Pulmonary Conditions and Interventions Quiz
31 Questions
2 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to Lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which intervention is LEAST likely to be used in the immediate treatment of a pulmonary embolism (PE)?

  • Heparin IV drip
  • Thrombolytics
  • Initiation of active range of motion (AROM) exercises (correct)
  • Oxygen administration

    • What is the primary mechanism by which aspiration leads to pneumonia?

  • Systemic contamination from the circulation.
  • Direct damage to the lung tissue by gastric acids.
  • Initiation of an autoimmune response within the lungs.
  • Inhalation of pathogens from oropharyngeal secretions. (correct)

    • During the pathogenesis of pneumonia, what directly leads to consolidation of the lungs?

  • Invasion of inflammatory cells into the alveolar septa.
  • Filling of alveolar air spaces with exudative fluid. (correct)
  • Inhalation of toxic substances.
  • The pathogen directly destroying the alveoli.

    • A patient with pneumonia presents with a persistent, productive cough. Which intervention would be MOST appropriate?

    <p>Encouraging increased fluid intake. (A)</p> Signup and view all the answers

    Which of the following is the MOST important measure to prevent venous thromboembolism (VTE) in a patient at risk?

    <p>Avoiding prolonged bedrest. (A)</p> Signup and view all the answers

    What is the defining hemodynamic characteristic of pulmonary hypertension (HTN)?

    <p>Sustained pulmonary artery systolic pressure &gt; 25 mm Hg (D)</p> Signup and view all the answers

    Which of the following is a typical clinical manifestation of pulmonary hypertension?

    <p>Syncope (D)</p> Signup and view all the answers

    What is a key element in the pathogenesis of pulmonary hypertension?

    <p>Fibrotic changes to the internal layer of the pulmonary artery wall (B)</p> Signup and view all the answers

    What is the primary focus of the treatment for secondary pulmonary hypertension?

    <p>Treating the underlying cause of the condition (A)</p> Signup and view all the answers

    Which element of Virchow's triad is directly associated with a patient who is immobile for an extended period?

    <p>Venous stasis (D)</p> Signup and view all the answers

    Which of the following is LEAST likely to be a risk factor for pulmonary embolism (PE)?

    <p>Regular exercise (D)</p> Signup and view all the answers

    A patient presents with dyspnea, tachycardia, and chest pain on inspiration. Which condition is MOST likely to be suspected?

    <p>Pulmonary embolism (D)</p> Signup and view all the answers

    What is the underlying cause of hemoptysis in advanced pulmonary hypertension?

    <p>Bleeding from damaged pulmonary vessels (C)</p> Signup and view all the answers

    Which factor does not increase the risk of tuberculosis (TB) infection?

    <p>Living in sparsely populated areas (B)</p> Signup and view all the answers

    Reactivation of tuberculosis (TB) can occur due to:

    <p>A weakened immune system (B)</p> Signup and view all the answers

    How does tuberculosis (TB) primarily spread from one person to another?

    <p>Through the inhalation of infected, aerosolized droplets (A)</p> Signup and view all the answers

    Which of the following is not a typical clinical manifestation of active tuberculosis (TB)?

    <p>Sudden weight gain (B)</p> Signup and view all the answers

    What is generally the recommended duration of treatment for drug-sensitive tuberculosis (TB)?

    <p>6-9 months (B)</p> Signup and view all the answers

    Which of the following is a key component of tuberculosis (TB) pathogenesis?

    <p>Formation of Ghon complexes in the lungs. (C)</p> Signup and view all the answers

    Which diagnostic test is most definitive for active tuberculosis (TB)?

    <p>Sputum culture (C)</p> Signup and view all the answers

    What is a major challenge in tuberculosis (TB) treatment that promotes the emergence of drug-resistant mycobacteria?

    <p>Poor patient adherence to the drug regimen (D)</p> Signup and view all the answers

    Multidrug-resistant tuberculosis (MDR TB) is defined as tuberculosis that is resistant to at least:

    <p>Both isoniazid and rifampin (A)</p> Signup and view all the answers

    Which of the following is the most appropriate initial action when a regimen for tuberculosis (TB) is failing?

    <p>Add additional anti-TB agents to the regimen (A)</p> Signup and view all the answers

    What indicates a positive reaction to the tuberculin skin test (TST)?

    <p>A region of induration (hardness) around the injection site 48 to 72 hours after injection. (D)</p> Signup and view all the answers

    Why is it crucial to rule out active TB before treating latent TB?

    <p>Treating latent TB when active TB is present can promote the emergence of drug-resistant bacteria. (A)</p> Signup and view all the answers

    What is a significant drawback of using isoniazid as a treatment for latent TB?

    <p>It poses a risk of liver damage and requires a long treatment duration. (C)</p> Signup and view all the answers

    What is an advantage of using isoniazid and rifapentine in combination for treating latent TB, compared to using isoniazid alone?

    <p>The combination only needs to be taken once a week for 3 months. (C)</p> Signup and view all the answers

    Which of the following is a common adverse effect associated with isoniazid?

    <p>Peripheral neuropathy (B)</p> Signup and view all the answers

    Rifampin is used to treat:

    <p>Tuberculosis, leprosy, and meningococcus carriers. (A)</p> Signup and view all the answers

    What is a notable adverse effect of rifampin that patients should be informed about?

    <p>Discoloration of body fluids (D)</p> Signup and view all the answers

    Rifampin induces P450 and can hasten drug metabolism. What is a potential consequence of this drug interaction?

    <p>Reduced effectiveness of drugs for HIV infection (D)</p> Signup and view all the answers

    Flashcards

    Pulmonary Hypertension (HTN)

    Sustained pulmonary artery systolic pressure > 25 mm Hg.

    Etiologies of Pulmonary HTN

    Can be idiopathic or secondary to conditions causing increased blood flow or resistance.

    Pathogenesis of Pulmonary HTN

    Increased systolic pressure leads to thickening of small pulmonary vessels and fibrotic changes.

    Symptoms of Pulmonary HTN

    Includes exercise intolerance, syncope, fatigue, chest pain, and increasing dyspnea.

    Signup and view all the flashcards

    Pulmonary Embolism (PE)

    Blockage in pulmonary artery typically due to a thrombus from the deep veins.

    Signup and view all the flashcards

    Risk Factors for PE

    Includes immobility, trauma, smoking, cancer, and genetic factors like Factor V Leiden.

    Signup and view all the flashcards

    Clinical Manifestations of PE

    Depend on thrombus size, may include dyspnea, tachycardia, chest pain, and hemoptysis.

    Signup and view all the flashcards

    Treatment for Pulmonary HTN and PE

    Treating underlying causes, using vasodilators, oxygen, and possibly lung transplant.

    Signup and view all the flashcards

    Pneumonia Classifications

    Types of pneumonia categorized by acquisition: community or hospital-aquired, and based on the infecting agent: viral, bacterial, atypical.

    Signup and view all the flashcards

    Pneumonia Risk Factors

    Factors increasing pneumonia risk include elderly age, diminished gag reflex, times of hospitalization, and compromised immune systems.

    Signup and view all the flashcards

    Pneumonia Etiologies

    Causes of pneumonia include aspiration of bacteria, inhalation of pathogens, and contamination from systemic circulation.

    Signup and view all the flashcards

    Pneumonia Symptoms

    Signs of pneumonia may include fever, cough with purulent sputum, dyspnea, and crackles in lung sounds.

    Signup and view all the flashcards

    Pneumonia Treatment

    Management includes cough suppressants, fluid intake, avoiding smoke, and antibiotic therapy based on culture sensitivity.

    Signup and view all the flashcards

    Primary TB Infection

    Initial TB infection that can remain dormant for years without symptoms.

    Signup and view all the flashcards

    Reactivating TB

    TB that re-emerges years later due to impaired immunity, such as HIV or diabetes.

    Signup and view all the flashcards

    TB Diagnosis Methods

    Includes sputum culture, chest x-ray, skin test, and DNA amplification.

    Signup and view all the flashcards

    Anti-TB Treatment Duration

    ActiveTB treatment lasts 9-12 months; shorter for latent TB.

    Signup and view all the flashcards

    Multidrug-Resistant TB (MDR TB)

    TB resistant to isoniazid and rifampin, complicating treatment.

    Signup and view all the flashcards

    Extensively Drug-Resistant TB (XDR TB)

    TB resistant to isoniazid, rifampin, and all fluoroquinolones.

    Signup and view all the flashcards

    Latent Tuberculosis (LTB)

    A condition where people are infected but do not show symptoms or spread TB.

    Signup and view all the flashcards

    Immunity Development After TB

    Most individuals develop immunity within weeks, preventing clinical TB.

    Signup and view all the flashcards

    TB Skin Test (TST)

    A test involving an intradermal injection of PPD to detect exposure to M.tuberculosis.

    Signup and view all the flashcards

    Purified Protein Derivative (PPD)

    An antigen from M.tuberculosis used in TB skin tests.

    Signup and view all the flashcards

    Positive TB Test Reaction

    A local immune response indicating possible TB exposure, shown by induration.

    Signup and view all the flashcards

    Isoniazid Treatment Duration

    Standard treatment duration for latent TB is at least 6, preferably 9 months.

    Signup and view all the flashcards

    Isoniazid + Rifapentine

    Combination treatment for latent TB taken weekly for 3 months, effective as Isoniazid for 9 months.

    Signup and view all the flashcards

    First-Line Antituberculosis Drugs

    Include isoniazid, rifampin, and others for TB treatment.

    Signup and view all the flashcards

    Rifampin Adverse Effects

    Can cause hepatotoxicity, discoloration of fluids, and GI disturbances.

    Signup and view all the flashcards

    Peripheral Neuropathy

    A side effect of isoniazid linked to vitamin B6 deficiency.

    Signup and view all the flashcards

    Study Notes

    Pulmonary Disorders 2

    • Pulmonary Hypertension (HTN): Normal pulmonary circulation is high flow and low pressure. Pulmonary hypertension is sustained pulmonary artery systolic pressure greater than 25 mm Hg.

    Pulmonary Hypertension Etiologies

    • Idiopathic (Primary): Primarily affects females. Rapidly progressive. Poor prognosis and treatment ineffective.
    • Secondary: Secondary to another disease. Caused by pulmonary blood flow resistance and left atrial pressures.

    Pulmonary Hypertension Pathogenesis

    • Pulmonary artery systolic pressure greater than 25 mm Hg causes the walls of pulmonary vessels to thicken.
    • Internal layer of pulmonary artery wall becomes fibrotic.
    • Formation of plexiform impedes blood flow.

    Pulmonary Hypertension Clinical Manifestations

    • Exercise intolerance and fatigue.
    • Syncope
    • Hemoptysis
    • Chest pain with exertion.
    • Increasing dyspnea (shortness of breath).
    • Cor pulmonale
    • Hoarse voice

    Pulmonary Hypertension Treatment

    • Treat underlying cause.
    • Supplemental oxygen.
    • Vasodilators
    • Diuretics
    • Prostacyclin.
    • In advanced cases: Lung or heart-lung transplant or left-to-right shunts (surgery).

    Pulmonary Embolism (PE) Etiology

    • Virchow's Triad: Venous stasis/sluggish blood flow, Thromboemboli formation, Intimal injury and Hypercoagulability all play a role in PE development.

    Pulmonary Embolism Risk Factors

    • Immobility
    • Trauma
    • Pregnancy
    • Cancer treatments
    • Heart failure
    • Smoking
    • Diabetes (comorbidity)
    • Cholesterol (hyperlipidemia)
    • Genetic factors like Factor V Leiden

    Pulmonary Embolism Pathogenesis

    • Direct trauma.
    • Exercise
    • Muscle action
    • Changes in blood flow
    • Dislodged thrombus
    • Stuck in pulmonary vasculature causing PE

    Pulmonary Embolism Clinical Manifestations

    • Depends on size of thrombus.
    • Restlessness
    • Apprehension
    • Anxiety
    • Dyspnea (difficulty breathing)
    • Tachycardia (rapid heartbeat)
    • Tachypnea (rapid breathing)
    • Chest pain (on inspiration)
    • Hemoptysis (coughing up blood).

    Pulmonary Embolism Treatment

    • Treat underlying problems
    • Heparin IV drip
    • Thrombolytics
    • Supplemental oxygen
    • Bedrest
    • Umbrella filter
    • Embolectomy
    • Prevention

    Restrictive: Infection & Inflammation

    • Pneumonia
    • Pulmonary Tuberculosis

    PNA: Classifications

    • Community-acquired vs. Hospital-acquired
    • Viral
    • Bacterial
    • Atypical

    PNA: Risk Factors

    • Elderly
    • Diminished gag reflex (risk for aspiration)
    • Seriously ill
    • Hospitalized patients
    • Hypoxic patients
    • Immune-compromised patients

    PNA: Etiologies

    • Aspiration of oropharyngeal secretions (normal bacterial flora or gastric contents) — (25% to 35% of cases).
    • Inhalation of pathogens.
    • Contamination from systemic circulation.

    PNA: Pathogenesis

    • Pathogen enters lungs and multiplies
    • Inflammation process begins
    • Inflammatory cells invade alveolar septa.
    • Alveolar air spaces fill with exudative fluid.
    • Fluid-filled air spaces consolidate.

    PNA: Clinical Manifestations

    • Severity of disease and patient age cause variations in symptoms.
    • Crackles (rales) and bronchial breath sounds over affected lung tissue
    • Fever/chills
    • Cough
    • Purulent sputum
    • Dyspnea (shortness of breath), SOB

    PNA: Treatment Implications

    • Cough management: Codeine-containing medications, Suppressants/expectorants, increase fluid intake.
    • Avoid smoke
    • Use a vaporizer
    • Antibiotic therapy (based on culture sensitivity).

    Mycobacterium Tuberculosis (TB): Risk Factors

    • Prior TB infection (90% of cases).
    • Malnourished
    • Immunosuppressed
    • Living in overcrowded conditions.
    • Incarcerated
    • Immigrant
    • Elderly

    Mycobacterium Tuberculosis (TB): Classifications

    • Primary TB (lying dormant for years/decades).
    • Reactivating TB (Occurring many years after primary infection). Impaired immune system causes reactivation, as seen in HIV, corticosteroid use, silicosis or diabetes mellitus.

    Mycobacterium Tuberculosis (TB): Pathogenesis

    • Mycobacteria enter lung tissue.
    • Ingested/processed by alveolar macrophages.
    • Mycobacteria multiply
    • Disseminates through body via blood and lymph.
    • Forms Ghon tubercle or complex.

    Mycobacterium Tuberculosis (TB): Clinical Manifestations

    • Low-grade fever
    • Chronic cough
    • Later productive cough with purulent sputum
    • Night sweats
    • Fatigue/malaise
    • Weight loss/anorexia/malnutrition
    • Apical crackles
    • Bronchial breath sounds over consolidation.

    Mycobacterium Tuberculosis (TB): Diagnosis

    • Sputum culture (1-3 weeks for results, requiring 3 consecutive, morning specimens).
    • DNA or RNA amplification techniques
    • Pulmonary function tests
    • Chest x-ray (nodules with infiltrates)
    • TB skin test (Mantoux/PPD test)
    • Determine if current or past infection

    Mycobacterium Tuberculosis (TB): Treatment

    • Anti-TB medications.
    • 9-12 months therapy for active TB, shorter if no active disease.
    • Add agents when regimen is failing.
    • Nonadherence is a main cause of treatment failure.

    Treatment of Mycobacterial Infections

    • Slow-growing microbes require prolonged treatment, leading to side effects from the drugs and poor patient adherence.
    • Drug toxicity and poor adherence promotes emergence of drug-resistant mycobacteria.

    Tuberculosis (TB): Overview

    • Global epidemic.
    • Approximately 2 billion infected worldwide.
    • Kills ~1.3 million people annually.
    • New cases in the US are declining.
    • 95% of cases occur in developing countries.
    • Rising incidence due to HIV and emerging multidrug-resistant mycobacteria.

    Tuberculosis (TB): Transmission

    • Transmitted from person to person via inhalation of infected, aerosolized sputum (coughing and sneezing).

    Tuberculosis (TB): Initial Infection

    • Initially in the lung.
    • Immunity often develops within a few weeks.
    • 90% of individuals with normal immune function never develop clinical or radiologic evidence of TB.

    Tuberculosis (TB): Diagnosis (2)

    • Indications for testing (e.g., exposure, symptoms)
    • Definitive Diagnosis (chest x-ray).
    • Sputum culture (drug sensitivity evaluation).
    • Treatment regimens (e.g., duration, promotion of adherence, evaluation of treatment efficacy).

    Multidrug-Resistant Tuberculosis (MDR TB) and Extensively Drug-Resistant TB (XDR TB)

    • MDR-TB is resistant to both isoniazid and rifampin.
    • XDR-TB is resistant to isoniazid, rifampin, and at least one injectable second-line drug, and all fluoroquinolones.

    Tuberculosis (TB) Treatment Regimens

    • Drug-sensitive tuberculosis, Isoniazid-, or rifampin-resistant tuberculosis, MDR-TB, and patients with TB and HIV infection, all have different treatment durations, ranging from 6 months for drug-sensitive TB to up to 24 months for more complex cases like MDR-TB or HIV/AIDS.

    Latent Tuberculosis (LTB) Diagnosis and Treatment

    • 9million to 14 million people in the US have latent TB (LTB).
    • 5% to 10% of individuals with latent TB will develop active TB without treatment.
    • Targeted TB testing: Who should be tested?, TB skin test (TST), and QuantiFERON-TB Gold (QFT-G) blood test are used to diagnose latent TB.
    • Treatment for LTB includes Isoniazid alone (daily for 9 months) or Isoniazid + Rifapentine (weekly for 3 months).

    Tuberculin Skin Test

    • Intradermal injection of purified protein derivative (PPD), an antigen derived from M. tuberculosis.
    • If the individual has been exposed to TB in the past, the body will illicit a local immune response.
    • Read in 48-72 hours for induration (hardness).

    Isoniazid

    • For over 30 years, standard treatment for latent TB.
    • Effective, comparatively safe, and inexpensive.
    • Drawbacks: Must be taken for a long time (at least 6 months, preferable 9 months). Risks of liver damage.

    Isoniazid Plus Rifapentine

    • The combination is just as effective as 9 months of isoniazid alone in a weekly dose. Effective for 3 months, as observed in the PREVENT TB trial.

    Antituberculosis Drugs

    • First-line drugs include: Isoniazid, rifampin, rifapentine, rifabutin, pyrazinamide, and ethambutol.
    • Second-line drugs include: Levofloxacin, moxifloxacin, kanamycin, amikacin, capreomycin, and streptomycin

    Isoniazid (2)

    • Primary agent for TB treatment & prevention.
    • Bactericidal
    • Resistance may develop.
    • Adverse effects: Peripheral neuropathy (Vitamin B6 deficiency in some cases), hepatotoxicity, optic neuritis, and anemia.

    Rifampin [Rifadin]

    • Broad-spectrum antibiotic.
    • Tuberculosis, Leprosy, and Meningococcal carriers
    • Adverse Effects:Hepatotoxic/hepatitis, discoloration of body fluid, GI disturbances, drug interactions e.g., induces P450-accelerates drug metabolism. Oral contraceptives, Warfarin, & HIV drugs.

    Pyrazinamide

    • Bactericidal against M. tuberculosis.
    • Use in tuberculosis treatment
    • Adverse effects: Hepatotoxicity, Non-gouty pararthralgias, Hyperuricemia, GI disturbances, and photosensitivity.

    Ethambutol [Myambutol]

    • Active against mycobacteria, effective against isoniazid and rifampin-resistant M. tuberculosis strains.
    • Initial TB treatment and treatment for patients previously treated with TB therapy.
    • Adverse effects: Optic neuritis (loss of vision).

    Second-Line Anti-TB Drugs

    • Fluoroquinolones (e.g., Levofloxacin, moxifloxacin).
    • Aminoglycosides (e.g., Amikacin).

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    Pulmonary Disorders-2 PDF

    Description

    Test your knowledge on key aspects of pulmonary conditions, including pulmonary embolism, pneumonia, and pulmonary hypertension. This quiz covers intervention strategies, pathogenesis, and clinical manifestations related to these conditions. Assess your understanding of crucial medical concepts and preventive measures in pulmonary health.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser