Pulm: Tb, Cocci, Etc. Flashcards by Anthony Carli

After initial transmission, primary tuberculosis can take ______ weeks to show as positive on PPD skin test…

6-8 weeks

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In this stage of TB, macrophages ingest tubercle bacilli, creating a granuloma, rendering transmission unlikely

latent TB

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Latent TB (LTBI) is present in what percent of TB cases?

95%

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What percent of TB disease (active form) develops from latent TB?

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Patients with DM are ____ x more likely to develop TB

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What are 4 important lines of questioning to explore during hx in a potential TB case?

immunocompromised?
immigrant from high TB area?
IVDU?
close living quarters?

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What are three major sxs of TB?

Fever, cough, CP

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How long does the cough in TB persist, and what are two other features of the cough?

3+ weeks

+/- productive, hemoptysis

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What might be heard on auscultation of the lungs in TB?

posttussive crackles

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On PE, a patient presents with:

Dullness to percussion
decreased fremitus

This is concerning for…

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What 4 diagnostics are helpful in assessing TB

TB testing (TST or IGRA)
CXR
Bacteriological exam
Drug Susceptibility testing

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Which TB diagnostic?

wheal created with 0.1ml PPD
read in 48-72 hours
may not present for 2-8 weeks following exposure

TST

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The following groups are considered TB positive if induration is…

HIV
close contacts
Evidence on CXR
Immunosuppressed
Organ Transplant

5+ mm

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The following groups are considered TB positive if induration is…

recent immigrants from high TB

IVDU

Mycobacteriology lab personnel

Healthcare workers

medical conditions

< 4yo

children/adolescents exposed to adults at high risk

10+ mm

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A TB test is considered positive in anybody if it is greater than…

15mm

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Who should receive 2 step TB testing?

healthcare workers

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What vaccine may create false positives?

BCG

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Which TB test measures immune response to TB in blood?

IGRA (quantiferon gold, T-Spot)

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For the IGRA test, blood is incubated ______ and response is measured

TB antigen

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When would IGRA be considered instead of TST?

compliance/return

BCG vaccination

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Can IGRA differentiate between TB disease and latent TB?

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What 4 features on CXR can help diagnose TB?

hilar LAD
effusion/infiltrate
cavitation
miliary pattern

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Can CXR determine active vs inactive disease?

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The following CXR finding indicates…

dense nodule/lesions with calcification

latent TB

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The following CXR for TB finding indicates... cavities infiltrates LAD

reactivation of latent TB

Where are abnormalities typically seen in the lungs in TB?

apical/posterior upper lobes superior lower lobe

The following on CXR for TB indicates... 1. calcified parenchymal granuloma 2. ipsilateral calcified hilar lymph node

Healed primary pulmonary TB (Ranke Complex)

What is used for bacteriologic study in diagnosing TB?

sputum collection

What is the protocol for sputum collection in TB?

3 specimens 8-24 hr apart 1 sample in the morning

What type of bacteriologic study for TB? Easy/quick supports Dx, doesn't confirm smear

acid fast bacilli (AFB)

What type of bacteriologic study for TB? supports dx, doesn't confirm used if high suspicion cytology

Nucleic acid amplification (NAA)

What is the gold standard for diagnosis of TB, but takes weeks for results?

culture

You receive a positive AFB and NAA. What action occurs next?

begin treatment, presume TB

If culture is positive for TB, how do you proceed?

treatment and drug susceptibility testing

If culture is negative, but TB is still suspected, how do you proceed?

treat and monitor response

What is hallmark on biopsy for TB?

necrotizing granuloma

Which TB test has the following features? - automated NAA test - uses disposable cartridge - identifies TB DNA and rifampin resistane

Xpert MTB/RIF assay

What are the advantages to Xpert MTB/RIF assay?

2 hours | minimal training

What are the disadvantages for Xpert MTB/RIF assay?

cost doesn't replace AFB smear or cx

For whom is Xpert MTB/RIF assay indicated?

patients with < 3 days of therapy

TB must be reported within ______ hours

24 hours

What are the 4 first line drugs for TB?

Rifampin isoniazid pyrazinamide ethambutol

What must be part of administering TB drugs?

direct observed treatment

Which of the 4 TB drugs has the following side effects? skin sensitivity

RIF

Which of the 4 TB drugs has the following side effects? hepatotoxicity peripheral neuropathy fatal hepatitis

INH

Which of the 4 TB drugs has the following side effects? hepatotoxicity hyperuricemia

PZA

Which of the 4 TB drugs has the following side effects? optic neuritis

EMB

What is the protocol for tx of TB in the initial phase?

1. 4 meds daily x 2 mo | 2. repeat CXR, AFB, Cx

What is the protocol for tx of TB in the continuation phase?

1. RIF and INH daily or 2x weekly for 4 months

HIV extends treatment of TB for...

9-12 mo

What drug can't be given to pregnant women?

PZA

What drug shouldn't be given to infants and children?

EMB

What three criteria must be present to not be considered infectious with TB...

2 weeks of tx 3 negative sputum cultures improved sxs

Who isn't allowed to go home while still infectious with TB?

if children < 5 or immunocompromised in home

TB Tx completion is based on _______ not duration...

based on doses

The initial phase of TB tx requires how many doses?

56 doses

The continuation phase requires how many doses of TB tx if daily or weekly?

126 if daily 36 if weekly

What tx for latent TB? - preferred for adults/children 12+ yo - 12 weekly doses - not used in pregnancy - uncomplicated HIV

INH and Rifapentine

What tx for latent TB? - 9 month regimen optimum - 300mg daily or 900 mg twice weekly

INH

What tx for latent TB? 4 month regimen 120 doses daily given if pt. can't tolerate INH

RIF

Does latent TB require tx

yes

What 2 types of CP can be common with TB?

retrosternal or pleuritic

This TB infx doesn't respond to INH or RIF

MDR-Tb

This TB infx responds to fewer drugs, including fluoroquinolones

XDR-TB

What tx is available for XDR-TB?

surgery

What are 4 solutions to the MDR/XDR problem?

1. cure TB 1st time 2. access to diagnostics 3. infection control 4. use 2nd line meds

Is the BCG vaccine live?

yes

Does BCG prevent TB?

no, protects against meningitis and disseminated TB

What are 2 contraindications for the BCG vaccine?

immunocompromised pregnancy

For whom is BCG vaccine recommended?

negative TST, continual exposure healthcare workers at risk of MDR

Where is histoplasma most common?

OH and Mississippi river valleys

Histoplasma is spread via...

bird or bat droppings

What patient populations are most at-risk for histoplasma?

HIV/AIDS immunocompromised

90% of cases of histoplasma are ______ or flu-like

asymptomatic

What type of histoplasma infx? most common in healthy ppl CXR showing residual granuloma

asymptomatic primary histoplasmosis

What type of histoplasma infx? Fever, fatigue, few respiratory sxs sxs for 1 week to 6 mo

acute symptomatic pulmonary histoplasmosis

What type of histoplasma infx? immunocompromised fatigue, fever, cough, dyspnea, weight loss fatal w/in 6 weeks multiple organ involvement

progressive disseminated histoplasmosis

What type of histoplasma infx? older COPD patients progressive lung changes apical cavity

chronic pulmonary histoplasmosis

What two antibody tests are available for dx of histoplasmosis?

Immunodiffusion test complement fixation test

This Ab test monitors for acute and chronic infx of hisptoplasmosis

ID test

This Ab test for histoplasmosis is more sensitive, but less specific and may take up to 6 weeks for results

CF test

What is used in EIA testing for histoplasmosis?

urine or serum

Besides serology, what other two diagnostics can be used in dx histoplasmosis?

biopsy culture

What can be seen on CXR of histoplasmosis?

hilar adenopathy patchy or nodular infiltrates in lower lobes

Tx for Acute pulmonary histoplasmosis: mild-moderate

< 4 weeks, no tx 4+ weeks Itraconazole PO x 6-12 weeks

Tx for Acute pulmonary histoplasmosis: moderate-severe

amphotericin B IV x 1-2 weeks THEN itraconazole PO x 12 weeks

what is added in Tx for Acute pulmonary histoplasmosis: moderate-severe with respiratory complications

methylprednisolone IV x 1-2 weeks

Tx for progressive disseminated histoplasmosis...

amphotericin B IV x 1-2 weeks THEN Itraconazole PO x 12+ mo

Tx for chronic histoplasmosis?

itraconazole PO x 12+ months

Tx for HIV/AIDS histoplasmosis?

amphotericin B IV x 2 weeks + itraconazole PO maintenance therapy

The following are suspicious of what pulmonary disorder? 1. PNA w/ mediastinal or hilar LAD 2. mediastinal or hilar mass 3. pulmonary nodule 4. cavitary lung disease 5. pulmonary sx with RA/arthralgia and erythema nodosum 6. dysphagia with esophageal narrowing

Histoplasmosis

What percent of valley fever cases are asymptomatic?

60%

What 5 groups have the most severe presentation in valley fever?

immunocompromised pregnant women DM African/filipino

A patient presents with the following, which is concerning for... Fever, cough, pleuritic CP Marked Fatigue erythema multiform/erythema nodosum

Cocci, valley fever

Disseminated disease in valley fever affects what three tissues?

lungs bones brain

A patient presents with positive cocci and the following sxs, this is concerning for what complication? lung abscess bone lesions lymphadenitis, menigitis

disseminated disease

What three serologic tests are available for cocci diagnosis?

Enzyme immunoassay Immunodiffusion Complement fixation

which valley fever serology test has the following characteristics: detects IgG assess severity

complement fixation

which valley fever serology test has the following characteristics: more specific, used after a positive detects IgM

Immunodiffusion

This valley fever serology test is more sensative than the ID test...

enzyme immunoassay

CBC in valley fever can show...

eosinophilia, slight leukocytosis

What 4 findings on CXR can be present with cocci infx?

hilar adenopathy patchy infiltrate miliary infiltrate thin wall cavity

How long do thin wall cavities last in VF?

2 years

What may mimic TB with VF infection?

cavitary lesion with infiltrate

Who requires treatment for cocci?

high-risk/severe illness

What is used to treat valley fever?

azoles

What drug is used to treat cocci in pregnancy?

amphotericin B

When is f/u required while treating cocci infx?

2-4 weeks while treatment, 3-6 mo after, then yearly

Pulmonary complaints plus the 3 Es should make you think cocci... what are the 3 Es?

erythema nodosum erythema multiforme eosinophilia

Pulm: Tb, Cocci, Etc. Flashcards

(109 cards)