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Clinical Medicine II > "Other" Infectious Disorders > Flashcards

"Other" Infectious Disorders Flashcards

1
Q

Chronic infection with mycobacterium tuberculosis leading to granuloma formation; high mortality rates in untreated smear positive.

A

Tuberculosis

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2
Q

Close contact of patient with active TB, health care workers are at an increased risk of _____

A

Exposure

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3
Q

Immigrants from high-prevalance areas and homeless are at an increased risk of _______

A

Infection

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4
Q

Immunodeficient patients, such as those with HIV, CRI, DM, IVDA, ETOHics, and those with malignancy are at a high risk of ?

A

Active TB once infected

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5
Q

Inhalation of air droplets –> Mycobacterium reaches alveoli and is ingested by alveolar macrophages –> Mtb remains viable within macrophage, bypasses or escapes defense –> active infection

A

Tuberculosis

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6
Q

What are the three different outcomes of a TB infection?

A

Primary
Chronic (Latent) infection
Secondary (reactivation)

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7
Q

The outcome of initial infection (usually self-limited)

A

Primary TB

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8
Q

Most exposed people mount an immune response sufficient to prevent further profession from initial infection to clinical illness. T cells and macrophages surround the organism and form a granuloma.

A

Primary TB

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9
Q

How many people who are infected with TB will develop the disease?

A

10%

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10
Q

When a person fails to contain the primary TB infection and progresses to active TB

A

Progressive primary TB

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11
Q

Are patients with primary progressive TB contagious?

A

YES!

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12
Q

How many patients will contain the TB bacterium without becoming contagious? What is this called?

A

95%; Latent TB infection (Chronic TB)

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13
Q

Do patients with chronic/latent TB have a positive PPD? Are they contagious?

A

Yes, usually within 2-4 weeks post infection

Not contagious!

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14
Q

What keeps patients with chronic/latent TB from having a primary TB infection?

A

Granuloma formation of T cells and macrophages around the bacteria

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15
Q

What is it called when someone has chronic/latent TB that is reactivated by a waning immunity? (Elderly, HIV, steroid use, malignancy)

A

Secondary reactivation TB

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16
Q

Where is TB usually located in the lungs?

A

Apex/upper lobes with cavitary lesions

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17
Q

Are patients with reactivation TB contagious?

A

YES!

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18
Q

What are the two types of TB?

A

Pulmonary and extra-pulmonary

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19
Q

Classically presents with pulmonary symptoms and constitutional symptoms

A

Pulmonary TB

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20
Q

Chronic, productive cough, chest pain (pleuritic), hemoptysis in advanced disease; Drenching night sweats, fever/chills, fatigue, anorexia, weight loss

A

Pulmonary symptoms of TB

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21
Q

What would you expect to see on a physical exam in a patient with pulmonary TB?

A

Signs of consolidation: Rales or rhonchi near apices/involved areas, rhonchi, dullness.

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22
Q

Which organs can extra-pulmonary TB affect?

A

Any organ!

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23
Q

Vertebral TB

A

Pott’s disease

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24
Q

Lymph node TB

A

Scrofula

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25
Q

Meningitis caused by TB

A

TB meningitis

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26
Q

Other extra-pulmonary infections caused by TB

A

Pericarditis, peritonitis, joints, kidney, adrenal, cutaneous infections

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27
Q

What is the change yearly of having a reactivation of LTBI in patients with HIV?

A

7-10%

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28
Q

For an immunosuppressed patient, a patient who has had close contact with active TB, or a CXR consistent with old or healed TB (granuloma), what is the reaction size of a PPD that would be considered positive?

A

> /= 5mm

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29
Q

For all other high-risk populations and high prevalence populations, what is the reaction size of a PPD that is considered positive?

A

> /= 10mm

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30
Q

How do you diagnose suspected TB? What is considered non-infectious?

A

Acid-fast smears and sputum culture for 3 days

3 negative smears = non-infectious

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31
Q

What is the gold standard for diagnosing TB?

A

Acid fast bacillus culture

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32
Q

How do you exclude active TB in a patient with a new + PPD?

A

CXR

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33
Q

CXR shows apical upper lobe fibrocavitary disease

A

Reactivation

34
Q

Middle/lower lobe consolidation on CXR

A

Primary TB

35
Q

CXR shows small millet0seed like nodular lesions (2-4mm)

A

Miliary TB

36
Q

Pleural effusion on CXR

A

TB Pleurisy

37
Q

Detected as residual evidence of healed primary TB on CXR

A

Granuloma

38
Q

What is the 4 drug regiment to treat an active TB infection?

A

Isoniazid, rifampin, pyrazinamide, ethambutol OR streptomycin

RIPE: Rifampin, INH, Pyrazinamide, Ethambutol

39
Q

When are patients considered to no longer be infectious?

A

2 weeks after initiation of therapy

40
Q

TB resistant to both INH and rifampin

A

Multi drug resistant TB

41
Q

Which TB drug has an adverse side effect of hepatitis and peripheral neuropathy?

A

Isoniazid

42
Q

Which TB drug has an adverse side effect of thrombocytopenia and orange colored secretions?

A

Rifampin

43
Q

Which TB drug has an adverse side effect of Which TB drug has an adverse side effect of hepatitis and hyperuricemia, GI sx, arthritis, and a photosensitive dermatologic rash?

A

Pyrazinamide

44
Q

Which TB drug has an adverse side effect of optic neuritis, scooter, color perception problems, red-green visual changes, and peripheral neuropathy?

A

Ethambutol

45
Q

Which TB drug has an adverse side effect of ototoxicity with CN8 and nephrotoxicity?

A

Streptomycin

46
Q

Highly contagious infection secondary to bordetella pertussis; Rarely seen due to widespread vaccination Gram negative coccobacillus. Most commonly seen in children under 2 years old.

A

Pertussis (Whooping cough)

47
Q

What are the 3 phases of pertussis?

A
  1. Catarrhal phase
  2. Paroxysmal phase
  3. Convalescent phase
48
Q

URI symptoms for 1-2 weeks

A

Catarrhal phase Pertussis

49
Q

Severe paroxysmal coughing fits (with inspiratory whooping sound after coughing fit) with or without post coughing emesis

A

Paroxysmal phase Pertussis

50
Q

Resolving of cough and emesis (Coughing phase may last up to 6 weeks)

A

Convalescent phase Pertussis

51
Q

How can you diagnose whooping cough?

A

Nasopharyngeal swab

Severe lymphocytosis seen on differential

52
Q

How soon does a nasopharyngeal swab need to be done to diagnose pertussis?

A

First 3 weeks of symptom onset

53
Q

What is the mainstay of treatment with pertussis?

A

Supportive Rx

54
Q

If you choose to treat pertussis, what are some drugs you could use?

A

Macrolides or Bactrim (use if allergic to macrolides)

55
Q

According to the green PANCE book, what is the DOC for pertussis?

A

Erythromycin (macrolide)

56
Q

Pneumonia, encephalopathy, otitis media, sinusitis, and seizures are all complications of?

A

Pertussis

57
Q

What is treatment of Pertussis aimed at?

A

Treatment is aimed at stopping transmission

58
Q

Inflammation of the epiglottis that can interfere with breathing. MEDICAL EMERGENCY!

A

Epiglottitis

59
Q

What is the common etiology of epiglottitis? What else could cause it?

A

Primarily Haemophilus influenzae B

Can be caused by s. pneumoniae, s. aureus, GABHS

60
Q

What are the “3 D’s” that characterize epiglottitis?

A

Drooling, distress, dysphagia

61
Q

What are some addition clinical manifestations of epiglottis other than the “3 D’s?”

A

Fevers
Odynophagia
Inspiratory stridor
tripoding

62
Q

If you have a suspicion of epiglottis, what should you never do?

A

Try to visualize epiglottis –> this can obstruct the airway!

63
Q

How should you diagnose epiglottitis?

A

Lateral cervical X-ray: Look for “thumb sign” of swollen, enlarged epiglottis

64
Q

What is the mainstay of treatment with epiglottitis?

A

Supportive Rx and maintain airway
use dexamethasone to reduce airway edema
Tracheal intubation for severe cases

65
Q

What type of abx should you use to treat epiglottitis?

A

2nd/3rd gen cephalosporins

66
Q

AKA acute viral laryngotracheobronchitis, commonly affects children 6 months to 5 years. Most common cause is parainfluenza type 1 and 2. RSV, adenovirus, influenza, and rhinovirus are also implicated.

A

Croup

67
Q

Symptoms for this disease are a harsh, barking, seal-like cough; inspiratory stridor, hoarseness, aphonia, low-grade fever; and rhinorrhea.

A

Croup

68
Q

How do you diagnose croup?

A

Clinically

69
Q

What would a PA neck film show in a patient with croup?

A

subglottic narrowing (steeple sign)

70
Q

Why should you do a lateral neck film when you diagnose croup?

A

To differentiate between croup and epiglottitis

71
Q

How do you treat croup?

A

Typically does not require treatment; hydrate

72
Q

What are some things you can give your patient to help them recover from croup?

A

Humidified air or oxygen, nebulizer epinephrine

73
Q

When should you hospitalize your patient with croup?

A

Severe symptoms

74
Q

Acute respiratory illness caused by influenza A or B viruses with outbreaks mainly in fall/winter; spreads primarily via airborne secretions

A

Influenza

75
Q

Which strain of influenza is associated with more severe, extensive outbreaks?

A

A

76
Q

What is characteristic about flu symptoms?

A

They usually have a very abrupt onset

77
Q

How do you usually diagnose influenza?

A

Clinically or with a culture

78
Q

What are the two types of influenza vaccine?

A

Influenza trivalent vaccine

Intranasal (live attenuated)

79
Q

Who should always get a flu shot?

A

everyone! More specifically >50 years of age and those with underlying chronic medical conditions like asthma, sickle cell disease, and COPD

80
Q

How do you manage the flu?

A

Best if begun within 48 hours of onset of symptoms:

Acetaminophen or salicylate for symptoms
Antivirals

Clinical Medicine II (10 decks)

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