Which clinical manifestations would you assess for in a painter with pulmonary hypertension?
(Select All that Apply.)

A. Antibody production against the offending fungi is delayed by the patient's age and the virulence of the organism: In older adults, the immune response may be slower or less effective due to age-related changes in the immune system. The virulence of Histoplasma capsulatum can also contribute to the severity of the infection, making it more difficult for the immune system to mount an effective response quickly, which explains the symptoms of fever, nausea, and vomiting.

B. Macrophages are able to remove the offending fungi from the bloodstream but can't destroy them: While macrophages play a crucial role in the immune response to fungi, in the case of histoplasmosis, they often engulf the fungi but may struggle to completely eradicate them, especially in immunocompromised individuals or the elderly. However, this option does not fully explain the delayed symptoms associated with the patient's age and the organism's virulence.

C. Spore inhalation initiates an autoimmune response that produces the associated symptoms: Histoplasmosis is caused by inhaling spores of Histoplasma capsulatum, but the symptoms are not the result of an autoimmune response. Instead, the immune system's attempt to combat the infection leads to the clinical manifestations, not an autoimmune process.

D. Toxin production by Histoplasma capsulatum is triggering an immune response: Histoplasma capsulatum does not produce toxins that directly trigger an immune response. Instead, the immune response is primarily due to the presence of the fungi themselves and the inflammatory response they provoke, which leads to the associated symptoms of the infection.

A. Deep vein thrombosis: Patients with deep vein thrombosis (DVT) are at a significantly higher risk for developing pulmonary embolism (PE) due to the potential for thrombus formation in the veins to dislodge and travel to the lungs. Assessing this patient as a priority is crucial, as timely intervention can prevent the development of PE.

B. Endocarditis: While endocarditis can lead to embolic events, it typically results in systemic emboli rather than specifically causing pulmonary embolism. The immediate priority for PE assessment is lower in patients with endocarditis compared to those with DVT.

C. Left heart failure: Left heart failure can lead to pulmonary congestion and respiratory symptoms but does not directly indicate a high risk of pulmonary embolism. While it is important to monitor these patients, assessing for PE is not the immediate priority.

D. Valvular disease: Valvular disease can increase the risk of thrombus formation, particularly if it results in atrial fibrillation. However, the direct connection to pulmonary embolism is not as pronounced as in patients with DVT. Therefore, assessing patients with valvular disease for PE is not the priority compared to those with DVT.