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Clinical Medicine I > COVID, polio, TB, atypical diseases > Flashcards

COVID, polio, TB, atypical diseases Flashcards

1
Q

What are general prodromal symptoms of COVID?

A

fever, chills, myalgias, fatigue, anorexia

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2
Q

What are common upper resp infections of COVID?

A

pharyngitis, congestion, rhinorrhea, conjunctivitis

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3
Q

What are some cardiopulm symptoms of COVID?

A

cough (dry or wet), SOB, hypoxia

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4
Q

What are some cardio symptoms of COVID?

A

chest tightness, pain, pressure; palpitations

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5
Q

What are some GI symptoms of COVID?

A

decreased appetite, diarrhea, N/V

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6
Q

What are some neuro symptoms of COVID?

A

headache, confusion, dizziness, altered taste/smell

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7
Q

What are some skin symptoms of COVID?

A

rash, covid toes, acrocyanosis

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8
Q

What are some allergic symptoms of COVID?

A

urticaria, angioedema

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9
Q

How do children differ with COVID symptoms?

A

mixture of these symptoms, generally with pharyngeal erythema and less severity

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10
Q

Who are at risk for COVID?

A
  • pregnancy
  • young/middle aged adults
  • mortality >50 years
  • exposure to children=lowers elderly risk
  • unvaccinated
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11
Q

Who are at risk for severe COVID?

A
  • BMI>35
  • CKD
  • DM
  • immunocompromised
  • immunosuppressant use
  • pregnancy
  • > 65
  • > 55 and comorbidities
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12
Q

Is COVID transmitted through breast milk?

A

No

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13
Q

What is it called: 24 hour risk of critical respiratory disease after hospital admission, taking into consideration their pulse, O2, and RRR?

A

quick COVID-19 severity index

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14
Q

What’s a way to score the risk of COVID severity?

A

COVID-GRAM critical illness risk score

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15
Q

What are some labs that can help diagnose COVID?

A
  • CBC: lymphophenia, leukocytosis, thrombocytopenia
  • LFTs: elevated AST, ALT
  • CRP, d-dimer (acute phase)
  • PCR, rapid antigen detection, antibody tests
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16
Q

What imaging can help diagnose COVID?

A

CXR, CT, lung ultrasound

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17
Q

What are markers of increased mortality in COVID?

A

serum troponin, IL-6, LFTs, serum CR, CK, ferritin, procalcitonin

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18
Q

What O2 sat = mild-moderate COVID?

A

> 94%

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19
Q

What O2 sat = severe COVID?

A

<94% on room air

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20
Q

What signifies critical COVID?

A

respiratory failure

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21
Q

What can COVID cause that you need to be on the lookout for?

A

multi-system inflammatory syndrome

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22
Q

In what population are COVID complications the most common?

A

Blacks, men, obesity, and with pre-existing conditions

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23
Q

What characterizes long COVID?

A
  • fatigue
  • smell/taste disorder
  • dyspnea
  • headache
  • memory impairment
  • hair loss
  • sleep disorder
  • female sex + overweight
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24
Q

When should you consider treatment in mild/moderate COVID?

A

With risk factors – start ASAP and within 5-7 days of onset to decrease severity

Paxlovid

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25
Q

What symptom is most common in polio?

A

asymptomatic

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26
Q

What type of polio involves: fever, headache, vomiting, diarrhea, constipation, and sore throat?

A

abortive poliomyelitis

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27
Q

What type of polio involves: fever, headache, vomiting, diarrhea, constipation, sore throat AND signs of meningeal irritation, muscle spasm w/ absence of frank paralysis?

A

nonparalytic poliomyelitis

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28
Q

What type of polio is: flaccid asymmetric paralysis, affecting proximal muscles of lower extremities, with a fever 2-3 days, spinal or bulbar?

A

paralytic poliomyelitis

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29
Q

What puts someone at risk for polio?

A

<15 yo
traveling to developing countries

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30
Q

What is the polio virus?

A

poliomyelitis virus - fecal-oral

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31
Q

What s post-poliomyelitis syndrome?

A

chronic and new denervation, progressive muscle limb paresis w/ muscle atrophy, fasciculations, fibrillation, restless leg syndrome

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32
Q

How do you diagnosis polio?

A

PCR of washings, stool, CSSF:
* increased pressure/protein
* non-lowered glucose
* WBC<500

33
Q

How do you treat polio?

A
  • hospitalize
  • pocapavir
34
Q

How do you prevent polio?

A

PREVENT!!! IPV- 2 months, 4 months, 6-18 months, 4-6 years

35
Q

How do you treat someone with polio who’s never been vaccinated?

A

3 doses w/ 2nd 1-2 months later, 3rd 6-12 months

36
Q

Can you distinguish latent from active TB?

A

No

37
Q

Is primary tubercolosis or latent TB asymptomatic?

A

generally, both!

38
Q

What are some risk factors for TB?

A

malnourished, homeless, HIV, DM, CKD, organ transplant, silicosis, immunosuppressive drugs, illicit drug use

39
Q

What happens with primary tuberculosis?

A

turns into latent

40
Q

What is a Ghon complex?

A

pulmonary lesion usualy in middle or lower lobes of the lung that contain a granuloma

41
Q

Is latent TB contagious?

A

No, but remains dormant

42
Q

True or false: you have to report TB to the authorities

A

true

43
Q

True or false: you can use a TB skin test/PPD test/Mantoux test w/ BCG vaccine

A

FALSE – CANNOT

44
Q

How can you test for TB?

A
  • skin test, results in 48-72 hours
  • interferon-gamma release assay (Gold, T spot), results in 24 hours
  • CXR
  • morning sputum specimens (3 recommended, 8 hrs, 1 early morning) with Ziehl-Neelsen stain
  • Need positive sputum culture for definitive diagnosis
  • biopsy of caseating granulomas
  • DNA/RNA amplification
45
Q

What on a CXR can signify TB?

A

apical caseating granulomas, nodular infiltrates, hilar lymph node enlargement, Ghon or Ranke complexes

46
Q

What could you find on PE for TB?

A

non-specific, usually absent in mild/moderate, crackles in inspiration or after cough

chronically ill, malnourished, weight loss

47
Q

When should extra-pulmonary TB be considered with TB?

A

entering bloodstream

when foci develops in lungs = miliary TB

48
Q

What does this triad signify: fever, weight loss, and severe night sweats (with the addition of productive cough and malaise)?

A

ACTIVE TB

49
Q

How should you treat primary TB?

A

Isoniazid x 9 months
Rifampin x 4 months

2 drug therapy!
Isoniazid & Rifapentine weekly x 3m
Isoniazid & Rifampin daily x 3m

50
Q

What characterizes TB?

A

latent TB becomes immunocomp, then no longer can contain infection –> moves to apices of lungs and adds lesions
Generally in at risk patients

51
Q

In a patient with no risk factors, what is the minimum lesion size of concern in a TB test?

A

greater than 15mm

52
Q

In a patient with medium risk factors, what is the minimum lesion size of concern in a TB test?

A

greater than 10 mm, RFs like travelers in high TB areas, IV drugs, healthcare workers, medical conditions, children <4 or exposed

53
Q

In a patient with high risk factors, what is the minimum lesion size of concern in a TB test?

A

greater than 5 mm; RFs like HIV+, evidence of Tb on CXR, immunosuppressant, contact w/ active TB

54
Q

How do you treat active TB?

A

6 month regimen:
4 medications x 2 months
* isoniazid
* rfampin
* ethambutol
* pyrazinamide

continue treatment for 4+ months if needed, and must treat 3 months longer than neg cultures (top two for longer)
regular physician visits!

55
Q

How long do you have to treat active TB after a negative culture?

A

3 months

56
Q

What should physician visits look like while treating active TB?

A

regular visits
check sputum @ 2 months
if positive, recheck at 3 months
if negative, check at 5 & 6 months

57
Q

What indicates acute miliary TB?

A

multi-organ system failure, septic shock, acute respiratory distress syndrome

58
Q

How may an extrapulmonary TB patient present?

A

failure to thrive, fever w/ unknown origin, dysfunction of organ systems (infection OUTSIDE the lungs)

59
Q

What are common issues associated with extrapulmonary TB?

A

tuberculosis pleurisy, meningitis, constrictive pericarditis, acute hepatitis, Addison’s disease, lymphatic scrofula of neck, urogenital, Pott’s disease of the spine, arthritis, osteomyelitis, ulcer

60
Q

What can help diagnose extrapulmonary TB specifically?

A
  • biopsy (acid fast and culture of tissue, fluid, drainage)
  • urine culture
  • CT scan
  • MRI –> needle biopsy for confirmation of CNS lesion w/ stain & culture
61
Q

What indicates atypical mycobacterial disease?

A

persistent fever + weight loss
HIV = <50 CD4 count

62
Q

What can cause atypical mycobacterial disease?

A

soil and water, NOT person to person, resistant to standard anti-TB drugs
1) avium
2) M. kansasii (lungs)
3) M. marinum (skn/soft tissue)
4) M. abscessus (skin/ soft tissue AND lungs)
5) M. Chelonae (skin/soft tissues)
6) M. fortuitum (skin/soft tissue/lungs)

63
Q

How can you diagnose atypical mycobacterial disease

A

blood culture
skin and soft tissue = biopsy + positive culture
lymphadenitis = biopsy + positive culture

64
Q

How can you treat atypical mycobacterial disease?

A

Clarithromycin or azithromycin + ethambutol
+/- rifampicin
can be d/c after 12 months if no active disease and CD4>100

65
Q

When should you add prophylaxis for MAC in HIV patients?

A

CD4 <50

66
Q

What is the treatment for prophylaxis of MAC?

A

clarithromycin/azithromycin/rifabutin
single drug therapy!
Treat until >100 for 3 months

67
Q

What are M. kansasii treatments specifically?

A

isoniazid, ethambutol, rifampin for 18 months

68
Q

What is the skin and soft tissue mycobacterial infections treatment?

A

2 abx x 3 months
azithromycin, clarithromycin, imipenem, linezolid, fluoroquinolones

69
Q

What is the mycobacterial lymphadenitis treatment?

A

usually surgically, but if not, azithro + rifampin + ethambutol

70
Q

What is also known as Lady Windermere syndrome?

A

Nodular/bronchiectatic NTM

71
Q

What are symptoms of nontuberculosis mycobacteria (nodular/bronchiectatic)?

A

progressive respiratory symptoms + recurrent respiratory infections

Prolonged cough, fatigue, weight loss

72
Q

In who are NTMs more common?

A

post-menopausal, non-smoking, white women

73
Q

How can you diagnose NTM?

A
  • CT - bronchiectasis w/ nodules “tree in a bud” appearance, classically RML and lingual
  • culture from 2 sputum samples, 1 BAL sample, or lung biopsy w/ typical histology AND positive culture of biopsy, BAL, sputum
74
Q

What are symptoms of fibrocavitary NTM?

A

progressive, systemic symptoms like fever, fatigue, weight loss, night sweats

worse outcome

75
Q

In who are fibrocavity NTMs common in?

A

male >50, underlying lung condition

76
Q

How can you diagnose fibrocavity NTMs?

A
  • CT - fibrocavitary lesions and upper lobe involvement
  • culture from 2 sputum samples, 1 BAL sample, or lung biopsy w/ typical histology AND positive culture of biopsy, BAL, sputum
77
Q

What should be performed on all isolates of NTM?

A

susceptibility testing for macrolide resistance

78
Q

How do you treat nodular NTM and fibrocavitary NTM?

A

3 drug therapy for at least 12 months:
- clarithromycin/azithromycin +
- rifampin/rifabutin +
- ethambutol

Clinical Medicine I (33 decks)

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