Highlights Wk 1 Flashcards
Whose responsibility is it to report diseases?
The provider’s (NOT the pt’s)
What is necessary to contract TB?
Someone w. active, pulmonary TB must cough on you
1) Which immune response is activated by TB?
2) What specific cells are involved?
3) What cells does HIV attack?
1) Cellular immune response
2) CD4 and CD8 T cells
3) T cells
After you contract TB, one of what two things happens?
1) Latent TB: in Granulomas
OR
2) Active TB (spreads)
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?
1) Primary
2) Reactivation
3) Latent
90% of the time, primary infection results in __________- infection
latent
The primary mechanism the immune system has for controlling TB is walling it off in granulomas, primarily because of what response?
healthy CD4 and CD8 T-cell
1) Describe caseating granulomas
2) Define granuloma
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
Latent TB can progress to Active TB. This is called ____________
reactivation.
What are 3 symptoms that are pretty unique to TB?
1) Coughing up blood
2) Unintended weight loss
3) Night sweats
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?
Yes
Reading TB test results:
1) When is 5mm of induration positive? (3 groups)
2) What about 10mm? (6 groups)
3) What abt 15mm?
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
What do TB blood tests measure to estimate T cell activity?
Interferon gamma
What causes interferon gamma production in a positive TB blood test tube?
Effector T cells are present and re-encountering TB antigen
1) Cavitation on a CXR can be a sign of what infectious disease?
2) What can cavitation cause?
1) TB
2) Hemoptysis
What do TST and IGRA TB tests have in common?
A negative rxn doesn’t exclude the Dx of LTBI or TB
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?
1) IGRA
2) IGRA
Which type of TB test can NOT cause a boosted rxn?
IGRA
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
True
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)
1) INH (> EMB > RIF > PZA)
2) RIF (> PZA > INH > EMB)
3) INH (> RIF > EMB > PZA)
What are the two exceptions to the general active TB treatment plan?
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
What two labs are specific to HIV?
1) CD4 Cell Count
2) Viral Load
Candida species:
1) A budding yeast that forms _______________
2) Is it common normal flora?
1) pseudo-hyphae
2) Yes (but opportunistic pathogen)
Candidemia
1) Blood Cx positive only ____% of patients
2) What may be positive (even if neg blood Cx)?
1) 50%
2) (1,3)-Beta-D-glucan
Eye lesions are a big clue for what?
Invasive candidiasis
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)
1) Candida endocarditis
2) Possible visual loss
3) Amphotericin B (3-5mg/kg/day; or high-dose echinocandin) & valve replacement
1) Name an infection primarily of lungs & CNS
2) Where is it found in the environment?
1) Cryptococcus
2) Soil & dried pigeon & chicken dung
True or false: cryptococcus is mostly asymptomatic
True
What Cryptococcus presentation is most often found in immunodeficiency?
Progressive lung disease & dissemination
Noncalcified nodules upon CT scan that is [most often] pleural based is characteristic of what condition?
Cryptococcus
What is the most common cause of fungal meningitis?
Cryptococcal meningitis
What does CrAg test for?
Cryptococcus
How is cryptococcus meningitis treated?
Amphotericin B + Flucytosine (+Fluconazole for a year)
What condition can be contracted from bird & bat droppings?
Histoplasmosis (Histoplasma capsulatum)
What condition is endemic to the Mississippi River Valley area?
Histoplasmosis
What is the most common form of histoplasmosis?
Acute pulmonary histoplasmosis
1) What are two risks for chronic pulmonary histoplasmosis?
2) What does it look like on CXR?
1) Older pts with chronic lung disease + smokers
2) Cavities
What are the 2 types of progressive disseminated histoplasmosis?
Acute and chronic
Lifelong immunity after infection typically prevents recurrent infections of what condition?
Coccidiomycosis “Valley Fever”
Erythema nodosum, arthralgias, productive cough, and fever are all symptoms of what?
Coccidiomycosis/ “Valley Fever”
What condition is endemic to Tennessee, Ohio, Minnesota, surrounding states, & part of the northeast?
Blastomyces
What can form a “fungus ball” in the lung?
Aspergillus
Galactomannan antigen detection is used for what condition?
Aspergillus
Where was COVID-associated Mucormycosis infection most common?
India (by a lot)
(also seen in China, Brazil, Mexico)
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?
1) Pneumocystis
2) “Bat winging” appearance
How is pneumocystis treated?
21 days of Trimethoprim-Sulfamethoxazole (Bactrim; an antibiotic)
1) What broad spectrum medication binds to sterols?
2) Flucytosine interferes with the synthesis of what?
3) What inhibit cytochrome P450?
1) Amphotericin B
2) Flucytosine
3) Azoles
