11: TB Flashcards
What is read in the TB skin test?
Induration, not erythema.
Is this a positive reading at 5, 10, or 15 mm on the TB skin test?
People with other medical conditions
10 mm
Who might have a false negative TB skin test (4)?
- Immunocompromised
- Infants <6 months,
- 45+
- Poor nutrition/concurrent infx
Which type of TB?
High fever, malaise, poor appetite, weight loss, fatigue, lymphadenopathy, hepatosplenomegaly.
Miliary TB
T/F False negative skin tests will occur in 10-15% of those with active TB.
True. Skin tests require good cell-mediated immunity. Active TB decreases CD4 count and cell-mediated immunity.
What is the drug most commonly used for latent TB?
Isoniazid (INH)
The TB blood test is expensive and does not require a follow-up reading. It is based on _____.
Interferon-Gamma Release Assay (IGRA)
Is this a positive reading at 5, 10, or 15 mm on the TB skin test?
Healthcare workers
10 mm
Are children at high risk of transmitting TB to others?
No, because of low tidal volume.
Is this a positive reading at 5, 10, or 15 mm on the TB skin test?
Anyone who has been exposed in past
10 mm
What should be used in pleural/pericardial effusion to help with inflammation, mortality, and neurologic disability?
Corticosteroids
Is this a positive reading at 5, 10, or 15 mm on the TB skin test?
Clinical findings suggestive of TB
5 mm
Risk factors for TB (6)?
- Foreign-born
- Poor
- Poor nutrition
- Lack of healthcare
- Overcrowded living conditions
- Ethnic minority
T/F Children under 10 may have active TB but exhibit no coughing.
True
What is the NP role in TB treatment?
Stay up-to-date on treatment guidlines. PCP may treat latent TB, but most cases are handled by the Department of Public Health. Active TB is treated by specialists.
Who should not get the TB blood test d/t high inaccuracy.
Children under 5
This type of TB travels from primary site through blood/lymph and seeds multiple organs.
Miliary TB
How is TB spread?
Droplet. Particles can stay in the air for hours. Grows slowly in culture.
When is monotherapy for TB indicated?
Latent TB. Never treat active TB with a single drug. Mycobacterium can quickly become drug resistant.
What is the infx response to TB in an immunocompetent child or adult (4)?
- Encapsulation of lesion
- Calcification
- Cavitation
- Upper lobe infiltrates
Types of TB (4)?
- Latent (most common in US)
- Active
- Miliary
- Extrapulmonary
What is the classic presentation for pulmonary TB (5)?
- Pneumonia
- Pulmonary Fibrosis
- Cough/Wheezing
- Blood-tinged Sputum
- Chest Pain
Who is the largest pool of potential TB transmitters?
Foreign-born (often asymptomatic)
Is this a positive reading at 5, 10, or 15 mm on the TB skin test?
Immunosuppression
5 mm
Is this a positive reading at 5, 10, or 15 mm on the TB skin test?
HIV
5 mm
T/F Once primary infx has resolved, recurrence can happen at any time.
True
What are common TB meds (5)?
- Isoniazid (INH)
- Rifampin
- Pyrazinamide
- Streptomycin
- Ethambutol
This type of TB is rare in the US and occurs most frequently in children <3, elderly, or those with HIV.
Miliary TB
Is this a positive reading at 5, 10, or 15 mm on the TB skin test?
Pts with organ transplants
5 mm
Who should not receive the TB skin test (2)?
- Hx of Positive Reading (can cause huge blistering reaction)
- Live Vaccine in Past Month (can cause false negative)
Note that BCG recipients can receive the skin test, but the blood test is preferred.
Is this a positive reading at 5, 10, or 15 mm on the TB skin test?
Positive in everyone
15 mm
Who is more likely to develop full-blown pneumonia with TB infx?
Immunocompromised patients
Which type of TB?
Pulmonary symptoms may or may not be present.
Miliary TB
Is this a positive reading at 5, 10, or 15 mm on the TB skin test?
Immigrants
10 mm
What are clinical manifestations of TB (3)?
- Keratoconjunctivitis
- Mediastinal lymph nodes (difficulty swallowing)
- Cough (10 years old+)
Children have an incubation period of 2-12 weeks. Small children are at highest risk of developing active disease in the first _____ years after infection.
2
This TB test is cheap, easy, accurate in adults and children. Requires follow-up reading in 48-72 hours.
Skin Test
Is this a positive reading at 5, 10, or 15 mm on the TB skin test?
Children under 4
10 mm
Is this a positive reading at 5, 10, or 15 mm on the TB skin test?
IV drug users
10 mm
Who are the TB cohorts (3)?
- Children
- Elderly
- Pregnant/PP women
Which type of TB?
Lymph node disease is unilateral at start. May involve skin, ocular, endocrine, GU, cardiac, etc.
Extrapulmonary TB
Miliary TB leads to _____ and _____ of organs. It is deadly unless treated.
Necrosis and cassation of organs
Who should have the blood test vs the skin test?
If patient received BCG
Is this a positive reading at 5, 10, or 15 mm on the TB skin test?
Contact with known or suspected TB
5 mm
What is primary prevention for TB?
Screen all at-risk patients
