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NURS 502 > Exam 2 - ID (need to know) > Flashcards

Exam 2 - ID (need to know) Flashcards

1
Q

Indications for emergent admission to the hospital and GI/hepatology referral

A
  • Patients with increasing signs of liver failure
  • Decompensation of cirrhosis
  • Newly diagnosed hepatitis
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2
Q

Which three hepatitis viruses cause chronic hepatitis?

A

B, C, and D

Others are just acute (A, E, G)

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3
Q

High risk groups for hepatitis screening

A
  • Household or sexual contact
  • IV drug use
  • Multiple sexual partners, MSM
  • Inmates in correctional facilities
  • Chronically elevated ALT/AST
  • HIV or hep C infection
  • Hemodialysis
  • Pregnancy
  • Occupation (healthcare workers)
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4
Q

Hep A mode of transmission

A
  • Fecal-oral
  • Blood
  • Person to person contact
  • Ingestion of contaminated foods (e.g. shellfish) or water
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5
Q

Hep B mode of transmission

A

Blood, tears, CSF, breastmilk, saliva, vaginal secretions, seminal fluid

  • Sexual contact
  • IV drug use
  • Vertical transmission (pregnancy)
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6
Q

Hep C mode of transmission

A

Blood borne disease

  • IV drug use
  • Blood transfusions before 1992 or receipt of clotting factors before 1987
  • Chronic hemodialysis
  • Intranasal drug use (sharing needles or straws)
  • Sexual contact
  • Tattoos, manicures, pedicures, body piercings
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7
Q

What are the phases of hepatitis A?

A

Pre-icteric: lasts 5-7 days

Icteric phase: lasts 4-30 days

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8
Q

What are the symptoms associated with the pre-icteric phase of hepatitis A?

A
  • Fever
  • Malaise
  • N/V
  • Abdominal pain
  • Anorexia
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9
Q

What are the symptoms associated with the icteric phase of hepatitis A?

A
  • Dark urine (before jaundice, 1-5 days)
  • Pale, clay colored stool
  • Jaundice
  • Hepatomegaly, splenomegaly
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10
Q

Testing for hepatitis (lab results)

A
  • Positive IgM anti-HAV, negative IgG anti-HAV → early infection
  • Elevated AST and ALT (LFTs)
  • Elevated lymphocytes
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11
Q

What does HBsAg mean?

A

Hepatitis B surface antigen

  • Positive indicates patient is infected with hep B (active illness)
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12
Q

What does anti-HBs mean?

A

Hepatitis B surface antibody

  • Positive indicates patient is protected and has immunity (via vaccine or successfully recovering from previous infection)
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13
Q

What does anti-HBc mean?

A

Hepatitis B core antibody

  • Positive indicates patient had previous or current hep B infection
  • Provides no protection against hep B virus
  • Need more information from HBsAg and anti-HBs
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14
Q

What does IgM anti-HBc mean?

A

Patient is actively ill since IgM is present

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15
Q

HBsAg → negative

anti-HBs → negative

anti-HBc → negative

A

NOT immune - not protected

  • Needs hep B vaccine
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16
Q

HBsAg → negative

anti-HBs → positive

anti-HBc → positive

A

Immune controlled (protected)

  • Surface antibodies present d/t natural infection
  • Has recovered from prior hep B infection
  • Cannot infect others
  • NO vaccine needed
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17
Q

HBsAg → negative

anti-HBs → positive

anti-HBc → negative

A

Immune (protected)

  • Has been vaccinated
  • Does not have the virus and has never been infected
  • NO vaccine needed
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18
Q

HBsAg → positive

anti-HBs → negative

anti-HBc → positive

A

Infected

  • Positive HBsAg indicated hep B virus is present
  • Virus can spread to others
  • More testing needed
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19
Q

HBsAg → negative

anti-HBs → negative

anti-HBc → positive

A

Could be infected

  • Results unclear (possible past or current hep B infection)
  • More testing needed
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20
Q

What is the role of the primary care NP in managing patients with acute hepatitis?

A
  • Treating acute symptoms
  • Supportive care
  • LFTs every 2 weeks until normalization
  • Monitoring
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21
Q

What patient population will it be important to screen for hep C?

A

Baby boomers (1945-1965)

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22
Q

Hepatitis patient education

A
  • Avoidance of hepatotoxic substances (alcohol, medications)
  • Avoid contaminated foods and should not handle/prepare food if hep A +
  • Wear gloves when handling fluids or blood (healthcare workers)
  • Travelers should avoid consuming uncooked shellfish, fruits, vegetables, drinking tap water
  • Don’t share razors, toothbrushes, nail clippers
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23
Q

What is hepatitis C antibody is negative but RNA is positive?

A

Current HCV infection

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24
Q

What is hepatitis C antibody and RNA are positive?

A

Current HCV infection

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25
Q

What is hepatitis C antibody positive and RNA negative?

A

No current HCV infection

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26
Q

CBC recommendations for routing HIV testing

A
  • All pregnant patients
  • Patients 15-65 years old at least once; can screen more often depending on increased risk
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27
Q

Chronic HIV infection screening and diagnostic tests

A

Screening test → ELISA

  • If negative, no further testing needed
  • If positive, order Western blot or IFA (performed automatically in U.S. if ELISA is positive)
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28
Q

What additional testing can be done to confirm HIV infection?

A
  • CD4 count
  • Viral load
  • STIs
  • Toxoplasma gondi
  • CMV
  • Hep A, B, C
  • TB
  • Routine CBC, CMP, lipid panel, UA
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29
Q

New CDC recommendations for HIV screening - what test? What does it detect?

A

4th generation antigen/antibody combination immunoassay

  • Detects both HIV1 and HIV2 antibodies
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30
Q

What should be done if the fourth generation test for HIV is reactive?

A

Retest with HIV1/HIV2 antibody differentiation immunoassay

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31
Q

What is the next step if HIV1 and HIV2 are negative after antibody differentiation immunoassay?

A

Reflex testing with HIV1 NAT

32
Q

What are the stages of HIV?

A
  • Acute HIV infection
  • Clinical latency or chronic infection
  • AIDS
33
Q

What symptoms are associated with the acute phase of HIV?

A

Before seroconversion (can take up to 3 months) → seroconversion illness

  • Flu-like (fever, myalgia, headache, pleomorphic rash)
  • Lasts 2-4 weeks s/p infection
34
Q

What symptoms are associated with the clinical latency or chronic HIV phase?

A

Often asymptomatic, but monitor for OIs (TB, shingles, severe psoriasis, leukoplakia, idiopathic thrombocytopenia, pneumococcal disease)

  • Slow viral replication → can go 10-15 years without treatment
35
Q

What symptoms are associated with AIDS?

A
  • Fatigue
  • Malaise
  • Anorexia
  • Night sweats
  • OIs and malignancies
36
Q

HIV management - role of NP in primary care?

A
  • ART - long life expectancy r/t to patient’s ability to tolerate it and adherence (a lot of side effects)
  • Prevention of OIs
  • Immunizations
  • Screening: latent TB, HPV, STIs, risk for cardiovascular disease
  • Management of hep B and C infections
  • Treat comorbidities
37
Q

What are the stages of Lyme disease?

A
  • Early localized
  • Early disseminated
  • Late persistent
38
Q

What symptoms/manifestations are seen during the first stage (early localized) of Lyme disease?

A
  • Enlarging erythematous circular rash (erythema migrans) → bulls eye appearance
  • Flu-like illness → fatigue, malaise, lethargy, fever, headache, arthralgia, myalgia, regional lymphadenopathy
39
Q

What symptoms/manifestations are associated with the second stage (early disseminated) of Lyme disease?

A
  • Multiple EM lesions
  • Neurologic complications → meningitis, cranial nerve palsy, motor/sensory neuritis, carditis
  • Cardiac complications → heart block, bradycardia
40
Q

What symptoms/manifestations are associated with the third stage (late persistent) of Lyme disease?

A
  • Arthritis with swelling and pain
41
Q

How would the provider diagnose Lyme disease?

A
  • Visual inspection of skin for EM → should be >5cm in diameter, circular, expanding
42
Q

Lyme disease treatment for early localized infection

A

Doxycyline x10 days

  • Or amoxicillin or cefuroxime for 14 days
43
Q

Lyme disease treatment for patients with early or late neurologic signs

A

Ceftriaxone IV once daily

  • Or PCN G or oral doxycycline x14 days
44
Q

Lyme disease treatment for patients with Lyme carditis

A

Ceftriaxone IV

  • Hospitalized if evidence of symptomatic myopericarditis (syncope, dyspnea, chest pain) or heart block
  • Can be discharged on oral doxycycline x14 days
45
Q

Lyme disease treatment for Lyme arthritis

A

Same antibiotic as early localized

  • Doxycycline, amoxicillin, or cefuroxime x28 days
46
Q

Is a second round of antibiotics indicated if a patient is reinfected with Lyme?

A

No because patient did not respond to previously given antibiotic (but can retreat Lyme arthritis)

  • Treat the symptoms → NSAIDs, corticosteroid injections, temporary pacemaker (with heart block)
47
Q

Is prophylaxis available for patients who have been bitten by ticks?

A

Yes, single dose doxycycline given with 72 hours of tick bite

48
Q

What conditions must be met before chemoprophylaxis with doxycycline is considered for patients with known tick bite exposure?

A
  • Attached tick can be reliably identified as scapularis tick and has been attached for >36 hours
  • Prophylaxis can be started within 72 hours of tick removal
  • Local rate of infection is at least 20%
  • No contraindication to the use of doxycycline (pregnant, lactating, children under 8 years old)
49
Q

How is babesiosis different from other tick borne vectors?

A

It is protozoan (e.g. can be transferred through blood transfusions)

50
Q

What clinical manifestation sets babesiosis apart from other tick borne illnesses?

A

May show proteinuria or hematuria

51
Q

Besides a PCR and blood smear, what other diagnostic testing is needed for babesiosis?

A
  • CBC w/ diff
  • LFTs
52
Q

Is treatment indicated for patients who are asymptomatic with babesiosis?

A

Antimicrobial therapy not recommended (unless present for >3 months upon analysis)

53
Q

Babesiosis treatment for mild to moderate disease

A

Oral atovaquone + azithromycin

54
Q

Babesiosis treatment for severe disease

A
  • Hospitalization w/ IV clindamycin + oral quinine
  • RBC exchange transfusion (high grade parasitemia)
55
Q

What diagnostic tests would the provider order to rule out anaplasmosis or ehrlichiosis infection?

A
  • PCR
  • Blood smear
56
Q

Anaplasmosis and ehrlichiosis present similarly. What symptoms sets anaplasmosis apart?

A
  • GI symptoms
  • Mild anemia
57
Q

What symptoms do anaplasmosis and ehrlichiosis have in common?

A
  • Fever, chills, HA, myalgias
  • Leukopenia
  • Thrombocytopenia
  • Elevated liver transaminase
58
Q

Does anaplasmosis present with a rash?

A

No, but ehrlichiosis does 33% of the time

59
Q

Treatment for anaplasmosis and ehrlichiosis

A

Doxycycline x10 days

60
Q

What is the most lethal tick borne illness in the U.S.?

A

RMSF

61
Q

RMSF clinical presentation

A
  • Fever, malaise, HA, myalgia, GI symptoms
  • Rash (becomes petechial)
62
Q

RMSF lab results

A
  • Thrombocytopenia
  • Elevated liver transaminase
  • Hyponatremia
63
Q

Diagnostic testing for RMSF

A
  • Indirect immunofluorescence antibody (IFA) assay to Rickettssia → not accurate since antibodies still developing in first week of infection
  • Confirmed with IgG titers, 2-4 weeks apart
64
Q

RMSF treatment

A

Empiric doxycycline while waiting for lab results

65
Q

Are patients with latent TB symptomatic?

A

Asymptomatic - cannot spread disease

  • But will show up positive on TST and IGRA tests
66
Q

Symptoms of pulmonary TB (most common)

A
  • Fatigue
  • Anorexia
  • Weight loss
  • Night sweats
  • Cough
  • Chest pain
  • Hemoptysis
  • Irregular menses
  • Low grade fever
67
Q

High risk groups for TB

A
  • Foreign born persons from areas where TB is common (Asia, Africa, Latin America)
  • Low income
  • Migrant farm workers
  • Homeless
  • Residents of long term care facilities
68
Q

What happens if a patient does not return within 72 hours to have their TST read?

A

Positive reaction can still be measurable up to 1 week later

69
Q

True/false: Once a patient has a positive TST reading, no further skin testing is indicated

A

True

70
Q

Criteria for positive TST reaction → induration >5mm

A
  • HIV infection
  • Close contact of person with TB
  • Persons with fibrotic lesions or evidence of old, healed TB on chest x-rays
  • Organ transplant recipient
  • Immunosuppressed (e.g. prednisone or TNF alpha)
71
Q

Criteria for positive TST reaction → induration > 10 mm

A
  • Recent immigrant from high risk country
  • Resident or employees of high risk settings
  • Medically underserved, low income
  • Children < 4 years
  • Children with chronic disease
  • IV drug abuse
72
Q

Criteria for positive TST reaction → induration > 15 mm

A

Over age 4 years with no risk factors

73
Q

LTBI treatment (preferred) for all patients >2 and/or HIV positive

A

3 months of weekly isoniazid + rifapentine

74
Q

LTBI treatment (preferred) for all patients and/or HIV negative

A

4 months of daily rifampin

75
Q

LTBI treatment (preferred) for all patients and/or HIV positive

A

3 months daily isoniazid + rifampin

NURS 502 (43 decks)

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