CHapter 18: Pneumonia, Lung Abcess Formation, and Important FUngal Diseases

When a patient has pneumonia, which of the following would be found in the alveolar effusion fluids?

1. Mucus

2. Macrophages

3. Saliva

4. Red blood cells

a. 1, 3

b. 2, 4

c. 2, 3

d. 1, 3, 4

b. 2, 4

A patient has a bacterial pneumonia. What kills the invading bacteria?

a. Macrophages

b. Red blood cells

c. Polymorphonuclear leukocytes

d. Serum fluid

c. Polymorphonuclear leukocytes

Which of the following can cause pneumonia?

1. Bacteria

2. Viruses

3. Prions

4. Fungi

a. 1, 2

b. 2, 3

c. 1, 2, 4

d. 2, 3, 4

c. 1, 2, 4

If a patient has pneumonia, which of the following can increase the risk for life-threatening illness or death?

1. Weakened immune system

2. COPD

3. Marfan's syndrome

4. Heart disease

a. 1, 3

b. 2, 4

c. 1, 2, 3

d. 1, 2, 4

d. 1, 2, 4

Overall, most cases of pneumonia are caused by:

a. viruses.

b. gram-negative bacteria.

c. protozoa.

d. fungi.

a. viruses.

Which of the following pulmonary infections is most commonly seen in patients with AIDS?

a. Anaerobic

b. Pneumocystis jiroveci

c. Streptococcus pneumoniae (Diplococcus pneumoniae)

d. Legionella pneumophila

b. Pneumocystis jiroveci

A 28-year-old patient who has dogs, parakeets, and cats as pets has been admitted with pneumonia. It is suspected that she acquired the infection from one of her pets. What organism is likely to be found in her sputum?

a. Bacteroides melaninogenicus

b. Staphylococcus aureus

c. Chlamydia psittaci

d. Haemophilus influenzae

c. Chlamydia psittaci

Ventilator-acquired pneumonia (VAP) is defined as pneumonia that develops:

a. between 24 and 48 hours after endotracheal intubation.

b. more than 48 to 72 hours after endotracheal intubation.

c. less than 24 hours after mechanical ventilation is started.

d. more than 72 hours after mechanical ventilation is started

b. more than 48 to 72 hours after endotracheal intubation.

A patient has a pleural effusion and atelectasis related to her pneumonia. Which of the following therapies should the respiratory therapist recommend as treatment for the pleural effusion?

a. Hyperinflation therapy

b. Supplemental oxygen

c. Thoracentesis

d. Percussion and postural drainage

c. Thoracentesis

Physical assessment findings on a patient with pneumonia would include:

1. bradycardia.

2. whispered pectoriloquy.

3. dull percussion note.

4. increased vocal fremitus.

a. 1, 3

b. 1, 2, 4

c. 2, 3, 4

d. 1, 2, 3

c. 2, 3, 4

A patient has bilateral pneumonia. What findings can be expected on the CT scan?

1. Depressed diaphragms

2. Elongated heart

3. Air bronchograms

4. Consolidation

a. 3, 4

b. 1, 2

c. 2, 3, 4

d. 1, 2, 3

a. 3, 4

Which of the following are considered to be normal causative agents for community-acquired pneumonia?

1. Staphylococcal pneumonia

2. Haemophilus influenza

3. Legionella pneumophila

4. Candida albicans

a. 1

b. 2, 3

c. 2, 3, 4

d. 1, 2, 3

d. 1, 2, 3

. During the early stages of a lung abscess, the pathologic process is identical to that of:

a. pulmonary edema.

b. bronchopulmonary dysplasia.

c. acute pneumonia.

d. pulmonary fibrosis

c. acute pneumonia.

What is the term for the fibrinous membrane that surrounds a lung abscess?

a. Serous membrane

b. Sclerotic membrane

c. Alveolar membrane

d. Pyogenic membrane

d. Pyogenic membrane

Which of the following can occur when tissue necrosis occurs in a lung abscess?

1. Fluid can rupture into a bronchus.

2. Broncholithiasis can occur.

3. Bronchospasm can close off the affected bronchi.

4. Fluid can rupture into the intrapleural space.

a. 1, 2

b. 1, 4

c. 3, 4

d. 1, 2, 3

b. 1, 4

An unconscious patient aspirated gastric contents. Which of the following anaerobic microorganisms would likely now be found in her lower respiratory tract?

1. Legionella pneumophila

2. Pseudomonas aeruginosa

3. Peptococci

4. Bacteroides fragilis

a. 1, 3

b. 3, 4

c. 1, 3, 4

d. 2, 3, 4

b. 3, 4

Which of the following are predisposing factors to aspiration of oropharyngeal secretions and/or gastric contents into the lower respiratory tract?

1. General anesthesia

2. Asthma

3. Seizure disorder

4. Alcohol abuse

a. 1, 2

b. 2, 4

c. 1, 2, 3

d. 1, 3, 4

d. 1, 3, 4

Which of the following conditions can result in a lung abscess?

1. Penetrating chest wound

2. Septic embolism

3. Swallowing disorders

4. Bronchogenic cyst

a. 1, 2

b. 3, 4

c. 1, 2, 4

d. 2, 3, 4

c. 1, 2, 4

Following a cerebrovascular accident, a patient lying in the supine position aspirated gastric contents. In what area(s) of the lungs would a lung abscess be most likely to develop?

1. Posterior segments of the upper lobes

2. Apical segments of the upper lobes

3. Superior segments of the lower lobes

4. Anterior segments of both lower lobes

a. 1

b. 1, 3

c. 1, 4

d. 1, 2, 3

b. 1, 3

Which of the following are considered to cause an opportunistic fungal infection?

1. Candida albicans

2. Aspergillus

3. Coccidioides immitis

4. Cryptococcus neoformans

a. 1

b. 2, 3

c. 2, 3, 4

d. 1, 2, 4

d. 1, 2, 4

The respiratory therapist heard a pleural friction rub while performing a chest assessment on a patient with a lung abscess. What does this likely indicate?

a. The lungs are hyperinflated.

b. Hemoptysis has developed.

c. The abscess is located near the pleural surface.

d. A pneumothorax has developed.

c. The abscess is located near the pleural surface.

What is the standard treatment for a lung abscess caused by an anaerobic pathogen?

a. Clindamycin

b. Penicillin

c. Neomycin

d. Omalizumab

a. Clindamycin

What is the recommended treatment for a lung abscess caused by methicillin-resistant Staphylococcus aureus (MRSA)?

a. Neomycin

b. Linezolid

c. Penicillin

d. Clindamycin

b. Linezolid

Fungal diseases can cause which type of pulmonary disorder?

a. An acute restrictive disorder

b. A chronic restrictive disorder

c. An acute obstructive disorder

d. A chronic obstructive disorder

b. A chronic restrictive disorder

What is considered to be the gold standard for the diagnosis of histoplasmosis?

a. Fungal culture test

b. Blood serum antigen levels

c. Chest x-ray

d. Fungal culture

d. Fungal culture

Anatomic alterations found in the lungs of patients with a fungal infection include:

1. fibrosis of lung parenchyma.

2. alveolar-capillary destruction.

3. hyperinflation.

4. mucosal edema.

a. 1, 2

b. 2, 3

c. 3, 4

d. 1, 2, 4

a. 1, 2

Which of the following is a disadvantage of the fungal culture test?

a. A large amount of blood is needed.

b. It has a high false-positive and is not very accurate.

c. It takes 4 weeks or longer for the fungus to grow.

d. A large amount of lymph node tissue is needed.

c. It takes 4 weeks or longer for the fungus to grow.

Which parts of the lungs are most commonly affected by a fungal infection?

a. Mainstem bronchi

b. Lingula

c. Lower lobes

d. Upper lobes

d. Upper lobes

Fungal lung infections are usually spread by:

a. inhaling spores.

b. blood.

c. contact with infected sputum.

d. inhaling infected droplets.

a. inhaling spores.

A patient lives in Cleveland and has HIV and a weakened immune system. What fungal infection is the patient at risk for developing?

a. Mycoplasma infection

b. Blastomycosis

c. Streptococcal infection

d. Disseminated histoplasmosis

d. Disseminated histoplasmosis

Which type of fungal lung infection frequently results in productive cough with purulent sputum?

a. Staphylococcal infection

b. Blastomycosis

c. Klebsiella infection

d. Histoplasmosis

b. Blastomycosis

A skin test is available to confirm which of the following fungal infections?

a. Coccidioidomycosis

b. Blastomycosis

c. Tuberculosis

d. Pseudomonal infection

a. Coccidioidomycosis

After cleaning out his chicken coop, a farmer has developed a fungal lung infection. What type of infection is it most likely to be?

a. Coccidioidomycosis

b. Blastomycosis

c. Histoplasmosis

d. Cryptococcal infection

c. Histoplasmosis

Which of the following are identified as opportunistic yeast pathogens?

1. Candida albicans

2. Cryptococcus neoformans

3. Aspergillus

4. Mycoplasma

a. 1

b. 2, 3

c. 2, 3, 4

d. 1, 2, 3

d. 1, 2, 3

In the Midwestern part of the United States, what is the most common fungal infection of the lungs?

a. Cryptococcosis

b. Histoplasmosis

c. Blastomycosis

d. Coccidioidomycosis

b. Histoplasmosis

Severe acute respiratory syndrome is believed to be caused by:

a. an arthropod.

b. HIV infection.

c. a coronavirus.

d. H5N1.

c. a coronavirus.

Pulmonary function testing results on a patient with advanced fungal pneumonia will display which of the following?

1. Increased ERV

2. Decreased IRV

3. Decreased IC

4. Increased TLC

a. 1, 4

b. 2, 3

c. 2, 3, 4

d. 1, 2, 3

b. 2, 3

During the advanced stages of a fungal lung infection, which of the following is commonly seen on the chest radiograph?

a. Hyperinflation

b. Spherical nodules

c. Right shift of the heart

d. Cavities

d. Cavities