Term
| What type of histoplasmosis is uncommonly diagnosed? |
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Definition
| primary acute histoplasmosis |
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Term
| Primary acute histoplasmosis affects who the most? |
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Definition
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Term
| What % of histoplasmosis infxn is the benign form? |
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Definition
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Term
| What dz is often discovered by accident through a skin test or routine chest x-ray? |
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Definition
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Term
| What does POHS stand for? |
|
Definition
| Presumed Ocular Histoplasmosis Syndrome |
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|
Term
|
Definition
develops in pt's with benign histoplasmosis
Leads to circumpapillary choroiditis, atrophoic chorioretinal scars and exudative maculopathy |
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|
Term
|
Definition
| It is not tested for, therefore it is presumed |
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Term
| What can triger choroidal neovascularization? |
|
Definition
|
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Term
| Is AC rxn or vitreous inflammation seen in POHS? |
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Definition
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Term
| What is the pathophysiology of POHS? |
|
Definition
| fungi enter the choroid through the bloodstream, attack Bruch's membrane --> choroidal neovascularization |
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Term
| What increases risk for POHS? |
|
Definition
| DM, immunosuppressants. Anything that weakens the immune system |
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|
Term
| What is disseminated histoplasmosis? |
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Definition
| poor T-cell immune response allows fungi to spread |
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Term
| Who is at most risk for disseminated histoplasmosis? |
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Definition
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Term
| What are s/sx of disseminated histoplasmosis? |
|
Definition
fever
chills
cough
HA
diarrhea
weight loss
dyspnea |
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Term
| Where is hypersplenism often seen? |
|
Definition
| disseminated histoplasmosis |
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|
Term
| What is the most common pulmonary presentation of disseminated histoplasmosis? |
|
Definition
| diffuse interstitial infiltrates |
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|
Term
| What SE of disseminated histoplasmosis results from adrenal gland involvement? |
|
Definition
|
|
Term
| What systems can disseminated histoplasmosis affect? |
|
Definition
liver
lymph
GI
CNS
panophthalmitis |
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|
Term
| What happens if disseminated histplasmosis is left untreated? |
|
Definition
| 80% mortality rate within 4-10 months |
|
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Term
| What histoplasmosis can present with a negative skin test? |
|
Definition
| disseminated histoplasmosis |
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|
Term
| What is histoplasmosis infxn of compromised lung tissue? |
|
Definition
| chronic pulmonary histoplasmosis |
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|
Term
| What forms in the lungs in chronic pulmonary histoplasmosis? |
|
Definition
histoplasmomas
bronchiectasis |
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|
Term
| What are s/sx of chronic pulmonary histoplasmosis? |
|
Definition
weight loss
fever
chronic cough
chest pain |
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Term
| What careers/activities increase risk of histoplasmosis? |
|
Definition
living in the midwest
spelunking
Any job that exposes pt to bat or bird droppings |
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|
Term
| What is a slow laboratory dx for chronic pulmonary histplasmosis? |
|
Definition
Culturing, takes 5-6 weeks
of limited use as a result, too long to wait |
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|
Term
| What does the histoplasmin skin test indicate? |
|
Definition
| Whether or not the pt has been exposed to histoplasmosis, NOT to indicate active infection. Rarely used. |
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Term
| What is seen on the x-ray of chronic pulmonary histoplasmosis? |
|
Definition
| multiple calcified foci in both lungs |
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|
Term
| Are serologic tests reliable for chronic pulmonary histplasmosis? |
|
Definition
| large number of false positives and false negatives. So no. |
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Term
| When can a serologic test be performed on a suspected histoplasmosis pt? |
|
Definition
| 2-3 weeks after suspected?? Ask Danny . . . |
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|
Term
| What types of histoplasmosis receives no tx? |
|
Definition
primary acute histoplasmosis
benign histplasmosis |
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|
Term
| How is disseminated histoplasmosis treated? |
|
Definition
| anti-fungals and systemic corticosteroids |
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Term
| How does the mortality rate change in disseminated histplasmosis with tx? |
|
Definition
| Drops from 80% mortality to less than 25% |
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Term
| In immunosuppressed histoplasmosis pts, what is the course for anti-fungal use? |
|
Definition
| possibly for the rest of life |
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|
Term
| What anti-fungals are used to treat histplasmosis? |
|
Definition
amphotericin B (IV)
Ketoconazole (oral)
Itraconazole (oral) |
|
|
Term
| What is the mechanism of anti-fungal drugs in histoplasmosis tx? |
|
Definition
| bind to fungal cell membrane and disrupts metabolic activity |
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|
Term
| What are negative SE of histoplasmosis anti-fungals? |
|
Definition
Can be toxic to human cells
N & V, anemia, nephrotoxicity, liver toxicity |
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|
Term
| Why are systemic corticosteroids given to histoplasmosis pts? |
|
Definition
to treat the Addison dz from adrenal gland involvement by decreasing damage from inflammation
Must be given with anti-fungals |
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|
Term
|
Definition
| complete cessation of respiration for 10 seconds |
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|
Term
| What are the 2 forms of sleep apnea? |
|
Definition
|
|
Term
|
Definition
| CNS respiratory centers dysfxn |
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|
Term
| What is obstructive apnea? |
|
Definition
| mechanical obstruction of the lungs |
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|
Term
| What is the most common sleep apnea? |
|
Definition
|
|
Term
| Who are most commonly affected by sleep apnea? |
|
Definition
1/4 of males over 20 yo
women less often than men
rarely in children |
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|
Term
| How often is sleep apnea misdiagnosed? |
|
Definition
|
|
Term
| What is a common cause of central apnea? |
|
Definition
|
|
Term
| What is the pathophysiology of central apnea? |
|
Definition
| instant feedback of blood gas control breaks down --> poor feedback loop --> alternating fast/slow breathing --> really slow breathing that can be fatal |
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Term
| What are s/sx of obstructive sleep apnea (OSA)? |
|
Definition
loud snoring
chronically disturbed sleep
excessive daytime sleepiness
morning HA
cognitive impairment
tired upon awakening |
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|
Term
| When does the airway obstruct in OSA? |
|
Definition
| as pt enters deep sleep, upper airway closes --> pt then thrashes, partially awakens to restore airway |
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Term
| What physical changes can be seen in the brain with lack of sleep? |
|
Definition
|
|
Term
| What are the mamillary bodies in the brain associated with? |
|
Definition
| memory. Can be disrupted by lack of sleep |
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Term
| What are contributing factors to OSA? |
|
Definition
obesity
"thick" necks
small or receding jaw
increased size of soft palate and tongue
history of heavy drinking |
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|
Term
| What is nocturnal polysomnography? |
|
Definition
the gold standard of OSA dx
pt sleeps in a laboratory and vital signs monitored |
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|
Term
| What is monitored in nocturnal polysomnography? |
|
Definition
eye movements
chest wall monitors
electromyogram
nasal and oral air flow meters
electroencephalogram
electrocardiogram
oximetry |
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|
Term
| What is an electromyogram? |
|
Definition
| measure muscle movement, often to monitor leg movements in OSA pt dx |
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|
Term
| What is the baseline for OSA dx from nocturnal polysomnography? |
|
Definition
| More than 20 episodes per hr --> positive OSA dx |
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|
Term
| What comorbidities are often seen in OSA? |
|
Definition
HTN in 30-50%
obesity
emotional problems
DM
CV Dz |
|
|
Term
| What CV dz's increase OSA dx? |
|
Definition
ischemic heart dz (4-7x)
nocturnal cardiac arrhythmias (2-4x)
MI
Stroke (3-8x) |
|
|
Term
| What dz's increase in incidence when OSA is already seen in a pt? |
|
Definition
impotence
glaucoma (7-8%)
increased retinopathy and macular edema in DM pts
anterior ischemic optic neuropathy
MVA (2-7x) |
|
|
Term
| What ocular SE present with CPAP use? |
|
Definition
corneal dryness
corneal ulcers
bacterial ocular infxns |
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|
Term
| What are non-surgical tx's for OSA? |
|
Definition
weight loss
tongue or jaw adjustment devices
Sew tennis balls on sleeping clothes to prevent sleeping on back
compression stockings during the day (HF aspect)
CPAP
oropharyngeal exercises |
|
|
Term
| Are medications effective for OSA tx? |
|
Definition
| many tried, few have worked. |
|
|
Term
| How does a CPAP machine work? |
|
Definition
| Controls OSA by pushing air into the nostrils at night --> opens airway |
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|
Term
| What is a surgical tx of OSA? |
|
Definition
Uvulopalatopharyngoplasty to open upper airway
jaw surgery
tracheostomy |
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|
Term
| When is surgery most often considered for OSA tx? |
|
Definition
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