CIS 5: Respiratory Case Flashcards
If a patient has had a BCG vaccine what can be used to determine if they do in fact have TB?
IFN-gamma release assay = more SENSITIVE to a true TB exposure
Most people who have had the BCG vaccin will have a TST reaction of 3-19 mm how long after the vaccine?
2-3 months
What is the usual induration of a TST >10 years after receiving a BCG vaccine?
<10mm
Gold standard for diagnosis of TB?
SPUTUM Culture –> 3 separate morning samples taken on liquid AND solid media
What does NAAT-TB and NAAT-R detect?
- NAAT-TB detects tuberculosis genetic material
- NAAT-R detect isoniazid and rifampin resistance
Which of the 4 first line agents for TB is associated with peripheral neuropathy as well as hepatitis as an AE?
Isoniazid (INH)
When placing a patient on the standard 4-drug therapy for TB it is important to follow your patients with what lab test and to assess what?
Follow w/ CMPs to monitor kidney and liver function
If screening PPD or IGRA is positive for TB and the CXR is negative + pt is asymptomatic; how should this be treated?
Tx as latent TB –> 9 months of INH
Which O2 delivery device is an aerosol mask that can provide oxygen up to 24-50% and allows for the amt. to be adjusted by an aperaure aka fixed orifice device?
Venturi mask
Which O2 delivery device allows for 15 liters of higher O2 delivery up to 80-100% and works through a bag reservoir which sits in front of the mask?
Non-rebreather (NRB)
What are the signs/sx’s associated with active pulmonary TB?
- Fever (can be diurnal)
- Night sweats
- Cough (generally >2 weeks) –> productive or hemoptysis
- Weight loss
- LAD
In which situations is a PPD induration ≥5mm considered positive?
- HIV
- Close contact w/ actively infected person
- CXR showing fibrotic change consistent w/ TB
- Immunosuppressed (TNF-alpha inhibitors, chronic glucocorticoids, organ transplant, chemotherapy)
What is the only situation where a PPD induration ≥15mm is considered a positive finding?
Healthy pt ≥4 yo w/ LOW likelihood of true TB infection
