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Disease 3 > Immunocompromised host > Flashcards

Immunocompromised host Flashcards

1
Q

What is the patient history?

A

Collection of historical subjective and objective data pertinent to diagnosis and treatment of a patient complaint

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2
Q

What are the standard questions we think about when considering patient history

A

Biographic data
Chief complaint
Present health or history of illness
Current medication
Past health
Family history
Review of body systems

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2
Q

What is the SAMPLE acronym

A

Signs and symptoms
Allergies
Medications
Past pertinent medical history
Last oral intake
Events leading up to condition or illness

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3
Q

When are RTs more responsible for retrieving the patient history?

A

Formal pulmonology visit
Nurse calls respiratory for bedside PRN
ER
Routine therapy

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4
Q

What is the OPQRST acronym specifically for pain

A

Onset of event
provokes/palliates
Quality of pain (describe it)
Region or radiation
Severity
Time (how long has this been going on)

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5
Q

Describe AAOx3

A

Awake
Alert
Oriented to person, place and time

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6
Q

Describe internal factors that a therapist can bring to a patient interview for more success

A

Empathy
Signal concern
Sit
Face the patient
Maintain open body posture
Withhold judgement
Maintain comfort
Confirm patient feelings

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7
Q

What internal factors are challenging in the face of how modern medicine is practiced?

A

Listening and recording simultaneously

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8
Q

What are examples of cultural differences that will need to be addressed in clinical conditions?

A

Religious bullshit, im looking at you jehovahs witnesses
Cultural norms (ie certain hands dont do certain things, women wont talk to you ect)

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9
Q

What external factors can aid in patient interviews?

A

Privacy
Prevent interruptions
Provide security
Provide comfort

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10
Q

Describe occams razor

A

Occam proposed that the best explanations are the simplest

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11
Q

What does hickams dictum say

A

People can have as many diseases as they want

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12
Q

What are the three elements of a good patient problem presentation?

A

Who
When
What

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13
Q

What information can be drawn from the “who” portion of the problem presentation?

A

Pertinent demographics
Relevant epidemiology
Risk factors
Medical history

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14
Q

What information can be drawn from the “when” portion of the problem presentation

A

Temporal pattern of illness
Duration (acute or chronic)
Tempo (stable or progressive)

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15
Q

What information can be drawn from the “what” portion of the problem presentation

A

Clinical syndrome
Key signs, symptoms, and other findings

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16
Q

What is an illness script?

A

Summation of providers knowledge of a condition

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17
Q

Describe the diagnostic schema

A

What we know about significant signs and symptoms in a problem representation

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18
Q

What is the interaction between the problem representation and the illness script?

A

The illness script influences the problem representation

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19
Q

Describe a diagnostic schema

A

A diagnostic schema is how you reason through a patients chief complaint and past medical history in order to reach a diagnosis

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20
Q

Describe what it means to be immunocompromised

A

People with immune systems that are slowed or blunted which impact the bodies ability to fight off infection successfully

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20
Q

What constitutes an immunocompromised host?

A

An immunocompromised host is defined by their susceptibility to infection by organisms of low virulence or severe infection with organisms of normal virulence

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21
Q

Define virulence

A

How readily a pathogen can infect a host and the potential of the disease to cause severe harm

22
Q

Describe what it means to be immune dysregulated

A

Autoimmune diseases
Immune system attacks the hosts body
Doesnt carry a high risk of infection

23
Q

Describe what it means to be immune deficient

A

Cells within the immune system arent working correctly, there arent enough immune cells, or they are missing all together

24
Q

Describe what it means to be immunosuppressed

A

Process of slowing down the immune system
Usually used for organ transplants or autoimmune diseases

25
Q

Describe what immunomodulatory therapies do

A

Slowing down or speeding up the immune system such as in autoimmune diseases or fighting cancer

26
Q

What patient populations tend to be immunosupressed?

A

Solid organ transplant recipients
Cancer patients
Hematopoietic cell transplant recipients
Pts with autoimmune disorders

27
Q

List patients who receive immunosuppressive drugs

A

Lupus
Rheumatoid arthritis
Scleroderma

28
Q

Describe allogeneic hematopoietic cell transplant

A

Stem cells removed from donor
Patient receives treatment to destroy blood forming cells
Patient receives stem cells

29
Q

What happens in graft vs host disease?

A

The donor stem cells attack the host body resulting in multiorgan failure in some cases

30
Q

What conditions can provoke immunocompromise or endanger patients with immunocompromised conditions?

A

IV drug use
Multiple blood transfusions
Patients from prisons/homeless shelters
Elderly

31
Q

T/F: Steroid use on a long term basis can cause immunocompromise

A

True

32
Q

What circumstances may provoke illness in immunocompromised populations?

A

Recent travel
Occupational exposure
Prolonged duration of neutropenia
Aspiration
Frequent antimicrobial exposure

33
Q

What medical circumstances or conditions may cause immunocompromise?

A

Vegetations on heart valves
Indwelling catheters
Septic emboli
Metastatic tumors
Diabetes mellitus

34
Q

What presentation in an immunocompromised host would raise suspicion of pulmonary infection?

A

Infiltrates
Signs of infection

35
Q

What is unique about pulmonary infections in immunocompromised populations?

A

Pulmonary infections are a hallmark of tissue invasive infections in immunocompromised patients

36
Q

What specific risks do immunocompromised patients have when dealing with pulmonary infections?

A

Increased risk of pulmonary infections
Diffuse alveolar hemorrhage
Pneumonitis secondary to drug toxicity
Pulmonary edema
Progression of underlying disease

37
Q

What is true regarding immunocompromised patients with pulmonary infiltrates?

A

They often have co-existing conditions

38
Q

Why is empiric treatment not the go-to with immunocompromised patients?

A

Usually are on an array of meds
Vulnerable to kidney toxicity
More vulnerable to c. diff infections

39
Q

Why is rapid pathogen identification required with immunocompromised hosts?

A

Allows for use of more specific safer antibiotics

40
Q

Why are CXR and sputum cultures not necessarily effective in immunocompromised patients?

A

May fail to distinguish between different pathologies in a useful manner

41
Q

Why is routine serologic testing helpful for immunocompromised patients?

A

Patients may not be producing antibodies at the time of any one test so multiple tests may be able to catch the antibodies better

42
Q

What is the benefit of CT and high resolution CT scans in immunocompromised patients?

A

Allows for different processes to be distinguished from one another in patients with multiple comorbidities

42
Q

What are the invasive strategies used in order to sample sputum and lung tissue?

A

Bronchoalveolar lavage
Transbronchial biopsy
Video assisted thoracoscopic biopsy
Open lung biopsy

43
Q

What is an opportunistic infection?

A

Infection by an organism that does not normally cause disease but becomes pathogenic under circumstances such as immunocompromise

44
Q

What pathogens afflict immunocompromised patients that generally do not affect the immunocompetent patients?

A

Cryptomegalovirus
Toxoplasma gondii
Pneumocystis jirovecii
Aspergillus
Cryptococcus
Candida

45
Q

What are the two names for pneumocytis carinii pneumonia (PCP)?

A

Pneumocystis jirovecii (fungal infection)

46
Q

Why is PCP difficult to diagnose?

A

Not easily seen on imaging
Cant be cultured

47
Q

What is required to confirm the presence of PCP in a sputum sample?

A

Methenamine silver stain

48
Q

What patient population is most like to contract mycobacterium tuberculosis?

A

HIV patients

49
Q

What is the most common non-tubercular mycobacteria?

A

Mycobacterium avium complex (MAC)

50
Q

What is the first line of prophylactic defense for pneumocystis jirovecii?

A

Trimethoprim sulfamethoxazole
Trim sulfa/TMP-SMX/bactrim

51
Q

What is the second line of prophylactic defense for pneumocystis jirovecii?

A

Pentamidine isethionate

52
Q

What nebulizer is used to administer pentamindine?

A

Respirgard II

53
Q

What is the dosage and frequency for nebulized pentamidine?

A

300 mg every 4 weeks

Disease 3 (9 decks)

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