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RTH 121 > Pneumonia, Fungal Infections and Tuberculosis > Flashcards

Pneumonia, Fungal Infections and Tuberculosis Flashcards

1
Q

What is the definition of pneumonia?

A

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

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2
Q

Community acquired pneumonia (CAP) can be ___ or ___

A

Acute; chronic

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3
Q

What is acute CAP?

A

A sudden onset over a few hours to several days

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4
Q

What is chronic CAP?

A

Gradual escalating symptoms over days, weeks or even months

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5
Q

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

A

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

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6
Q

More than ___ individuals develop HAP each year

A

250,000

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7
Q

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 ____)?

A

70%; pseudomonas aeruginosa

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8
Q

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

A
  • Tuberculosis
  • Histoplasmosis
  • Cryptococcosis
  • Blastomycosis
  • Q fever
  • Legionellosis
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9
Q

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

A
  • CAP
  • subtopic aspiration pneumonia
  • subtopic HAP
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10
Q

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

A
  • Impaired gag reflexes from narcotic use
  • Alcohol intoxication
  • Prior stroke
  • Seizure disorder
  • Cardiac arrest
  • Syncope
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11
Q

Intubated patients with chronic aspiration are at risk of what?

A
  • Mixed aerobic
  • Anaerobic gram-negative
  • Staphylococcal pneumonias
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12
Q

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

A
  • Inflammation of the alveoli
  • Alveolar consolidation
  • Atelectasis
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13
Q

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

A

Cold; flu

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14
Q

What are some early signs and symptoms of bacterial pneumonia?

A
  • Shaking chills
  • Shaking
  • High fever
  • Sweating
  • Chest pain
  • Increased RR
  • Cough producing yellow/green sputum
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15
Q

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

A

80%

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16
Q

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

A

Staphylococcal

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17
Q

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

A

HAP

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18
Q

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

A

Bacilli

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19
Q

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

A

Mycoplasma

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20
Q

____ 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

A

Legionella

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21
Q

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

A

Aspiration

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22
Q

What are the symptoms of viral pneumonia?

A
  • Dry (nonproductive) cough
  • Headache
  • Muscle pain
  • Fatigue
  • Fever
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23
Q

What are some examples of gram negative pneumonia?

A
  • Klebsiella
  • E Coli
  • Enterobacter species
  • Serratia species
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24
Q

What are some viral causes of pneumonia?

A
  • Parainfluenza
  • Adenovirus
  • Influenza A & B
  • RSV
  • SARS
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25
Q

What are some other causes of pneumonia?

A
  • Rickettsiae
  • Rubella
  • Varicella
  • Aspiration
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26
Q

What are the three distinctive forms of aspiration pneumonia?

A
  • Toxic injury to the lung (gastric acid)
  • Obstruction
  • Infection
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27
Q

In pneumonia, Vt does what?

A

Normal or decrease

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28
Q

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

A

Decrease

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29
Q

In pneumonia, RV/TLC does what?

A

Normal

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30
Q

In general, how do you treat pneumonia?

A

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

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31
Q

How do you begin treatment for bacterial pneumonia?

A

Antibiotics

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32
Q

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

A

Hypoxemia; decrease; decrease

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33
Q

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

A

Primary

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34
Q

When does primary TB begin?

A

When the inhaled bacilli implant in the alveoli

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35
Q

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

A

Tubercle or granuloma

36
Q

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

A

Postprimary

37
Q

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

A

Depressed immune systems

38
Q

Most new TB cases are associated with what risk factors?

A
  • HIV patients
  • Immunosuppressed patients
  • People in institutional housing
  • People living in overcrowded conditions
  • Alcoholism
  • Malnourished individuals
39
Q

____ 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

A

Disseminated (aka miliary TB)

40
Q

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

A
  • Long bones
  • Genital tract
  • Meninges
  • Brain
  • Apex of the lungs
  • Regional lymph nodes
  • Kidneys
41
Q

TB is primarily a chronic _____ pulmonary disorder

A

Restrictive

42
Q

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

A

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

43
Q

Most TB infections are contracted via the ____ route

A

Airborne

44
Q

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

A

Acid fast bacilli

45
Q

What are the most frequently used diagnostic methods for TB?

A
  • Mantoux tuberculin skin test (PPD)
  • Acid-fast staining
  • Chest radiographs
  • Sputum cultures
46
Q

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

A

48; 72

47
Q

An induration of less than 5 mm is a ___ result

A

Negative

48
Q

An induration of 5-9 mm is a ___ result

A

Suspicious; retesting is required

49
Q

An induration of 10+ mm is a ___ result

A

Positive

50
Q

In tuberculosis, Vt does what?

A

Normal or decrease

51
Q

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

A

Decrease

52
Q

In tuberculosis, the RV/TLC ratio is what?

A

Normal

53
Q

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

A

2-4; 6-9

54
Q

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

A

Isoniazid (INH) and Rifampin (Rifadin)

55
Q

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

A

Hypoxemia; decrease; decrease

56
Q

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

A

Acute ventilatory failure

57
Q

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

A
  • Tachypnea
  • Increased HR and BP
  • Chest pain
  • Cyanosis
  • Digital Clubbing
  • Peripheral Edema
  • Cough, dull percussion, bronchial breath sounds
58
Q

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

A
  • Alveolar consolidation
  • Alveolar-capillary destruction
  • Caseous tubercles
  • Cavity formation
  • Fibrosis and secondary calcification
  • Bronchial airway secretions
59
Q

What is the most common fungal infection in the US?

A

Histoplasmosis

60
Q

Where in the US histoplasmosis typically found?

A

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

61
Q

What is histoplasmosis frequently called?

A

Ohio Valley fever

62
Q

What is histoplasmosis commonly found in?

A

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

63
Q

What is the most common form of histoplasmosis?

A

Asymptomatic histoplasmosis

64
Q

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

A

Mild; serious illness

65
Q

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

A

Chronic pulmonary

66
Q

What are the three diagnostic tests used for fungal infections?

A

Fungal culture, fungal stain and serology

67
Q

What test is considered the gold standard for detecting histoplasmosis?

A

Fungal culture

68
Q

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

A

Fungal culture

69
Q

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

Fungal stain

70
Q

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

A

Blood serology

71
Q

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

A

Coccidiodomycosis

72
Q

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

A

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

73
Q

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

A

Blastomycosis

74
Q

Blastomycosis inhabits areas high in what?

A

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

75
Q

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

A

Pregnant women and middle-aged African-American men

76
Q

What are the three opportunistic pathogens?

A

Candida albicans, cryptococcus neoformans and aspergillus

77
Q

What is aspergillus found in?

A

Soil, vegetation, leaf detritus, food and compost heaps

78
Q

Who are at greatest risk of getting aspergillus?

A

Persons breathing the air of granaries, barns and silos

79
Q

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

A

Lungs; HIV; opportunistic

80
Q

In fungal infections, Vt does what?

A

Normal or decrease

81
Q

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

A

Decrease

82
Q

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

A

Normal

83
Q

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

A

Amphotericin B (fungizone)

84
Q

What are two other drugs used to treat fungal infections?

A

Fluconazole and itraconazole

85
Q

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

A

Hypoxemia; decrease; decrease

RTH 121 (9 decks)

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