TB & Fungal Pneumonias

Question 1

TB spread by

Answer 1

airborne by active TB during PROLONGED exposure

Question 2

latent TB (LTBI)

Answer 2

bacterial walled off, no symptoms, no active infection, not infectious, may reactivated in future

Question 3

primarily necrotizing (caseating) granulomas

Answer 3

TB

Question 4

risk for developing reactivation TB is greater during

Answer 4

first 2 years after infection

Question 5

secondary TB

Answer 5

reactivation of TB form LTBI

Question 6

TB risk factors

Answer 6

immune compromise (HIV), crowded living, exposure (healthcare work), nationality (africa, asia and latin america)

Question 7

active TB symptoms

Answer 7

fever, chill, night sweats, cough

Question 8

pulmonary aspergillosis is a complication of

Answer 8

TB

Question 9

lab findings of TB

Answer 9

hyponatremia (SIADH) and elevated CRP

Question 10

interferon gamma release assays a/w

Answer 10

TB testing

Question 11

TB CXR ?

Answer 11

shows active or inactive

Question 12

CXR findings of active TB

Answer 12

CLASSIC: focal infiltration in upper lobes

Question 13

Ghon/Ranke complex

Answer 13

TB: calcified primary focus and hilar lymph node, residual evidence of healed primary TB

Question 14

gold standard for Dx of TB

Answer 14

sputum culture

Question 15

sputum culture

Answer 15

3 consecutive morning

Question 16

TB histologic hallmark of biopsy

Answer 16

necrotizing (ceseating) granulomas

Question 17

TB skin testing

Answer 17

Mantoux test PPD

Question 18

Mantoux test PPD measures

Answer 18

induration not erythema read in 48-72 hrs

Question 19

if skin testing positive for TB then ?

Answer 19

CXR to r/o active dz

Question 20

if 2nd tb skin test positive

Answer 20

indicates TB infection in distant past-boosted response

Question 21

reaction size on tb skin test

Answer 21

HIV >5 mm, immigrants/healthcare related >10, nl people >15

Question 22

interferon gamma release assays benefits

Answer 22

not affected by BCG

Question 23

tx of active TB

Answer 23

RIPE x 2 months then RIF and INH x 4 months [DOT-directly observed]

Question 24

tx of latent TB

Answer 24

INH and B6 x 9 months

Question 25

what to monitor when treating TB

Answer 25

LFT

Question 26

complication of TB

Answer 26

drug resistant, miliary TB, uncontrolled hematogenous TB, multiorgan

Question 27

RIF

Answer 27

red orange tears, sweats, urine, stool

Question 28

INH

Answer 28

hepatitis, peripheral neuropathy (given w/ B6)

Question 29

PZA

Answer 29

hepatic toxicity, hyperuricemia (gout)

Question 30

EMB

Answer 30

optic neuritis

Question 31

histoplasmosis

Answer 31

caused by histoplasma capsulatum-isolated from soil contaminated w/bird or bat droppings

Question 32

asymptomatic primary histoplasmosis

Answer 32

may see residual granuloma (scar) on CXR

Question 33

acute symptomatic pulmonary histoplasmosis

Answer 33

due to prolonged exposure, fever, fatigue, few resp. symp. lasts 1 week-6 month

Question 34

progressive disseminated histoplasmosis

Answer 34

rare, fever , fatigue, cough, dyspnea, wt loss, multiple organ involvement, fatal w/in 6 weeks

Question 35

chronic pulmonary histoplasmosis

Answer 35

in COPD pts, apical cavities in lung

Question 36

lab for histoplasmosis

Answer 36

antigen detection in bronchoalveolar lavage fluid, urine, blood

Question 37

histoplasmosis cxr

Answer 37

hilar adenopathy

Question 38

tx for sever histoplasmosis

Answer 38

amphotericin B IV

Question 39

tx for chronic histoplasmosis

Answer 39

amphotericin B or itraconazole

Question 40

tx for histoplasmosis in AIDs pts

Answer 40

amphotericin B + itraconazole

Question 41

coccidioidomycosis (valley fever)

Answer 41

FEVER, cough, chest pain, ha, fatigue, arthralgias, rash (ERYTHEMA MULTIFORME), ERYTHEMA NODOSUM

Question 42

erythema nodosum in coccidioidomycosis (valley fever) vs sarcoidosis

Answer 42

valley fever has FEVER

Question 43

disseminated coccidioidomycosis

Answer 43

lung abscess, lymphadenitis, meningitis, BONE LESIONS at boney prominences

Question 44

cxr findings of coccidioidomycosis

Answer 44

hilar LAD, patchy nodular infiltrates, miliary infiltrates, THIN WALLED CAVITIES

Question 45

eosinophilia

Answer 45

coccidioidomycosis w/ slight leukocytosis

Question 46

tx of sever coccidioidomycosis

Answer 46

fluconazole, amp B IV

Question 47

coccidioidomycosis in pregnancy

Answer 47

if disseminated dz, mortality risk in both mother and fetus is high

Question 48

common SE of ..azoles

Answer 48

hepatotoxicity -->monitor liver function

Question 49

coccidioidomycosis 3 Es

Answer 49

1. erythema nodosum 2. erythema multiforme 3. eosinophilia

Question 50

most common opportunistic infection a/w AIDS

Answer 50

pneumocytostis jiroveci pneumonia