Highlights Wk 1

Question 1

Whose responsibility is it to report diseases?

Answer 1

The provider’s (NOT the pt’s)

Question 2

What is necessary to contract TB?

Answer 2

Someone w. active, pulmonary TB must cough on you

Question 3

1) Which immune response is activated by TB?
2) What specific cells are involved?
3) What cells does HIV attack?

Answer 3

1) Cellular immune response
2) CD4 and CD8 T cells
3) T cells

Question 4

After you contract TB, one of what two things happens?

Answer 4

1) Latent TB: in Granulomas
OR
2) Active TB (spreads)

Question 5

1) What type of mycobacterium tuberculosis infection can be asymptomatic or symptomatic?
2) What kind is related to prior containment?
3) What kind is inactive and non-communicable?

Answer 5

1) Primary
2) Reactivation
3) Latent

Question 6

90% of the time, primary infection results in __________- infection

Answer 6

latent

Question 7

The primary mechanism the immune system has for controlling TB is walling it off in granulomas, primarily because of what response?

Answer 7

healthy CD4 and CD8 T-cell

Question 8

1) Describe caseating granulomas
2) Define granuloma

Answer 8

1) Their areas of caseation are areas of necrosis with complete loss of tissue architecture
2) A rim of healthy macrophages and T cells that are walling off

Question 9

Latent TB can progress to Active TB. This is called ____________

Answer 9

reactivation.

Question 10

What are 3 symptoms that are pretty unique to TB?

Answer 10

1) Coughing up blood
2) Unintended weight loss
3) Night sweats

Question 11

If a pt with no symptoms is from somewhere w high rates of TB, has a high risk of reactivation (immunosuppressed), should you test for TB?

Answer 11

Yes

Question 12

Reading TB test results:
1) When is 5mm of induration positive? (3 groups)
2) What about 10mm? (6 groups)
3) What abt 15mm?

Answer 12

1) HIV+, organ transplant, other immunosuppressed people
2) Recent immigrants from areas with high TB incidence, health care workers, the homeless, and people
with hematologic or head/neck malignancies, renal failure, or diabetes
3) People with no known risk factors

Question 13

What do TB blood tests measure to estimate T cell activity?

Answer 13

Interferon gamma

Question 14

What causes interferon gamma production in a positive TB blood test tube?

Answer 14

Effector T cells are present and re-encountering TB antigen

Question 15

1) Cavitation on a CXR can be a sign of what infectious disease?
2) What can cavitation cause?

Answer 15

1) TB
2) Hemoptysis

Question 16

What do TST and IGRA TB tests have in common?

Answer 16

A negative rxn doesn’t exclude the Dx of LTBI or TB

Question 17

1) BCG vaccination doesnotcause
false-positive result with what TB test?
2) Infection with most nontuberculous mycobacteria doesnotcause false-positive result with which TB test?

Answer 17

1) IGRA
2) IGRA

Question 18

Which type of TB test can NOT cause a boosted rxn?

Answer 18

IGRA

Question 19

True or false: you should always rule out active TB before starting treatment for latent TB, b/c if you give a latent TB regimen (monotherapy) to someone with active TB, you risk development of drug resistant TB

Answer 19

True

Question 20

Describe TB drug action:
1) Which drug is the most early bactericidal?
2) Which is the best for long term sterilizing (bacilli w short metabolism periods)?
3) Which is best for resistance prevention? (actively growing bacilli)

Answer 20

1) INH (> EMB > RIF > PZA)
2) RIF (> PZA > INH > EMB)
3) INH (> RIF > EMB > PZA)

Question 21

What are the two exceptions to the general active TB treatment plan?

Answer 21

1) 7 months of cont. phase in patients with cavitary pulmonary TB and ongoing M. Tb in sputum samples at 2 months
2) In extrapulmonary TB, continuation phase is 9-12 months

Question 22

What two labs are specific to HIV?

Answer 22

1) CD4 Cell Count
2) Viral Load

Question 23

Candida species:
1) A budding yeast that forms _______________
2) Is it common normal flora?

Answer 23

1) pseudo-hyphae
2) Yes (but opportunistic pathogen)

Question 24

Candidemia
1) Blood Cx positive only ____% of patients
2) What may be positive (even if neg blood Cx)?

Answer 24

1) 50%
2) (1,3)-Beta-D-glucan

Question 25

Eye lesions are a big clue for what?

Answer 25

Invasive candidiasis

Question 26

1) What is the most serious manifestation of candidiasis & most common cause of fungal endocarditis?
2) Name one of its symptoms
3) How is it (& general invasive candidiasis) managed? (2 things)

Answer 26

1) Candida endocarditis
2) Possible visual loss
3) Amphotericin B (3-5mg/kg/day; or high-dose echinocandin) & valve replacement

Question 27

1) Name an infection primarily of lungs & CNS
2) Where is it found in the environment?

Answer 27

1) Cryptococcus
2) Soil & dried pigeon & chicken dung

Question 28

True or false: cryptococcus is mostly asymptomatic

Answer 28

True

Question 29

What Cryptococcus presentation is most often found in immunodeficiency?

Answer 29

Progressive lung disease & dissemination

Question 30

Noncalcified nodules upon CT scan that is [most often] pleural based is characteristic of what condition?

Answer 30

Cryptococcus

Question 31

What is the most common cause of fungal meningitis?

Answer 31

Cryptococcal meningitis

Question 32

What does CrAg test for?

Answer 32

Cryptococcus

Question 33

How is cryptococcus meningitis treated?

Answer 33

Amphotericin B + Flucytosine (+Fluconazole for a year)

Question 34

What condition can be contracted from bird & bat droppings?

Answer 34

Histoplasmosis (Histoplasma capsulatum)

Question 35

What condition is endemic to the Mississippi River Valley area?

Answer 35

Histoplasmosis

Question 36

What is the most common form of histoplasmosis?

Answer 36

Acute pulmonary histoplasmosis

Question 37

1) What are two risks for chronic pulmonary histoplasmosis?
2) What does it look like on CXR?

Answer 37

1) Older pts with chronic lung disease + smokers
2) Cavities

Question 38

What are the 2 types of progressive disseminated histoplasmosis?

Answer 38

Acute and chronic

Question 39

Lifelong immunity after infection typically prevents recurrent infections of what condition?

Answer 39

Coccidiomycosis “Valley Fever”

Question 40

Erythema nodosum, arthralgias, productive cough, and fever are all symptoms of what?

Answer 40

Coccidiomycosis/ “Valley Fever”

Question 41

What condition is endemic to Tennessee, Ohio, Minnesota, surrounding states, & part of the northeast?

Answer 41

Blastomyces

Question 42

What can form a “fungus ball” in the lung?

Answer 42

Aspergillus

Question 43

Galactomannan antigen detection is used for what condition?

Answer 43

Aspergillus

Question 44

Where was COVID-associated Mucormycosis infection most common?

Answer 44

India (by a lot)

(also seen in China, Brazil, Mexico)

Question 45

1) A pt w HIV with a CD4 count less than 200 is particularly at risk for what?
2) What unique thing is this condition associated with on CT scans?

Answer 45

1) Pneumocystis
2) “Bat winging” appearance

Question 46

How is pneumocystis treated?

Answer 46

21 days of Trimethoprim-Sulfamethoxazole (Bactrim; an antibiotic)

Question 47

1) What broad spectrum medication binds to sterols?
2) Flucytosine interferes with the synthesis of what?
3) What inhibit cytochrome P450?

Answer 47

1) Amphotericin B
2) Flucytosine
3) Azoles