or granuloma

A

cell wall produced in TB pts. Encapsulate, or trap the TB bacilli in a nutshell like structure

110
Q

Ghon nodules

A

TB on chest radiograph, lung lesions

-lymph nodes in the hilar region

111
Q

Dormant TB

A

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
Q

Postprimary TB

A

Reactivation of TB months or even years after the initial infection has been controlled.

113
Q

If the TB infection is uncontrolled,

A

further growth of the caseous granulomas tubercle develop

114
Q

pt is highly contagious at this stage of TB

A

TB consumption

115
Q

Disseminated TB

A

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
Q

Most common location for TB is the

A

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
Q

Genital TB in each gender

A

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
Q

Tubercular meningitis is caused

A

by an active brain lesion seeding TB bacilli into the meninges

119
Q

TB complications include

A

hemoptysis, pneumothroax, bronchiectasis, extensive pulmonary destruction, malignancy, and chronic pulmonary aspergillosis.

120
Q

TB primarily results in a what disorder

A

chronic restrictive pulmonary disorder

121
Q

In humans, TB is primarily caused by

A

bacteria called Mycobacterium tuberculosis

122
Q

Isolation procedures

A

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
Q

The TB bacilli are highly ___ and thrive best in areas of the body with ___

A

Aerobic organisms, high oxygen tension-especially in the apex of the lungs

124
Q

Most frequently used diagnostic methods for TB are teh

A

mantoux tuberculin skin test, acid fast bacilli sputum, cultures, and chest radiographs. New test called QuantiFERON-TB Gold

125
Q

Mantoux test

A

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
Q

Acid Fast Bacteria (AFB) test (sputum smear)

A

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
Q

Sputum culture

A

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
Q

QFT-B test

A

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
Q

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..

A

-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
Q

Isoniazid (INH) and rifampin (Rifadin)

A

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
Q

Directly observed therapy (DOT)

A

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
Q

When fungal spores are inhaled

A

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
Q

Fungal diseases of the lung cause a what disorder?

A

Chronic restrictive pulmonary disorder

134
Q

Changes of the lungs associated with fungal diseases of the lungs are as follows

A
  • Alveolar consolidation
  • Alveolar capillary destruction
  • Caseous tubercles or granulomas
  • Cavity formation
  • Fibrosis and secondary calcification of the lungs parenchyma
  • Bronchial secretions
135
Q

Fungal spores of various types are widely distributed throughout

A

the air , soil, fomites, and animals, and even exist in the normal flora of humans

136
Q

Histoplasmosis

A

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
Q

Asymptomatic histoplasmosis

A

most common form of histoplasmosis. May just be a small, healed lesion of the lung parenchyma or calcified hilar lymph nodes

138
Q

Chronic Pulmonary Histoplasmosis

A

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
Q

Disseminated histoplasmosis

A

May follow either self limited histoplasmosis or chronic histoplasmosis. Seen in very young or very old pts with compromised immune systems

140
Q

Screening and diagnosis of fungal disease-Histoplasmosis

A

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
Q

Coccidioidomycosis Fungal disease

A

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
Q

Spherules

A

when C.immitis spores are inhaled, they settle in the lugns, begin to germinate, and form round, thin walled cells

143
Q

Screening and Diagnosising Coccidiodomycosis fungal disease

A

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
Q

Blastomycosis Fungal disease

A

“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
Q

Opportunistic Pathogens

A

Candida albicans-thrush,
Cryptococcus neoformans- pigeon droplets high nitrogen content, and
aspergillus-most pervasive fungi in soil, vegetation, leaf, food, compost heaps (barns)

146
Q

General management of fungal disease

A
  • 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
Q

Most common fungal infection in the US

A

Histoplasmosis

148
Q

Incidence of histoplasmosis is especially high in which of the following areas

  1. Arizona
  2. Mississippi
  3. nevada
  4. Texas
A

Mississippi

149
Q

The condition called “desert bumps” “dessert arthritis” or “dessert rheumatism” is associated with which fungal disorder

A

Coccidiodomycosis

150
Q

Which of the following is or are used to treat fungal disease

  1. Streptomycin
  2. Amphotericin B
  3. Penicillin G
  4. Iltraconazole
A
  1. Amphotericin B

4. Iltraconazole

151
Q

Form of histoplasmosis characterized by healed lesions in the hilar lymph nodes as well as a positive histoplasmin test response?

A

Latent asymptomatic disease

152
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.
-Fluid first seeps into the perivascular and peribronchial interstitial spaces, may progress into the alveoli, bronchioles, and bronchi

153
Q

Known as the first stage of TB

  1. Reinfection TB
  2. Primary TB
  3. Secondary TB
  4. Primary infection stage
A

Primary TB, Primary infection stage

154
Q

What is the name of the protective wall that surrounds and encases lung tissue infected with TB

A

Granuloma and Tubercle

155
Q

The tubercle bacillus is

A
  1. High aerobic
  2. Acid Fast
  3. Capable of surviving for months outside of body
  4. Rod-shaped
156
Q

At which size wheal is a TB skin test considered to be positive

A

10mm

157
Q

Often prescribed as a prophylactic daily dose for 1 year in individual who has been exposed to TB bacilli

A

Isoniazid

Pathophysiology (9 decks)

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