Pneumonia study Flashcards
Name the 3 categories of bacterial pneumonia.
Gram +
Gram -
Anaerobic (such as that caused by aspiration of oropharyngeal secretions)
Define bacterial pneumonia.
Infection of the airspace including the lung parenchyma & area of gas exchange; often evidenced by cough, consolidation, and other changes in the lung
T or F: Pneumonia is an obstructive disease.
False; Pneumonia is a restrictive disease
Describe the pathophysiological mechanism of pneumonia and the bodies response. Name 3 main points.
1 The body amounts an immune response when it detects a micro-organism–this may manifest in a the symptom of fever
2 This results in decreased V/Q ratio: Hypoxemia, increased venous admixture, increased pulmonary shunting
3. Then decreased lung compliance due to increased lung density (consolidation)
What changes does a person infected with pneumonia experience in vital signs?
Increases in: Heart Rate Respiratory Rate Blood Pressure Temperature Cardiac Output
During inspection of a patient with pneumonia what will you see?
Chest excursion
Decreased chest expansion
Increased breathing pattern
What do you find on palpitation?
Tactile fremitus is increased
T or F: Chest pain is a normal symptom of pneumonia that often radiates down the arm.
False; Chest pain is a symptom of pneumonia but does not radiate
Why is percussion dull with pneumonia patients?
Due to alveolar filling and pleural effusion
T or F: Atelectasis and pneumonia often exist together?
True; it can be evidenced by the sounds of crackles during auscultation
T or F: Whispering pectoriloquey describes a sign of pneumonia which means that during auscultation when you listen to sound of the patient it becomes muffled and diminished due to consolidation of liquid in the alveoli.
False; In pneumonia the sound becomes louder & clearer as it goes through liquid
Describe the findings you would expect to see on an xray of a lung infected with pneumonia:
- Increased alveolar density appearing white on xray where it should not, liquid appears on the xray as white opacity where normally would be black
- Bronchograms: black branching on white border; often evidenced with a border when confined to one lobe
- Obscuring of the heart and/or its border
What is the normal plan of action to treat pneumonia when first diagnosed?
Monitoring saturation to keep above 90%
Antiobiotics to treat infection
Hydration
A pneumonia has a blood gas as follows:
pH 7.50
CO2 29
HCO3 30
PaO2 =36
SaO2 = 69%
Describe what phase is the patient exhibiting?
A. Severe pneumonia
B. Acute Ventilatory Failure superimposed with hypoxemia
C. Acute Alveolar Hypoventilation with hypoxemia
D. Acute alveolar hyperventilation superimposed with hypoxemia
D. Acute alveolar hyperventilation superimposed with hypoxemia
T or F: Pneumonia often causes a decrease in lung compliance which will result in an increase in the work of breathing.
T: A decrease in lung compliance will = an increase in the WOB; inversely related
If a patient experiences increased airway resistance they will respond by:
1. The patient will slow their RR and increase the tidal volume to respond to increased airway resistance
2. The patient will take big breaths and have a small flow rate
3. Patient will change the minute volume to respond to changes caused by airway resistance
4. The patient will maintain minute volume but change the breathing pattern
A. 1 & 2
B. 1, 2, 4
C. 1, 2, 3, 4
D. 1 & 4 only
B. 1, 2 & 4
In response to increased airway resistance a patient will respond by slowing RR and increasing tidal volume; taking big breaths and having a small flow rate
Maintaining minute volume but change the breathing pattern
When a person experiences a decrease in lung compliance how will this be exhibited?
A. Increase in RR
B. Decrease in RR & tidal volume
C. Increase in RR and decrease in tidal volume
D. Increase in RR and tidal volume
C. Increase in RR and tidal volume
This pneumonia patient had a blood gas drawn with the following results:
pH 7.24
PaCO2 55
what does this indicate?
Acute alveolar hyperventilation with hypoxemia or severe stage pneumonia
What is the formula for compliance?
RR x Vt
T or F: The first stage of pneumonia the patient exhibits a productive cough
False; Normally it is barking & non productive and then progresses to purulent, blood streaked sputum
What causes the rust color often seen in the sputum of a pneumonia patient?
Fluid moving from pulmonary capillaries into alveoli due to effects of inflammatory response; also some rbc emter
Commonly when evaluating the effects on pneumonia which way would you expect to see the oxyhemoglobin disoacciation curve to turn? Is it on steep or flat part? And how does this affect affinity?
The curve will shift to the right and stay longer on steep part; It has diminished affinity for O2; easy to unload O2 but not load; therefore hb due to increase temp not holding O2
Why is it uncommon not to see a productive cough when a person becomes infected with pneumonia?
Because it takes time for the secreation to reach the larger bronchi where it can be secreted
Name 4 manifestations that result from pneumonia?
Alveolar Consolidation
Increased alveolar capillary membrane thickness
Atelectasis
Excessive bronchial secreations
When prescribing the correct course of treatment for a newly diagnosed pneumonia patient the physician will:
A. Obtain a sputum sample, forward to the lab for analysis and begin a standard, protocol drug therapy for pneumonia so the patient is receiving immediate treatment
B. Obtain a sputum sample, forward to the lab but check patient history as to how or where the bug was acquired and prescribe the medicine based on these clues
C. Obtain sputum sample and forward to lab, wait for results and keep hydrated as prescribing the wrong medicine can result in a buildup of medicine resistant strains
D. None of the above
B
T or F: Bronchophony describes a evaluative technique in which an RT may listen to voice sounds to make a judgement on the existence of consolidation.
T: With bronchophony the patient will say a repetitive word several times and listen for a change in the clearness of the voice over different lung regions;
T or F: In a normal healthy lung when bronchophony the RT would hear clear sounds while patient repeats the repitive word.
F; With bronchophony the clear sound only exists over the lobes infected with pneumonia; normal lungs will sound muffled
What would you expect to find if a patient is positive for egophony?
When a patient repeats a vowel sound such as e it sets up vibration which can be heard; however, if lung consolidated then the vowel sound of e will sound like a over area of consolidation
T or F: If a patient is positive for whispering pectoriloquy the sounds becomes enhanced, louder & clearer because the sound travels through liquid.
True
T or F: TB is a bacterial infection that primarily affects they lungs, but can still affect other parts of the body if the host is weak or your body has poor immune response
True
T or F: Although TB is very virulent a health care practitioner can be assured proper protection if they include face mask, gown, and gloves when treating a patient with TB
F: The only mask that protects against TB is a HEPA mask
T or F: TB is very virulent but it will die on its own if left untreated within 24 hrs.
False; a person can be infected by TB up to several days as it travels in the air current.
T or F: TB is a very micro fine or small particle.
True
Describe what happens when the macrophage digests the TB.
A. The TB will continue to grow inside the macrophage
B. Nothing, the macrophage cannot hurt or assist the body with TB due to its virulence
C. After being engulfed by macrophage the body isolates it, forms a protective sheath to isolate and then a tubercle will form
D. The body has successfully mounted an immune response to the bacteria
C. After being engulfed by macrophage the body isolates it, forms a protective sheath, & then forms a tubercle
Name the 3 categories of TB
- Primary pulmonary TB
- Post Primary Phase
- Disseminated tb
Once a tubercle is result of TB what happens to the infective material inside the isolated lesion?
It can lie dormant for years & reemerge as a result of a trigger
Name 3 categories of TB
Primary pulmonary TB–initial infectious stage
Post Primary Phase–reinfection, sometimes years later
Disseminated TB- moves past lungs grows and forms tubercles
What is another name used to describe TB that has disseminated to the rest of the body?
Miliary
According to WHO by 2020 how many people will become infected with TB and who becomes ill & die?
1 billion people will become infected
200 million will become ill
35 million will die
What has the trend been with TB since 1985 in terms of infection and outcomes in the US?
Since 1985 it has increased in US; populations include HIV; Poor compliance with meds allows for mutation & drug resistant strains
T or F: Mycobacteria TB is rod shaped, grows slowly and grows best in a well oxygenated environment, is known as an obligate aerobe?
True
What is the route of infection of TB
Inhalation of organism from infected coughing person or even talking breathing it in from an exhaled tidal volume
Describe what occurs in Stage I TB
This is an infectious stage; Bacilli implant after inhaled in alveoli; incubate & grow for 3-4 weeks; Then you see alveolar and interstitial inflammation which leads to consolidated lungs; at this stage appears like pneumonia; Next, after the acute part of stage a tubercle will form and the infected area becomes isolated & walled off; fibrous tissue forms & surrounds bacteria, bacteria stays in side
T or F: Once a nodule is formed after 2-10 weeks of exposure it can be viewed on an xray?
True
Name the 3 parts of the structure of the tubercle?
Central Core–where the bacteria remains
Enlarged macrophage–surrounds core
Outer layer of fibroblasts, lymphocytes, and neutrophils
The formed tubercle plays an important role to the body in protection; explain the advantage of disadvantage.
The tubercle acts to prevent further infection but it is a waiting time bomb as it can rupture and reinfect the patient years, or decades later
T or F: In post primary pulmonary TB the bacteria for TB is not infectious to others when it becomes reactivated.
False, it can affect others once becomes reactivated
T or F: TB affects both the lung alveoli and the pleura.
True
T or F: The TB especially in the second stage prefers the bottom lobes
False, TB tends to like the superior part of the upper lungs
T or F: In the long term the presence of TB can cause fibrosis
True
Explain what happens in Stage III TB.
When bacilli escape from tubercle it can move anywhere in the body and effect any system; it becomes “military” & systemic
Another name for Stage III TB is?
Disseminated or Miliary TB
How can TB be diagnosed?
A PPD subcutaneous skin test can show exposure, The AFB test (acid fast stain) shows pink staining if one is positive for TB, it shows a presence of immune response
Name the test used to check for delayed hypersensitivity of TB?
Mantoux Test
How large will the inflamed spot show on the skin after subcutaneous injection during the skin test?
Greater than 10 mm or greater than 5 mm in HIV patients
T or F: PPD is known to be a very reliable predictor in the presence of true TB infection
False; it can show false negative especially in combination with certain other conditions such as infection, sarcoidosis, lymphoma, malignancy, and treatment with immunosuppressed drugs
T or F; There is a vaccine available to prevent TB
True
Why is the vaccine not provided in the US
Due to the use of PPD skin test for measurement of exposure; once a person is vaccinated it will show immune response and the tool of diagnosis will not be available
T or F: The AFB test is a form of a subcutaneous test used to diagnose TB
False; The AFB test is a microbiology test; The PPD is a subcutaneous test
Name the vaccine for TB?
BGC vaccine or calmette guerin
T or F; There is no known treatment for TB except isolation & quarantine.
False; Treatment of TB is available which requires a 6 month regimen of medications:
Isoniazid, Rifampin
And 2 months of pyrazinamide
T or F: There are a lot of side effects to the medications associated with TB treatement
True
T or F: TB is never seen on an xray which is why it is so hard to diagnose?
False: TB can be seen on an Xray–It is seen as a cavity lesion with a white density that surrounds it; appears as white circles with dark insides & can view the fibrous cover of the cavity
T or F: Once TB becomes military you may be able to view on the surface of the body
True; Once military, it can be viewed on the skin
Name some common distinguishing symptoms of TB:
The symptoms look like pneumonia but may also include “night sweats” with chills; Decreasing appetite and rapid weight loss may be seen; A cough may become productive
T or F: Just like pneumonia one symptom is chest pain which is especially intense when breathing, may favor left side and is non radiating.
True
T or F: Increased sputum production is another hallmark symptom of TB which may appear thick, yellow with occasional fleck of blood
True
If you induced a sputum sample and received sputum that appeared rusty, purulent & thick with an order which disease would you probably diagnose?
Pneumonia because TB normally manifests with a thick yellow sputum although both may appear with blood; often TB shows up with occasional flecks of blood; In pneumonia, hemoptysis is a common symptom, more blood may be visible in pneumonia
T or F; if someone tests positive for TB on the PPD test they need to begin a regiment of 3 drug combination immediately to last approx. 6 months?
False; Further diagnosis is necessary with tools such as chest xray due to possibility of exposure only with no active infection; it needs to always be followed by diagnosis
What cause the sound of fine inspiratory crackles in inspiration with restrictive diseases such as TB or pneumonia?
The alveoli or areas close by that are closed and then forced open
T or F: An xray for TB and pneumonia are virtually indistinguishable therefore further lab analysis is needed for accurate diagnosis.
False; X ray is very reliable tool of diagnosis for TB vs Pneumonia; In tb you will see tubercles, eventually cavities; while in pneumonia you can expect to see bronchograms and obscurement of the heart
Name a hallmark sign of pneumonia on a chest xray
Air bronchograms
T or F increased alveolar density appears black where it should be white.
False; increased alveola density appears white on an xray where it normally would be black
T or F: After initial diagnosis of pneumonia the RT plays a vital role in administering treatment and oxygen
False, in the early treatment of pneumonia the primary focus is treating the infection and administering the antibiotic; The RT will monitor saturation and administer O2 therapy only if prescribed
T or F Bronchial hygiene plays a major role in the initial treatment of pneumonia to remove the infected material in the lungs
False; you would not perform bronchial hygiene on an early pneumonia patient with active infection due to fact it only would be spreading or moving infected material around
Describe a blood gas seen in mild/moderate pneumobnia:
During first stage of mild/moderate pneumonia aka alveolar hyperventilation you will see an elevation of pH and decrease of CO2; Slight rise of HCO3;
T or F: Hypoxemia is the typical cause of hyperventilation
True
T or F: alveolar consolidation causes no ventilation & no perfusion leading to hypoxemia
False: it causes ventilation with no perfusion
T or F: In restrictive diseases the lung volumes will get smaller
True
Name the most common and prevalent fungal lung infection found which is endemic to the Ohio River Valley of the US.
Histoplasmosis
This fungal infection is frequently seen in the dry, desert regions of the SW United States
Coccidiodomycosis
This disease is sometimes called “Chicago’s disease”
Blastomyocis
This disease enjoys a wide variety of climates and can be seen in the south central parts of the US as well as regions such as the middle east and Canada and s america
Blastomyocis
Name the anatomical alterations that can occur in the lungs when infected with a fungal infection
Alveolar capillary destruction Alveolar consolidation Cavity formation Fibrosis of lung parenchyma Gaseous tubercle Increased airway secretions
T or F: TB is normally associated with tubercles that form in the lungs but other conditions such as histoplasmosis may also cause formation of tubercles viewable on xray
true
T or F: a typical response to inflammation is fever, accumulation of alveolar fluid
True
What can distinguish fungal infections from TB?
In fungal infections you can view a layer of yeast like substance
How is fungal diseases transmitted?
Inhalation route
Describe what happens once a fungal spore is inhaled
The spores germinate in the lungs & form yeastlike substance
Inflammatory response begins–macrophages move in; dilation of pulmonary capillaries
Due to these changes interstitial fluid backs up and accumulates causing swelling of epithelium of alveoli leading to flooding & then consolidation of alveoli
In severe cases of fungal infection what can happen to lung disuse?
Lung necrosis
Granulomas form around area creating a fibrous sheath making lungs stiffer, less compliant
Then Fibrosis forms
Calcification of area may result
T or F: The formation of cavities allows for easy access of medications to the infection
False; it makes it harder for medications to reach the area therefore causing the disease to harbor for years; this is true for fungal infections as well as TB
You find this disease in MI, IL, MS, MI, KY, TN, GA, ARK
Histoplasmosis
The fungal spores can be found in what medium in its home region?
Found in soil especially near birds
What determines whether the infection becomes chronic or acute?
The inflammatory response of the body
What is another important factor in determining the response to the exposure?
Inensity of exposure: Concentration of spores, amount of time exposed, and number of spores inhaled
T or F: the majority of those exposed to fungal infections never get sick or develop symptoms
True only about 40% every develop phases
What may be seen as evidence of exposure, sometimes it may be the only evidence of exposure?
In histoplasmosis a single solitary pulmonary module may be present
What are the phases of Histoplasmosis infection?
Symptomatic/Acute: Mild/Severe symptoms of fever, muscle and joint pain, chills sweas headache, dry hacking coug, chest pain, weight loss
Severe Acute: Symptoms all the same but more severe and exaggerated/ Spelunkers lung
Chronic Pulmonary Histoplasmosis: Often with a co-morbidity; Evenutally condition reaches equilibrium, no better or worse, cavity formation often seen here in upper lobes
Disseminated Histoplasmosis–can affect anywhere, can be fatal
How can you diagnose fungal infections?
Fungal stain, fungal culture, serology
What is the gold standard of fungal infection diagnosis?
A fungal culture as it is 100& accurate but it takes a long time to grow causing delayed treatment
T or F: Serology is also a very reliable form of diagnosis in fungal infections.
False, it causes many false negatives
In the disease of coccidiomycosis there are all similar symptoms except with this condition we have a manifestation of a new symptom, what is it?
Thin walled cells called spherules form, these can be seen on xray, very distinctive
T or F: A visual sign of coccidiodomycosis may be desert bumps or swollen lumps on the skin
True
T or F: it is rare but possible for meningitis to result from disseminated version of coccidiodomycosis
True
How many cases of Chronic progressive coccidiomycosis occur?
1 in 200 cases, rare but can cause nodular growths or funagamos
What condition does desert arthritis refer to?
The disseminated version of coccidiodomycosis
T or F: Blastomycosis has a very low infection rate and manifests in unique symptoms that include a purulent yellow phlegm, chest pain, aching joints, pulmonary nodules or abscesses
True
T or F the new symptom for blastomycosis is presence of pulmonary nodules & abscesses
True
T or F: Once blastomycosis disseminates it often likes the skin although it can spread anywhere
True
What medications are commonly used to treat fungal infections?
Amphotericin B & itraconazole
What is a common infection of oral cavity often seen with use of inhaled corticoseteroids?
Candida albicans
This fungi is found everywhere & loves old building, can be dangerous to those who remodel
Aspergillius
This proliferates in bird droppings and often becomes scatterered in air?
Cryptococcus neoformans
T or F: 1 in 200 cases of desert fungi progress to more chronic phase, and 1 in 6000 disseminate:
True
If I see thin walled cells or spherules I probably have what condition?
Coccidiodomycosis
