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GI/Pulm Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Severe abdominal pain, fatigue, and nausea. Physical examination is significant for profound jaundice and tenderness to palpation of the right upper quadrant of the abdomen. The patient returned 2 weeks ago from a 1 month-long trip to India

A

Acute hepatitis

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2
Q

Causes of acute hepatitis

A
  • Viral hepatitides (e.g., HAV, HCV, and HBV)
  • Parasites (e.g., toxoplasmosis)
  • Alcohol
  • Drug-induced (e.g., acetaminophen)
  • Autoimmune hepatitis
  • Steatohepatitis
  • Metabolic disease
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3
Q

Sx of acute hepatitis

A
  • Initial prodrome of flu-like symptoms (fatigue, nausea, vomiting, headaches) followed by jaundice (1-2 weeks after)
  • Right upper quadrant (RUQ) pain, jaundice, scleral icterus, hepatomegaly, splenomegaly, fever
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4
Q

Ultrasound findings of acute hepatitis

A

Ultrasound is a good initial imaging modality for rule out of other causes of abdominal pain

  • Hepatomegaly (most sensitive sign) and gallbladder wall thickening
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5
Q

Labs associated with acute hepatitis

A
  • Hepatic panel
    • Mixed direct and indirect hyperbilirubinemia
    • Dramatically elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
      • ALT usually higher than AST
        • AST:ALT > 2, suspect alcoholic hepatitis
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6
Q

Which serology markers will be elevated in acute hepatitis

A

Anti-HbC IgM

C for capsule; M for men go first

+

HBsAg = Subway

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7
Q

What is the first hepatitis serology marker that will indicate early acute hep b infection?

A

HBsAG

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8
Q

What are the 2 serology markers indicating resolved hepatitis

A

Anti-HbC IgG

+

Anti-HbS

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9
Q

Chronic Hep B Serology markers

A

Anti- HBc capsule IgG = men aleady tried so guys left

+

HBsAG = Subway still transporting virus

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10
Q

Which serology marker indicates hep B immunity?

A

Anti-HBs

Anti-Subway = Already went through subway and now created antigens

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11
Q

IgM or IgG for acute vs chronic hep

A

Men first = GO TO WAR

g= guys after whats left behind

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12
Q

MCC of pancreatitis (get smashed)

A
  • The mnemonic GET SMASHHED is useful in recalling the most common causes: Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypercalcemia, Hyperlipidemia, ERCP and Drugs.
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13
Q

MCC for anorexia in ED

A

Appendicitis

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14
Q

Consider this in all patients over 50 with new-onset constipation

A

Colorectal cancer

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15
Q

hypomobility of the GI tract in the absence of mechanical obstruction, absent bowel sounds

A

Ileus

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16
Q

Choledocholithiasis accounts for 60% of cases

A

Cholangitis

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17
Q

MCC of cirrhosis

A
  • The most common cause is alcoholic liver disease
  • Second most common cause: chronic hepatitis B and C infections
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18
Q

Budd Chiari Syndrome

A

Hepatic vein thrombosis (Budd Chiari Syndrome): a triad of abdominal pain, ascites, and hepatomegaly

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19
Q

If pt has ascites what diagnostic test is performed next?

A
  • Abdominal ultrasound, diagnostic paracentesis - measure serum albumin gradient
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20
Q

In what condition is Asterixis (flapping tremor) - have patient flex hands seen?

A

Hepatic encephalopathy: ammonia accumulates and reaches the brain causing ↓ mental function, confusion, poor concentration

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21
Q

Rome criteria for diarrhea/constipation (less than 3 BM per week)

A

Any of 2 of the following + last three months with symptom onset six months prior to diagnosis

  • Straining
  • Lumpy hard stools
  • A sensation of incomplete evacuation
  • Use of digital maneuvers
  • A sensation of anorectal obstruction or blockage with 25 percent of bowel movements
  • A decrease in stool frequency (less than three bowel movements per week)
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22
Q

Common secondary causes of constipation include:

A
  • Think of causes of secondary causes of constipation: DM, hypothyroidism, MS, dehydration, medications are common
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23
Q

Bulk forming laxatives include:

A

psyllium seed (eg, Metamucil), methylcellulose (eg, Citrucel), calcium polycarbophil (eg, FiberCon®), and wheat dextrin (eg, Benefiber)

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24
Q

Osmotic laxatives include

A

Start with low-dose polyethylene glycol (PEG) as it has been demonstrated to be efficacious and well-tolerated in older adults.

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25
Q

Diarrhea breakout at daycare most likely organism

A

Rotavirus

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26
Q

MCC of diarrhea after hospital admission?

A

C. Diff

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27
Q

Which organism is MCC of diarrhea after picnic/egg salad?

A

Staphylococcus Aureus

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28
Q

MC organism found in Seafood, especially raw or undercooked shellfish

A

Vibrio cholerae, Vibrio parahaemolyticus

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29
Q

Which organisms are seen in ground beef or seed sprouts?

A

Shiga toxin-producing E. coli (e.g., E. coli O157: H7)

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30
Q

MC organism seen in pork/poultry

A

Salmonella

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31
Q

MCC or travelers diarrhea

A

Enterotoxigenic E. coli is most common (traveler’s diarrhea)

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32
Q

MC organism with fried rice

A

Bacillus cereus

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33
Q

MC organism seen in camping, consumption of untreated water:

A

Giardia - incubates for 1-3 weeks, causes foul-smelling bulky stool and may wax and wane over weeks before resolving

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34
Q

Rice water stool is seen with which organism MC

A

V. cholerae

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35
Q

Afebrile, abdominal pain with bloody diarrhea: MC organism is:

A

Shiga toxin-producing Escherichia coli

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36
Q

MC location of diverticulitisq

A

Sigmoid colon

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37
Q

Dx of diverticular disease

A

Diagnose using abdominal and pelvic CT with oral, rectal, and IV contrast; do colonoscopy 1 to 3 months after the episode to look for cancer.

  • CT revealing fat stranding and bowel wall thickening
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38
Q

Non-infectious causes of esophagitis

A
  • Reflux esophagitis: mechanical or functional abnormality of the LES
  • Medication-induced: think NSAIDS or bisphosphonates
  • Eosinophilic: Pt with Asthma symptoms and GERD not responsive to antacids. Allergic, eosinophilic infiltration of the esophageal epithelium.
  • Radiation: radiosensitizing drugs include doxorubicin, bleomycin, cyclophosphamide, cisplatin
    • Dysphagia lasting weeks-months after therapy
    • Radiation exposure of 5000 cGy associated with increased risk for stricture
  • Corrosive: Ingestion of alkali or acid from attempted suicide
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39
Q

odynophagia (pain while swallowing food or liquids) is the hallmark sign esophagitis MC from

A
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40
Q

MCC of gastritis (3)

A

Infection = H.pylori

Inflammation = NSAIDs/Alcohol

Autoimmune/hypersienisitivy = Pernicious anemia + schilling test → Decreased intrinsic factor

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41
Q

Hematochezia: bright red blood per rectum (BRBPR) causes

A
  • Hemorrhoids: painless bleeding with wiping
  • Anal fissures: severe rectal pain with defecation
  • Proctitis: rectal bleeding and abdominal pain
  • Polyps: painless rectal bleeding, no red flag signs
  • Colorectal cancer: Painless rectal bleeding and a change in bowel habits in a patient 50-80 years of age
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42
Q

Tx of giardia

A
  • TX with tinidazole (first line)
    • Flagyl (Metronidazole) 250-750 mg PO TID
      • Symptoms resolve within 5-7 days
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43
Q

GI symptoms and weight loss

  • Transmission from raw or undercooked meat
  • Associated with B12 deficiency
A

Tapeworm = tx w/ Praziquantel (anthelmintics)

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44
Q

cough, weight loss, anemia recent travel

A

Hookworm - Eosinophilia + Anemia

Tx= Mebendazole or pyrantel

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45
Q

Pancreatic duct, common bile duct, and bowel obstruction

A

Round worm = Most common intestinal helminth worldwide found in contaminated soil

Tx is TX: albendazole, mebendazole, pyrantel pamoate

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46
Q
  • Fecal-oral, contaminated water/food, anal-oral
  • Bloody diarrhea, tenesmus. abdominal pain
A

Amebia - Entamoeba histolytica (protozoa)

  • TX: Iodoquinol or paromomycin and Flagyl for liver abscess
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47
Q
  • Penetration of skin (contaminated freshwater) → enter the bloodstream and migrate to the liver, intestines, and other organs
A

Schistomiasis = parasitic flatworms

  • TX: Praziquantel
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48
Q

MCC of hematemesis

A
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49
Q

Tx of external thrombosed (pain, pruritis, no bleeding) palpable perianal mass with purplish hue

A

External - lower 1/3 of the anus (below dentate line)

  • Thrombosed:
    • Significant pain, and pruritus but no bleeding
    • Palpable perianal mass with a purplish hue
    • Treat with excision for thrombosed external hemorrhoids
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50
Q

Isolated to the colon starts at the rectum and moves proximally

  • Continuous lesions
A

Ulcerative colitis

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51
Q

Sx of UC

A
  • Hematochezia and pus-filled diarrhea, fever, tenesmus (feeling of incomplete defecation) anorexia, weight loss
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52
Q

Tx of UC

A
  • Colectomy is curative
  • Medications: Prednisone and mesalamine
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53
Q

A 24-year-old man with ulcerative colitis receives Lomotil for excessive diarrhea and develops fever, abdominal pain and tenderness

A

Toxic megacolon

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54
Q

Tx of toxic megacolon

A

Decompression of the colon is required

  • In some cases, colostomy or even complete colonic resection may be required
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55
Q

Fifty-year-old with a history of coronary artery disease experiencing recurrent cramping with postprandial abdominal pain

A

Ischemic bowel disease

SMA → MC affected

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56
Q

Dx of ischemic boweldisease

A
  • Plain films/CT: Bowel edema, pneumatosis intestinalis (gas within the bowel), portal venous gas
    • Mesenteric angiography is the gold standard
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57
Q
  • Increased indirect/unconjugated bilirubin, mild hyperbilirubinemia
  • Dark urine due to hemoglobinuria; dark stool

What is the cause hemolytic or obstructive?

A

Hemolytic = prehepatic

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58
Q

Causes of obstructive post hepatic jaundice

A
  • Cholestasis = bile duct blockage ⇒ increased conjugated bilirubin
  • Cholestasis / pancreatic CA
  • Increased direct/ conjugated hyperbilirubinemia
  • GGT and ALP elevated
  • Dark urine = increase direct bilirubin
  • Acholic stools = biliary obstruction (white)
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59
Q

MCC of melena

A
  • Gastric cancer, duodenal ulcers, right-sided colon cancer, portal hypertension with esophageal varices, severe erosive esophagitis, Mallory-Weiss syndrome.
60
Q

4 cardinal signs of strangulated bowel (bowel obstruction)

A

The 4 cardinal signs of strangulated bowel: fever, tachycardia, leukocytosis, and localized abdominal tenderness.

61
Q

MCC of sm bowel obstruction

A

MCC: adhesions or hernias, cancer, IBD, volvulus, and intussusception

62
Q

When do you hospitalize for acute bronchitis

A
  • Hospitalization if O2 saturation < 95-96%, age <3 months, RR > 70, nasal flaring, retractions, or atelectasis on CXR
63
Q

Supportive tx for acute bronchitis

A
  • Supportive ⇒ humidified O2, antipyretics, beta-agonist, nebulized racemic epinephrine, and steroids
64
Q

What is the prophylaxis given for bronchitis in immunocompromised, premies, or neuromuscular disorder patients?

A

Palivizumab prophylaxis (once per month for five months beginning in November) for special populations (immunocompromised, premature infants, neuromuscular disorders)

65
Q

MC bacteria in acute bronchitis

A
  • Most common - viral (95%)
  • Common bacterial = M. catarrhalis
  • Chronic lung patients: H. influenzae, S. pneumoniae, M. catarrhalis
66
Q

Supraglottic inflammation and obstruction of airway due to infection with Haemophilus influenzae type B (Hib)

A

Acute epiglottitis

67
Q

3 Ds of epiglottitis:

A

Tripod positioning ⇒ 3 Ds of epiglottitis:

  • Dysphagia
  • Drooling
  • Respiratory Distress
68
Q

The classic finding on x-ray lateral neck film for epiglottitis

A

The classic finding is thumbprint sign on x-ray lateral neck film, secure airway then culture for H.flu

69
Q

Pathophys for acute resp distress

A
  • ⇑ Permeability of alveolar-capillary membranes ⇒ development of protein-rich pulmonary edema (non-cardiogenic pulmonary edema)
70
Q
  • Rapid onset of profound dyspnea occurring 12-24 hours after the precipitating event
  • Tachypnea, pink frothy sputum, crackles
A

ARDS

71
Q

Mild intermittent asthma occurs how often

A

(<2x/week or <2 night/month) – SABA prn

72
Q

Mild persistent asthma occurs how often

A

(>2x per week or 3-4 night/month) – low dose ICS daily

73
Q

Moderate persistent asthma occurs how often

A

Moderate persistent (daily sx or >1 night/week)

  • Low dose ICS + LABA daily
  • Medium dose ICS + LABA daily
74
Q

Severe persistent asthma occurs how often?

A

Severe persistent (sx several times / day + nightly) –

  • High dose ICS + LABA Daily
    • High dose ICS + LABA + oral steroids
75
Q

Croup refers to an infection of the upper airway, which obstructs breathing and causes a characteristic barking cough

A

Croup

76
Q

MCC of croup

A

Parainfluenza virus

77
Q

Findings on cxr in a pt with suspected croup

A
  • Steeple sign on PA CXR (narrowing trachea in the subglottic region)
78
Q

Which type of bronchoscope is used in children vs adults

A
  • Rigid bronchoscopy preferred in children while flexible is diagnostic and therapeutic in adults
79
Q

MCC of hemoptysis

A

Other causes include bronchiectasis, pulmonary catheters, trauma, pulmonary hemorrhage

80
Q

Tx of hemoptysis

A
  • Massive hemoptysis warrants a more aggressive early consultation with a pulmonologist
  • ABCs ⇒ Airway maintenance is vital because the primary mechanism of death is asphyxiation, not exsanguination
81
Q

The most common presentation of acute or mild hemoptysis

A

Bronchitis

82
Q

Older smokers with hemoptysis lung cancer must be ruled out with

A

High resolution CT

NEGATIVE CXRs DO NOT RULE OUT LUNG CANCER

83
Q

Who is the flu vaccine contrainidcated in?

A
  • Avoid vaccination: severe egg allergy, previous reaction, Guillain-Barré syndrome (GBS) within 6 weeks of previous vaccination, GBS in the past 6 weeks, <6 mo old. Avoid FluMist in pt with asthma
84
Q

Which 2 medications treat both influenza A & B

A
  • Zanamivir and Oseltamivir both treat influenza A and B ⇒ (think Dr. “OZ” treats the flu)
85
Q

4 subtypes of non-small cell lung cancer

A

four subtypes include adenocarcinoma, squamous cell carcinoma, large cell carcinoma and carcinoid tumor

86
Q

What is the most common location for small cell lung cancer and what is the best tretment?

A
  • 99% smokers; doesn’t respond to surgery; metastases common at presentation
  • Central location, very aggressive
  • Associated with paraneoplastic syndromes; Cushing’s, SIADH

Tx: can’t have surgery; needs chemo

87
Q

MC type of non-small cell CA

A
  • Adenocarcinoma (35-40%): MOST COMMON, peripheral mass; smoking/asbestos exposure; thrombophlebitis
88
Q

Where does large cell lung cancer occur?

A

Periphery → Associated with gynecomastia

89
Q

What is carcinoid syndrome?

A
  • Carcinoid syndrome = cutaneous flushing, diarrhea, wheezing, hypotension (telltale sign)
  • Adenoma = MC type of carcinoid tumor (slow-growing, rare)
90
Q

What is dx for carcinoid tumor

A
  • Dx: bronchoscopy – pink/purple central lesion, well-vascularized; elevated 5-HIAA
91
Q

If suspicious pulmonary nodule is noted what is the next step

A

Biopy → Ill-defined lobular or spiculated suggests cancer

92
Q

If pulmonary nodule is not suspicious and less than 1 cm what is the next step?

A

If not suspicious < 1 cm it should be monitored at 3 mo, 6 mo, and then yearly for 2 yr

Calcification, smooth well-defined edges, suggests benign disease

93
Q

highly contagious respiratory tract infection marked by a severe hacking cough followed by a high-pitched intake of breath

A

Whooping cough

94
Q

MC organism associated with whooping cough

A

Gram negative - bordatella pertusisis

95
Q

3 stages of whooping cough

A
  • Catarrhal stage: cold-like symptoms, poor feeding, and sleeping
  • Paroxysmal stage: high-pitched “inspiratory whoop”
  • Convalescent stage: residual cough (100 days)
96
Q

How is whooping cough diagnosed

A

Diagnosed by a nasopharyngeal swab of nasopharyngeal secretions – culture

97
Q

Tx of whooping cough

A

Tx: macrolide (clarithromycin/azithromycin); supportive care with steroids / beta2 agonists

  • Vaccination: 5 doses – 2, 4, 6, 15-18 mo, 4-6yrs (DTap)
  • 11-18 yo = 1 dose Tdap
  • Expectant mothers should get Tdap during each pregnancy, usually at 27-36 weeks
98
Q

Accumulation of excess fluid between the layers of the pleura outside the lungs (pleural space)

A

Pleural effusion

99
Q

dyspnea, and a vague discomfort or sharp pain that worsens during inspiration

A

Pleural effusion

100
Q

How to differentiate between exudate and transudative pleural effusion?

A

Determine if the pleural fluid is exudative by meeting at least one of Light’s Criteria (increased protein, increased LDH)

  • Pleural fluid protein / Serum protein >0.5
  • Pleural fluid LDH / Serum LDH >0.6
  • Pleural fluid LDH > 2/3
101
Q

Common causes of exudative pleural effusion

A

Exudative = protein ratio ↑, LDH ↑: infection, malignancy, immune; MC cause = pneumonia, cancer, PE, TB

102
Q

Causes of transudate pleural effusion

A

Transudate = transient → from changes in hydrostatic pressure: cirrhosis, CHF, nephrotic syndrome, ascites, hypoalbuminemia

103
Q

Dx pleural effusion

A

Diagnose with lateral decubitus CXR, chest CT, U/S. Thoracentesis is the gold standard

104
Q

PE findings of pleural effusion

A
  • PE shows decreased tactile fremitus and dullness to percussion in pleural effusion
  • Isolated left-sided pleural effusion likely exudative
  • Right-sided = transudative
105
Q

Tx of pleural effusion

A

Treatment is with thoracocentesis

  • Effusions that are chronic or recurrent and causing symptoms can be treated with pleurodesis (pleural space is artificially obliterated) or by intermittent drainage with an indwelling catheter
106
Q

Common causes of pleuritic chest pain

107
Q

MCC of viral pneumonia

A

Viral: adults ⇒ flu = MC cause; kids ⇒ RSV; comes on fast

108
Q

fever, dyspnea, tachycardia, tachypnea, cough, +/- sputum

A

Bacterial pneumonia

109
Q

What is seen on cxr if a pt has suspected bacterial pneumonia

A
  • Dx: patchy, segmental lobar, multilobar consolidation; blood cultures x2, sputum gram stain
110
Q

Tx of bacterial pneumonia

A
  • Tx: outpatient = doxy, macrolides; inpatient = ceftriaxone + azithromycin/respiratory FQs
111
Q

Valley fever pnuemonia is suspected if

A

non-remitting cough/bronchitis non-responsive to conventional tx

Fungal inhalation in western states; test with EIA for IgM and IgG

112
Q

Tx of coccidioides or pulmonary aspergillosis pneumoina

A

Fluconazole or itraconazole

113
Q

Where is cryptococcus found

A

CRYPTS = Tombs in the soil

Can cause disseminated meningitis → Perform LP for meningitis

Tx w/ Amphotericin B

114
Q

pulmonary lesions that are apical and resemble cavitary TB; worsening cough and dyspnea, progression to disabling respiratory dysfunction; no dissemination

A

Histoplasma capsulatam

115
Q

Where is histoplasma found

A
  • Bird or bat droppings (caves, zoo, bird); Mississippi Ohio river valley
116
Q

What are cxr findings associated with histoplasma

A
  • Signs: mediastinal or hilar LAD (looks like sarcoid)
117
Q

Which two weird types of pnuemonia are treated with amphortericin B

A

Cryptococcus + Histoplasma

118
Q

What is the tx for PCP or PJP pneumonia

A

Bactrim + steroids

Seen in HIV pts with CD4 below 200

119
Q

What is the CURB-65 score for pnuemonia severity

A
  • confusion, urea >7, RR >30, Systolic BP < 90 mmHg or Diastolic BP ≤ 60 mmHg, age >65
  • 0-1 = low risk, consider home tx
  • 2 = probable admission vs close outpatient management
  • 3-5 admission, manage as severe
120
Q

ipsilateral chest pain and dyspnea with decreased tactile fremitus, deviated trachea, hyperresonance, diminished breath sounds

A

Pneumothorax

121
Q

Causes of pneumothorax

A

Spontaneous vs traumatic

  • Primary: occurs in absence of underlying disease (tall, thin males age 10-30 at greatest risk)
  • Secondary: in presence of underlying disease (COPD, asthma, cystic fibrosis, interstitial lung disease)
122
Q

Penetrating injury → air in pleural space increasing and unable to escape

  • A mediastinal shift to the contralateral side and impaired ventilation
A

Tension pneumo

123
Q

Tx of small vs large pneumothorax

A
  • Small - < 15% diameter of hemithorax will resolve spontaneously without the need for chest tube placement
  • Large - > 15% diameter and symptomatic pneumothoraces require chest tube placement
    • Serial CXR every 24 hours until resolved
124
Q

Tx of tension pneumothorax

A
  • Tension pneumothorax is a medical emergency! Large bore needles to allow air out of the chest; chest tube for decompression
125
Q

RF for pulmonary embolism

A

Virchow’s triad = hypercoagulable state, trauma, venostasis (surgery, cancer, oral contraceptives, pregnancy, smoking long bone fracture/fat emboli)

126
Q

What is homans sign

A
  • Homan’s sign: (Dorsiflexion of the foot causes pain in calf) indicative of deep vein thrombosis
127
Q

What findings are seen on EKG for suspected PE

A
  • EKG: TACHYCARDIA (most common), S1Q3T3 (rare), non-specific ST wave changes
128
Q

Gold std tx for pulmonary embolism

A
  • Pulmonary angiography = gold standard definitive
  • CXR: Westermark sign or Hampton hump (triangular or rounded pleural base infiltrate adjacent to hilum)
  • VQ scans are “old school”= perfusion defects with normal ventilation (normal VQ rules out PE; abnormal – non-specific)
  • Venous duplex ultrasound of lower extremities (normal test does not exclude PE)
129
Q

Anticoag of choice for pulmonary embolism

A

Heparin is the anticoagulant of choice for the acute phase with factor Xa inhibitors (eg, rivaroxaban, apixaban, edoxaban) and oral direct thrombin inhibitors (dabigatran) thereafter

130
Q

Duration of tx for anticoagulation after pulmonary embolism

A
  • Duration of treatment: minimum of anticoagulation 3 months with reversible risk factor
  • Unprovoked: anticoagulation recommended for at least 6 months then reevaluate
  • Two episodes unprovoked, long term with anticoagulation
131
Q

Indications for hospitalization in kids with RSV

A

Indications for hospitalization ⇒ tachypnea with feeding difficulties, visible retractions, oxygen desaturation < 95-96%

132
Q

Tx of RSV

A
  • Supportive measures include albuterol via nebulizer, antipyretics and humidified oxygen, steroids (controversial), resolves in 5-7 days
  • Vaccine for children with lung issues or born premature/immunocompromised at birth should get Synagis prophylaxis (palivizumab) = once per month for five months beginning in November
133
Q

General tx of SOB

A
  • Oxygen (high flow nasal canal or rebreathing mask)
  • Albuterol for asthma and COPD
  • Lasix for CHF
  • BIPAP for respiratory difficulty and low O2 saturations
  • Intubation for severe cases
134
Q

Tuberculosis presentation

A

Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis (acid-fast bacilli)

  • Presentation: fatigue, productive cough, night sweats, weight loss, post-tussive rales
135
Q

How is TB transmitted

A

Transmission: inhalation of aerosolized droplets

136
Q

TB test >5mm would be positive in what population

A
  • > 5 mm at high risk, fibrotic changes on CXR, immunocompromised HIV/drugs, steroids/TNF antagonists daily, or close contact with pt with infectious TB
137
Q

TB test of > 10 mm would be positive in what population?

A
  • > 10 mm in patients age < 4 or some risk factors = hospitals and other healthcare facilities, IVDU, recent immigrants from high prevalence area, renal insufficiency, prison, homeless shelter, diabetes, head/neck cancer, gastrectomy/jejunoileal bypass surgery
138
Q

TB test of > 15 mm is positive in what population

A

No other risk factors

139
Q

How is TB diagnosed

A

Diagnosis with sputum for AFB smears and Mycobacterium tuberculosis cultures – have to be 3 AFB negative

  • NAAT helps diagnosis better and sooner
  • CXR: cavitary lesions, infiltrates, ghon complexes in the apex of lungs
  • Biopsy ⇒ caseating granulomas
  • Miliary TB = spread outside lungs ⇒ vertebral column: Pott disease; scrofula (TB to cervical lymph nodes)
140
Q

PPD positive + CXR negative:

A

Latent TB = latent TB ⇒ Isoniazid for 9 months (+ B6 to prevent neuropathy)

141
Q

PPD positive + CXR positive

A

active TB** ⇒Quad therapy (RIPE):** rifampin, isoniazid, pyrazinamide, ethambutol – all are hepatotoxic

142
Q

How is RIPE tx prescribed for TB?

A
142
Q

How is RIPE tx prescribed for TB?

A
143
Q

What are the side effects to the RIPE drugs

A

Rifampin = Red/orange urine

Isoniazid = I SO NUMB = Peripheral neuropathy cant feel hands *take B6

Pyrazinamide = Pyramid → Egyptians love salt = GOUT

Ethambutol = EYES = Optic neuritis

144
Q

Patients with active TB will need two negative AFB smears and cultures in a row negative for therapy cessation

A
  • Prophylaxis for household members ⇒ Isoniazid for 1 year
  • D/C therapy if transaminases > 3-5 × ULN
    • Pt’s on INH should take supplemental Vitamin B6 (pyridoxine 25-50mg/day) to prevent neuropathy

EOR- ER (4 decks)

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