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clinical medicine II exam 2 > TB/Histo/Cocci > Flashcards

TB/Histo/Cocci Flashcards

(68 cards)

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1
Q

what organism causes TB

A

Mycobacterium tuberculosis

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2
Q

how is TB transmitted

A
  • airborne droplet nuclei
    • usually requires prolonged exposure
  • pt must have active TB to spread infection
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3
Q

when will a skin test show up positive after exposure to TB

A

6-8 weeks

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4
Q

of people who get infected with TB, what percentage will have active disease (primary)

A

5%

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5
Q

of people who get infected with TB, what percentage will have active disease (secondary) after latent TB

A

5%

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6
Q

of people who get infected with TB, what percentage will become latent infections

A

95%

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7
Q

describe latent TB infection

A
  • TB present in body without symptoms
  • TB live in granuloma
  • unable to transmit infection to others
  • Latent TB may activate to disease if pt becomes immunocompromised and granulomas break down
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8
Q

what percentage of patients infected with TB get active TB

A
  • 10%, 5% intially, and 5% develop from latent
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9
Q

list steps of medical evaluation of TB

A
  1. medical history
  2. physical exam
  3. TB infection testing
  4. CXR
  5. bacteriological examination
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10
Q

risk factors for TB

A
  • immunocompromised
    • HIV
  • immigrants from areas of high TB prevalence
  • IV drug users
  • close living quarters
    • nursing homes, correctional facilities, hospitals
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11
Q

clinical presentation

  • fever
  • cough
    • 3+ weeks
      • +/- hemoptysis
      • +/- productive
  • CP
  • weakness, weight loss, chills, night sweats
  • PE: posttussive rales
A

TB

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12
Q

what are possible complications from TB

A
  • pneumothorax
  • bronchiectasis
  • malignancy
  • pulmonary aspergillosis
  • septic shock
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13
Q

Describe TB skin testing

A
  • Mantoux tuberculin skin test (TST)
    • given in forearm intradermal
    • read in 48-72 hours
    • measure induration, not erythema
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14
Q

For what groups is a reaction size of > or = 5 mm considered positive TB skin test

A
  • HIV +
  • recent contacts of person with active TB
  • persons with evidence of TB on CXR
  • immunosuppressed
  • organ transplant
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15
Q

For what groups is a reaction size of > or = 10 mm considered positive TB skin test

A
  1. recent immagrants from areas with high rate of TB
  2. IV drug users
  3. mycobacteriology lab personnel
  4. residents.employees of high risk congregate setting
  5. children < 4 yo
  6. infants, children, adolescents exposed to adults at high risk
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16
Q

For what groups is a reaction size of > or = 15 mm considered positive TB skin test

A

positive in anyone even without risk factors for TB

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17
Q

describe the 2 step skin test for TB. When it is recommended

A
  • recommended as initial test for health care workers and individuals requiring periodic retesting
    • 1st negative, repeat in 1-3 weeks
    • 2nd positive, TB infection present (creates boosted response)
  • ** BCG vaccine may create false positive
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18
Q

what is the interferon gamma release assay: Quantiferon TB Gold

A
  • measure immune response in blood to TB
  • may be used in place of TST if patient has recieved BCG vaccination
  • unable to differentiate between TB disease and latent TB infection
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19
Q

what initial presentation may be seen on CXR when you suspect a patient has TB

A
  • normal or hilar lymphadenopathy
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20
Q

What is typical on CXR of a person with latent TB

A
  • typically normal
  • can see dense nodules or lesions with possible calcification
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21
Q

TB usually settles in what part of lung

A
  • apical/posterior upper lobes
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22
Q

If patient has positive TB skin test, and suspicious CXR, what is the third step? describe it

A
  • bacteriological exam: sputum collection
    • ​3 specimens (8-24 h apart)
    • at least 1 in the morning
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23
Q

What three things are you looking for in sputum collection for TB patient

A
  1. smear: acid fast bacilli
  2. cytology: nucleic acid ampification test (NAA)
  3. culture: gold standard **confirms diagnosis but may take weeks
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24
Q

how is TB diagnosed

A
  • if both smear (showing acid fast bacteria) and nucleic acid amplification test are positive, TB disease is presumed and treatment begins
    • DO NOT delay treatment waiting for culture
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25
Treatment of active TB
* isolated negative pressure inpatient hospital room * drugs (RIPE) * **Isoniazid** * **Rifampin** * **Pyrazinamide** * **Ethambutol** * **\*\*DOT:** direct observed treatment
26
side effects of isoniazid
* **hepatotoxicity**; monitor LFT * **peripheral neuropathy**; patients given Vitamin B6
27
side effects of rifampin
red-orange tears, sweat, urine
28
side effects of pyrazinamide
* hepatotoxicity * hyperuricemia
29
side effects of ethambutol
**optic neuritis**: test visual acuity and color vision
30
length of treatment for TB
* initial phase: 4 meds daily x 8 weeks, then * continuation phase: * RIF and INH daily x 18 weeks or * INH and RIF twice weekly for 18 weeks
31
length of treatment for TB in HIV +
treatment is extended 9-12+ months
32
treatment for TB in pregnant women
Pyrazinamide not given
33
treatment for TB in infants/children
ethambutol not given and may extend treatment
34
When is a person on TB medication not considered infectious
* 2 weeks of treatment regimen * 3 negative sputum smears * symptoms improve
35
treatment for latent TB
* 9 month daily regimen of **isoniazid** * monitor LFT * give with vit B6
36
What classifies TB as MDR-TB
does not respond to at least INH and RIF
37
What classifies TB as XDR-TB
does not respond to INH, RIF or fluoroquinolones
38
is there a test available to quickly determine if TB is drug resistant
Xpert MTB/RIF test * rapid TB test: result in 2 hours
39
Describe the bacille calmette guerin vaccine. type and purpose
* intradermal live strain vacccine * purpose: decrease risk of severe consequences due to TB disease * does not prevent primary infection or activation of LTBI
40
CDC recommendations for who should get BCG vaccine
* children with negative TST and continual exposure * does not recommend HIV positive children * health care workers if high risk of MDR-TB
41
CDC recommendations for who should NOT get BCG vaccine
* immunosuppressed * pregnancy
42
is TST or blood test contraindicated if person has recieved BCG vaccine
No, blood test will likely produce false positive
43
where is histoplasmosis normally found
* **soil** contaminated with **bird** or **bat** droppings * midwestern states: **ohio** and **mississippe river valleys**
44
how is histoplasmosis transmitted
* inhalation of fungal spores from contaminated soil * body temp converts spores to yeast * yeast proliferates in lungs and spreads to lymphatics -\> other organs
45
histoplasmosis is most commonly found in what patient populations
* HIV/AIDS * weakened immune systems
46
clinical presentation * recent activity: **spelunking**, construction, mining, farming, gardening * mild flu like symtpoms
histoplasmosis
47
define asymptomatic primary histoplasmosis
* most common in otherwise healthy people * CXR may show residual granuloma
48
define acute symptomatic pulmonary histoplasmosis
* fever and marked fatigue, few respiratory symptoms * symptoms 1 week-6 months * typically self limitied
49
define progressive disseminated histoplasmosis
* pt typically immunocompromised * fever, marked fatigue, cough, dyspnea, weight loss * mutliple organ involvement * fatal within 6 weeks
50
older COPD patients who get histoplasmosis, usually present with
* chronic pulmonary histoplasmosis * see progressive lung changes * apical cavities
51
how is histoplasmosis diagnosed
* \*\*antigen detection: **enzyme immunoassay (EIA test)** : recommended to get this first * **​**typically urine or serum testing * antibody tests * immunodiffusion (ID) test * tests for acute and chronic infection * complement fixation * **culture: gold standard** * definitive diagnosis; may take 6 weeks
52
When does a patient start to get treatment for histoplasmosis? What is the treatment?
* acute pulmonary: mild-moderate **\> 4 weeks** * treatment: **itraconazole** x 6-12 weeks
53
What CXR findings are consistent with histoplasmosis
* hilar adenopathy * patchy or nodular infiltrates in lower lobes
54
If patient /o pulmonary sx with rheumatologic arthritis and erythema nodosum, what should you be concerned about
fungal infection
55
How is Coccidioidomycosis (valley fever) transmitted
* inhalation of spores from contaminated soil * endemic to lower desserts of western hemisphere * outbreaks occur following dust storms
56
high risk groups who tend to have a more severe presentation of Coccidioidomycosis (valley fever)
* immunocompromised * pregnant * DM * African or Filipino ethnicity
57
What percentage of people who are exposed to histoplasmosis are symptomatic
90% are asymptomatic or have mild flu-like symptoms
58
what percentage of individuals exposed to Coccidioidomycosis (valley fever) are symptomatic
* 60% are asymptomatic * 40% symptomatic (\<1/2 seek medical care)
59
if a person has asymptomatic Coccidioidomycosis (valley fever), what could still be present on CXR
residual granuloma
60
What are typical symptoms of Coccidioidomycosis (valley fever) in previously healthy people
* mild respiratory sx; self limited, lasting weeks-months * may progress to chronic pulmonary or disseminated disease in high risk group
61
clinical presentation * CAP 7-12 days following exposure * fever, cough, pleuritic CP * marked fatigue, HA, arthralgia * rash: erythema multiform, erythema nodosum
primary infection Coccidioidomycosis (valley fever)
62
if Coccidioidomycosis (valley fever) disseminates, where does it usually go
* Lungs, Bones, Brain * more pronounced lung findinds: abscess * bone lesions * lymphadenitis, meningitis
63
how is Coccidioidomycosis (valley fever) diagnosed
* immunodiffusion (ID) test * detects IgM * enzyme immunoassay (EIA) * complement fixation * detect IgG
64
what immune cell type is prominant in Coccidioidomycosis (valley fever) infection
eosinophilia
65
what CXR findings are consistent with Coccidioidomycosis (valley fever)
* vary * hilar adenopathy * patchy, nodular pulm infiltrates * miliar infiltrates * thin wall cavities * chronic pulm dz: residual lung nodules thin walled cavities or chronic cavitary lesions with infiltrates
66
treatment for Coccidioidomycosis (valley fever)
* typically not required, if appear healthy, do NOT need treatment * tx recommended for high risk or severe illness * **fluconazole and itraconazole** * \*\*check LFTs
67
treatment of Coccidioidomycosis (valley fever) in pregnant females
**amphotericin B** (azoles are teratogenic)
68
what is highest on your differential with these: * pulmonary complaints * ertyhema nodosum * erythema multiforme * eosinophilia
Coccidioidomycosis (valley fever)

clinical medicine II exam 2 (7 decks)

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