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Flashcards in TB Deck (27):
1

what is TB bact

mycobacterium
- special cell envelope
- leads to it being acid fast - doesn't show up on gram stain
- grows slowly - slow cultures

2

how is TB transmitted

ppl with pulmonary or laryngeal aerosolize
- local defences can destroy if it doesn't get too deep

3

what happens if gets into alveoli

- cell mediated immunity creates a granuloma
- person now has latent TB

4

what is chance of going active

10% will go active
50% of those in 2 year
- most TB in world is reactivated

5

what is TB in toronto

from immigrants

6

2 ways to test latent

1. skin test - TST
2. interfereon gamma release assay - IGRAS

7

3 ways to diagnose active

1. acid fast bacilli and cultures
2. path consisitent with necrotizing granulomas
3. clinical presentations

8

what is TST

- glyscerol extract of TB is put in skin
- read 48-72 hours later

9

what is IGRA

- tests to see if WBCs from infected patient will release IFN-g when mixed with antigens from TB

10

how does TST and IGRA compare

- IGRA are more specific than TST if previus BCG given
- neither can separate latent from active
- IGRA more specific for TB versus other non TB bacterium

11

3 parts of interpreting TST

1. size of induration
2. PPV
3. risk of disease if truly infected

12

3 levels and situations that would be considered pos.

0-4
- normal, but for children

13

2 things that PPV is confounded by on TST

1. previous BCG - after 1yo
2. previous NTM
- found in soil and such stuff

14

7 things that make a person high risk

1. AIDS
2. HIV
3. tranplant
4. silcosis
5. chronic renal failure
6. carcinoma of head
7. recent TB

15

7 things that make increased risk

1. steroid tx
2. TNF-a is
3. diabetes
4. underweight
5. young when infected
6. smoker
7. granuloma

16

what to do if find pos. TST

rule out active TB
- Hx and Phx
- CXR
- sputum

17

4 groups to offer Tx to

1. ALL CONVERTERS
2. new immigreants
3. HIV and immunosupressed
4. those with increased risk

18

what is LTB Tx

1. INH 9 mo
2. rifampin 4 mo

19

what are SE of isoniazide

- hepatotoxicity
- rash
- GI upset
- peripheral neuropathy

20

how to test after pot. TST

will always test pos. again, and can get bigger

21

Sx of active TB

- cough
- fever, chills, night sweats
- weight loss
- hemoptysis

22

4 other risk factors

- aborig
- previous TB or contact
- marginalized pop
- immunosupressed

23

3 steps if active suspected

1. isolation precautions
2. CXR
3. resp secretion analysis

24

what are extrapulm manifestations

- nodal
- pleural
- CNS
- percardial
- MSK
- peritoneal
- genitourinary
- miliary (disseminated)

25

what is MGMT of active

always start 4 drugs until cultured
1. INH
2. rifampin
3. pyrazinamide
4. ethambutol

26

why different drugs

hits different types

27

3 different types

1. extracellular with high O2
2. areas of low O2: inside cells, areas of fibrosis or caseum
3. areas of fibrosis or solid caseum

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