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TB/Histo/Cocci Flashcards

1
Q

What organism causes TB?

A

Mycobacterium tuberculosis

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2
Q

How is TB spread?

A

airborne droplets with ACTIVE TB infection

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3
Q

What are the two types of primary TB?

A
  1. Latent TB= 95%

2. Progressice Primary TB=5%= Active infection

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4
Q

Secondary TB

A

Reactivated TB from LTBI

Active Dz

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5
Q

What are the risk factors for TB

A
  1. Immunocompromised
    - HIV/AIDS=#1
    - Pt’s receiving immunosuppressive therapy
    - Children <5 y.o
  2. Crowded living conditions
  3. Exposure to someone with active infection
  4. Nationality/Geography
    - Africa, Asia, Latin America
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6
Q

What is considered a classic physical exam finding in TB?

A

Post-tussive rales

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7
Q

CXR findings in primary progressive active infection?

A
  1. Hilar adenopathy
  2. Hilar/middle lobe infiltrate
  3. Pleural effusions
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8
Q

CXR findings in reactive active infection?

A

Apical/upper lobe infiltrates and cavitation

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9
Q

Ghon/Ranke complex

A

Calcified primary focus and hilar lymph nodes= evidence of healed primary TB

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10
Q

What is the diagnostic gold standard for TB?

A

Sputum culture

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11
Q

What is the histologic hallmark in TB?

A

Biopsy showing necrotizing, caseating granuloma

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12
Q

What does the Mantoux test, PPD measure?

A

Induration

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13
Q

What could give you a false positive for TB on a skin test?

A

Bacillus Calmette-Guerin (BCG) vaccine

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14
Q

What test has better sensitivity and specificity than PPD for diagnosing TB?

A

Interferon Gamma Release Assays (IGRAs) blood test

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15
Q

What are the advantages of IGRAs blood test?

A
  1. Single visit
  2. Results in 24 hrs
  3. Not subjet to reader bias
  4. Not affected by BCG vaccine
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16
Q

What are the disadvantages of IGRAs blood test?

A
  1. Expensive
  2. Blood sample must be processed in 12 hrs
  3. Limited availability
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17
Q

Drug treatment for Active TB

A 
RIPE
R-Rifampin
I-Isoniazid
P-Pyrazinamide
E-Ethambutol
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18
Q

What is the main goal of latent TB treatment?

A

Prophylaxis tx to prevent active TB

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19
Q

Drug treatment for Latent TB

A

Isoniazid (INH) x 9 months

-AFTER you r/o active TB with hx and normal CXR

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20
Q

Rifampin (RIF) side effects

A

Excreted as red-orange compound in:

  • Tears
  • Sweat
  • Urine
  • Stool
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21
Q

Isonaizid (INH) side effects

A
  1. Hepatic toxicity- Monitor LFTs!

2. Peripheral neuropathy- Co-administer Vitamin B6 (pyridoxine)

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22
Q

Pyrazivlamide (PZA) side effects

A
  1. Hepatic toxicity

2. Hyperuricemia

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23
Q

Ethambutol (EMB) side effects

A

Optic neuritis

24
Q

What organism causes Histoplasmosis fungal infection?

A

Histoplasma capsulatum

25
Where do you find Histoplasma capsulatum
Isolated from soil contaminated with bird or bad droppings
26
Where is Histoplasma capsulatum more common?
Midwestern states | -Oho and Mississippi River valleys
27
What is the most common form of histoplasmosis?
Asymptomatic primary histoplasmosis
28
Sign and sx's of acute diffuse pulmonary dz in histoplasmosis infection
- Health people with intense exposure - Fever and fatigue - Duration: 1 wk-6 mos.
29
Signs and sx's of acute localized pulmonary dz in histoplasmosis infection
1. Pneumonia like sx's: fever, cough, dyspnea | 2. Local infiltrates
30
Signs and sx's of chronic cavitary pulmonary histoplasmosis
1. Apical cavities | 2. Occurs in older COPD pt's
31
Signs and sx's of disseminated histoplasmosis
1. Fever, fatigue, cough, dyspnea, wt. loss 2. Multiple organ failure-often fatal 3. Rare in immunocompetent host
32
CXR findings in histoplasmosis
1. Hilar adenopathy | 2. Patchy or nodular infiltrates in lower lung fields
33
Lab studies in histoplasmosis
1. Antigen detection- acute xz 2. Serology 3. Biopsy 4. Cultures- chronic dz
34
Histoplasmosis treatment for asymptotic pt's
No treatment
35
Histoplasmosis treatment for acute pulmonary infection
Oral itraconazole or Ketoconazole
36
Histoplasmosis treatment for Severe infections
Amphotericin B IV
37
Histoplasmosis treatment for chronic infections
Amphotericin B or itraconazole
38
Histoplasmosis treatment for AIDS pt's
Amphotericin B, maintenance therapy with itraconazole
39
What organism causes Coccidiodomycosis
Coccidioides immitis OR | Coccidioides posadasii
40
Where are Coccidiodomycosis organisms found?
Soil in semiarid areas - SW US - Mexico - South America
41
Incubation period of Coccidiodomycosis
7-21 days (1-3 wks)
42
Coccidiodomycosis clinical presentation
1. Pneumonia manifestations-Fever, cough, pleuritic CP 2. HA, arthralgias 3. Marked fatigue 4. Rash- erythema multiform,e, erythema nodosum 5. Disseminated extra pulmonary infection 6. Residual granuloma (scar) on CXR
43
Who is @ an increased risk for disseminated cocci?
1. HIV/immunocompromised pt's 2. African Americans, Asians 3. Women in 3rd trimester
44
How does disseminated cocci present differently?
1. Pulmonary findings more pronounced- lung abscess 2. Meningitis, lymphadenitis 3. Bone lesions @ bony bony prominences
45
Coccidiodomycosis CXR findings
1. Hilar adenopathy 2. Patchy, nodular pulmonary infiltrates 3. Miliary infiltrates-disseminated dz
46
Coccidiodomycosis lab findings
1. Eosinophilia 2. Serologic (blood) detection of IgM, IgG antibodies 3. Culture
47
When do you treat Coccidiodomycosis?
1. >10% loss body wt. 2. Night sweats >3 wks 3. Infiltrates >1/2 of one lung OR portions of both lungs 4. Prominent/persistent hilar adenopathy 5. Inability to work 6. Sx's > or equal 2 months
48
Coccidiodomycosis treatment
Fluconazole 3-6 months
49
What is the prognosis for disseminated and meningeal forms of Coccidiodomycosis?
- High mortality rate | - 50% in absence of therapy
50
Coccidiodomycosis treatment in 1st trimester of pregnancy? Why?
Amphotericin B IV | Azoles are contraindicated in 1st trimester
51
What do you want to watch out for when using Itraconazole?
CHF
52
What are -azoles (antifungals) drug interactions?
- Interact with everything | - CYP450
53
Major adverse reaction of Antifungal?
Hepatotoxicity
54
When would we want to use Amphotericin B-IV? Why?
Only for severe cases: progressive, potentially life-threatening MANY adverse rxns
55
What is the most common opportunistic infection associated with AIDS?
Pneumocystis jiroveci pneumonia (formerly PCP)
56
Pneumocystis jiroveci pneumonia clinical presentation
1. Fever, cough, SOB (pneumonia) 2. Hypoxemia 3. CXR- diffuse perihilar infiltrates

Foundations-Pulmonary (9 decks)

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