Week 12 - Topic 2: Pneumonia and Tuberculosis

Question 1

What does a chest x-ray show for pneumonia?

Answer 1

Infiltrate, consolidation or cavitation that persists for >48h

Question 2

What are symptoms of pneumonia?

Answer 2

• Rales or bronchial breath sounds (crackles)
• New onset or worsening cough
• SOB or incr. in respiratory rate
• Worsening gas exchange

Question 3

Why does positive end-expiratory pressure (PEEP) increase in pneumonia?

Answer 3

You need more pressure to push the air into your lungs that are now full with fluid –> need for intubation

Question 4

How is pneumonia classified (3)?

Answer 4

1) By region: lobar vs bronchial pneumonia
2) By organism: bacterial, viral or mycoplasma pneumonia
3) Aspiration pneumonia (fluid, fungus found in dust)

Question 5

You find consolidation in the chest x-ray of a pneumonia patient. What could be filling up the airways/alveoli (4)?

Answer 5

1) Pus
2) Fluid
3) Blood
4) Cancer cells

Question 6

When listening to the lungs of a pneumonia patient, where won’t you hear breathing/airway movement?

Answer 6

Where there is consolidation

Question 7

When looking at the chest x-ray of a pneumonia patient, what might you see?

Answer 7

• Consolidation
• Nodules
• Masses
• Atelectasis (lung collapse)
• Interstitial opacities (viral cause)

Question 8

What are common (3) bacterial pathogens for LRTI?

Answer 8

1) Strep pneumoniae
2) Haemophilus influenzae type B (Hib)
3) Any bacterial pathogen aspired into the lungs

Question 9

Who’s at risk for developing strep pneumonia?

Answer 9

Elderly > 65 y.o.
Kids <2 y.o.
Smokers
People with heart or lung diseases

Question 10

Who is at risk for developing an infection from Hib?

Answer 10

Unvaccinated children

Question 11

How can you find out if a patient has TB?

Answer 11

You do an acid fast bacillus culture to see if they have Mycobacterium tuberculosis

Question 12

What must you (the nurse) do when a physician request an acid fast bacilli culture?

Answer 12

Put the patient on isolation and airborne precautions

Question 13

Why MUST TB be reported and treated (4 reasons)?

Answer 13

• High risk of transmission
• Airborne transmission
• Lethal
• Treatment available and effective

Question 14

What are the symptoms of TB?

Answer 14

Fever, weight loss
Cough, night sweats, chills
Sometimes coughing blood (if cavitation in lungs)

Question 15

True or False: A chest x-ray can specifically show someone has TB.

Answer 15

False, unless it shows cavitation

Question 16

When is cavitation common?

Answer 16

In adults with reactivated TB

Question 17

True or false: Cavitation is uncommon in children with TB.

Answer 17

True

Question 18

True or False: Only pulmonary TB is contagious.

Answer 18

True, because that is when the patients are spewing out aerosols/secretions.

Question 19

What mode of transmission is TB?

Answer 19

airborne

Question 20

True or false: Liver TB is contagious and patient should be placed on airborne precautions.

Answer 20

False

Question 21

When is extra-pulmonary TB contagious?

Answer 21

In the OR when you are doing a biopsy and aerosols may be produced

Question 22

Who is at risk for TB?

Answer 22

• Immigrants from areas of high TB rates
• Being in close contact with someone of active TB
• Homeless, IV drug users, HIV (high rates of TB transmission)
• Kids <5 y.o. with a positive TB test

Question 23

What vaccine is there against TB? Why is it not very used anymore?

Answer 23

BCG (bacille Calmette-Guérin) vaccine

It is not effective in prevention (only offers protection to some people)

Question 24

True or false: We screen all healthcare workers for TB.

Answer 24

False, only those at high risk

Question 25

Why don't we really use blood test (IGRA) for TB exposure?

Answer 25

It is not very sensitive

Question 26

How do we test for TB exposure?

Answer 26

TST: tuberculin skin test

Question 27

Can TB exposure testing be used for diagnosis?

Answer 27

No, but can be an indicator in children

Question 28

When can BCG vaccine create a false positive for TST?

Answer 28

around 40% of cases if vaccine was done after 12 months-6 years of age (persistent false + after 10 years)

Question 29

How do we diagnose TB?

Answer 29

- Sputum culture (confirmation) - Smear microscopy for AFB - PCR-NAAT (only presumptive)

Question 30

How do you know if the physician is suspecting TB?

Answer 30

They will request 3 AFB sputums: 1) Collect them in the morning when the patient coughs the most 2) Bronchial washings/induced (PT is given a product that makes them cough, sputum collected 1h apart) 3) Gastric aspirates (usually children who cough+swallow a lot)

Question 31

How many people develop latent TB?

Answer 31

95% of people

Question 32

How many people will develop reactivated TB?

Answer 32

5% of people with latent TB

Question 33

Who can develop extra-pulmonary TB?

Answer 33

Those who have reactivated TB

Question 34

What is a latent TB infection?

Answer 34

Presence of M tuberculosis (tubercle bacilli) without: - Signs and sx - Culture is negative

Question 35

How does one with latent TB reduce the risk of getting it reactivated?

Answer 35

By getting treatment

Question 36

What is common between latent and active TB?

Answer 36

They give positive skin tests

Question 37

True or False: Latent TB is a reportable disease.

Answer 37

False, but active TB is

Question 38

True or False: A pt with latent TB does not need to be put in isolation/additional precautions.

Answer 38

True

Question 39

How long is active vs. latent TB treament?

Answer 39

Active: 6+ months Latent: 4-6 months (no obligation to get treated)

Question 40

What is DOT?

Answer 40

Direct observation therapy | Nurse must observe patients take their obligatory TB treatment (usually for non-compliant patients)

Question 41

Who is at risk of developing reactivated TB (after previously having latent TB)?

Answer 41

- HIV - Untreated TB + fibrotic lesions - Children < 5 - Substance abusers - Receiving TNF-a antagonists for treatment of rheumatoid arthritis or Crohn's disease

Question 42

When is TST done?

Answer 42

Pre-exposure to TB

Question 43

How is TST done?

Answer 43

Administer 0.1 mL of tuberculin intradermal and read 48-72h later Must be done in two steps (1-4 weeks apart) to eliminate false +

Question 44

What makes a negative TST?

Answer 44

<10 mm induration

Question 45

What makes a positive TST?

Answer 45

>= 10 mm induration

Question 46

True or False: You do not do a second TST on those who were tested + the first time.

Answer 46

True, to avoid getting an even worse reaction the 2nd time

Question 47

Who is given a 2 step TST?

Answer 47

- HCW - Prison workers - Residents of nursing homes - People who have travelled to TB endemic countries for a long time

Question 48

What does the contagiousness of TB depend on?

Answer 48

1) the level of bacilli in the sputum (can be AFB - or AFB 3+) 2) If the pt had sx An asymptomatic pt with AFB 3+ is less contagious than a symptomatic pt with AFB 2+

Question 49

True or False: You can get TB from simply sharing the same airspace as a TB person.

Answer 49

Yes, because it is airborne

Question 50

When is TST post-exposure done?

Answer 50

Once, at least 8 weeks post exposition

Question 51

A person has done a TST with a result of 0-4 mm. When would we give him treatmen?

Answer 51

If he is under 5 y.o. and was in contact with an infected person (Give treatment until we do another TST test 8 weeks after exposure)

Question 52

What is the best protection against TB?

Answer 52

Early diagnosis and treatment

Question 53

Where must you place in a TB PT in a hospital?

Answer 53

Negative-pressure room under airborne precautions

Question 54

What must the HCW do before entering the TB PT's room?

Answer 54

Need a fit check for the N95 respirator

Question 55

What is atypical/walking pneumonia?

Answer 55

Mild version of typical pneumonia (moderate to no sputum, absence of leukocytosis)

Question 56

How does atypical pneumonia progress?

Answer 56

Starts as mild URTI and develops into dry cough and dyspnea

Question 57

What bacteria cause atypical pneumonia?

Answer 57

Bacteria that does not gram stain: - Mycoplasma pneumoniae - Chlamydia pneumoniae - Chlamydia psittaci - Legionella spp**

Question 58

What viruses cause atypical pneumonia?

Answer 58

Influenza RSV Parainfluenza

Question 59

What fungus (2) cause atypical pneumonia?

Answer 59

Histoplasma | Pneumocystis

Question 60

Which microorganism generally causes atypical pneumonia?

Answer 60

Viruses

Question 61

What type of pneumonia is especially spread through contaminated water?

Answer 61

Legionella pneumophila that causes Legionnaire's disease/Legionellosis

Question 62

What is the mode of transmission of legionella infection?

Answer 62

Droplet

Question 63

How do you diagnose Legionnaire's diseae (3)?

Answer 63

1) Urine antigen test 2) Sputum culture 3) Blood serology (increase in IgG)

Question 64

What is pneumocystis pneumonia (PCP)?

Answer 64

Fungi pneumonia that greatly affects HIV or immunosuppressed patients

Question 65

What is characteristic of PCP?

Answer 65

Presence of cysts from the fungi

Question 66

What is aspergillosis?

Answer 66

Infection of the lungs caused by aspergillus (a mold)

Question 67

Who is at risk of aspergillosis?

Answer 67

Immunocompromised people (oncology especially)

Question 68

How do we diagnose aspergillosis?

Answer 68

Serology test that looks for galactomannan, a component of the cell wall of Aspergillus