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STEP 2 Pulmonary > Pulm. UW mainly + Mehlm: TBC (09-24) (2) > Flashcards

Pulm. UW mainly + Mehlm: TBC (09-24) (2) Flashcards

1
Q

UW. table. What about risk in CKD?

A

These patients are at increased risk due to impaired cellular mediated immunity

Same reason why they get TST anergy (false negative)

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1
Q

UW. table. Risk factors? 4

A

Immunosupression
Travel from endemic area
Exposure to infected household contact
Resident/employee of prison, homeless shelter, health care facility

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2
Q

UW. table. Risk factor, what is the most common behavioral?

A

Substance abuse

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3
Q

UW. table. Clinical?

A

Chronic cough, prolonged fever, weight loss, failure to thrive

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4
Q

UW. table. Diagnosis. tests. 2

A

Positive screening PPD OR interferon gama release assay

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5
Q

UW. table. diagnosis. what is seen xray?

A

Hilar adenopathy, effusion, consolidation, cavitation

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6
Q

UW. table. diagnosis. culture?

A

Positive AFB (acid-fast bacilli) and mycobacterial culture

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7
Q

UW. Primary. what pneumonia? granulomas?

A

Lobar pneumonia with cavitation

Caseating granulomas

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8
Q

UW. Primary. xray?

A

Ghon focus

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9
Q

UW. Primary. what symptoms in older?

A

nonspecific.
anorexia, muscle waisting, weight loss

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10
Q

UW. Primary. chronic cough definition?

A

chronic cough > 8 weeks in adult
>4 weeks in children

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11
Q

UW. Primary. Labs?

A

Anemia (of chronic disease)
Monocytosis
Hypergammaglobulinemia (incr. total protein)
Hypoalbuminemia (inflammatory cytokines stimulate production of acute phase reactants at the expense of albumin)

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12
Q

UW. Primary. what patients are at risk of progressive primary TB?

A

renal disease, DM, HIV, advanced aged, immunosuppressive medications

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13
Q

UW. Latent. what diagnostic tests?

A

Positive IGRA and TST and negative CXR and absence of symptoms.

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14
Q

UW. Latent. treatment options.

A
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15
Q

UW. Latent. treatment options. If 3 months?

A

ISONIAZID and RIFAPENTINE weekly for 3 months under direct observation

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16
Q

UW. Latent. treatment options. what therapy is not recomended in HIV patients?

A

ISONIAZID and RIFAMPICINE weekly for 3 month

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17
Q

UW. Latent. treatment options. what option for 6-9 months?

A

Isoniazid

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18
Q

UW. Latent. treatment options. what option for 4 months?

A

Rifampin

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19
Q

UW. Reactivated TB. clinical?

A

fever, night sweats, weight loss, cough with blood

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20
Q

UW. Reactivated TB. what 2 epidemiologic facts?

A

Emigration from endemic areas.
Risk is highest for those who lived in the USA for 5 years or less

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21
Q

UW. Reactivated TB. can be colonized by what?

A

Can be colonized by aspergillus species creating an aspergilloma.

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22
Q

UW. Reactivated TB. diagnosis xray?

A

CXR: apical cavitary lesion.

Due to higher oxygen tension and slower lymphatic elimination.

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23
Q

UW. Reactivated TB. treatment. first step?

A

stabilize the patient

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24
Q

UW. Reactivated TB. treatment. isolation?

A

respiratory isolation (airborn precaution)

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25
Q

UW. Reactivated TB. treatment. RIPE?

A

2 months of RIPE and 4 months of rifampin and isoniazid.

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

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26
Q

UW. Reactivated TB. treatment. Rifampin adverse?1

A

Rifampin: orange discoloration of secretions.

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27
Q

UW. Reactivated TB. treatment. Isoniazid adverse? 3

A

Isoniazid: peripheral neuropathy (stock and glove numbness and tingling), vitamin b6 deficiency causing vitamin b3 deficiency, and hepatotoxicity

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28
Q

UW. Reactivated TB. treatment. what patients population is at highest risk for vit B6 deficiency?

A

Patients with malnourishment, pregnancy, or certain
comorbid illnesses (DM) are at a high risk of vitamin B6
deficiency –> prophylactic supplementation.

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29
Q

UW. Miliary TB. spread?

A

Lymphohematogenous spread of mycobacterium tuberculosis.

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30
Q

UW. Miliary TB. may arise with..? 2

A

May arise with primary infection or reactivation.

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31
Q

UW. Miliary TB. what symptoms?

A

Subacute or chronic symptoms are common.

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32
Q

UW. Miliary TB. what extrapulmonary symptoms? 4

A

LNs, liver, bones, and CNS.

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33
Q

UW. Miliary TB. diagnosis? xray

A

diffuse reticulonodular pattern (“millet-seed”).

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34
Q

UW. Miliary TB. diagnosis. what ,,lab” testing? 2

A

They’re often immunocompromised so interferon-based testing (IGRA
and tuberculin skin testing).

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35
Q

UW. Miliary TB. diagnosis. biopsy what parts?

A

Lungs, blood, or tissue biopsy.

36
Q

UW. TBC. Asymptomatic screening. In what all patients?

A

All newly diagnosed HIV should be screened for TB.

37
Q

UW. TBC. Asymptomatic screening. PPD results based on induration. >/= 5 mm? in what patients?

A

HIV/AIDS, chemo, transplant, close contacts, or anergy

38
Q

UW. TBC. Asymptomatic screening. PPD results based on induration. >/= 10 mm? in what patients?

A

healthcare providers, prison, homeless, or travel

39
Q

UW. TBC. Asymptomatic screening. PPD results based on induration. >/= 15 mm? in what patients?

A

soccer mom

40
Q

UW. TBC. Asymptomatic screening. IGRA can be done instead of PPD. what result eg in BCG vaccine?

A

IGRA does not give a false positive with BCG.

41
Q

UW. TBC. Asymptomatic screening. IGRA can be done instead of PPD. minimal response in what conditions?

A

A minimal response to control antigens is most often seen with lymphocyte immunosuppression due to HIV or the use of the
immunomodulatory medications (discontinue them a couple of weeks before doing the test).

42
Q

UW. TBC. Asymptomatic screening. Positive PPD. whats next?

A

xray

43
Q

UW. TBC. Asymptomatic screening. Negative PPD. whats next?

A

annual screen or 2-tier test.

44
Q

UW. TBC. Asymptomatic screening.
Patients with CKD will have a negative TST cannot rule out active TB infection.

A

.

45
Q

UW. TBC. Asymptomatic screening.
Both interferon-based testing and tuberculin skin testing can be falsen negative.

A

.

46
Q

UW. TBC. Asymptomatic screening. negative xray?

A

Negative –> latent TB.
● Treatment: isoniazid and vitamin b6 for 9 months.
● Rescreen yearly with CXR.

47
Q

UW. TBC. Asymptomatic screening. positive xray?

A

AFB smear.

48
Q

UW. TBC. Asymptomatic screening. AFB smear. how is performed?

A

AFB smear: 3 early morning samples 24 hours apart.

49
Q

UW. TBC. Asymptomatic screening. AFB smear - negative?

A

latent

50
Q

UW. TBC. Asymptomatic screening. AFB smear - positive?

A

active TB
—> treatment RIPE

51
Q

UW. TBC. Asymptomatic screening. AFB smear.

TB cannot be ruled out from a single negative AFB result.

A

.

52
Q

UW. TBC. SYMPTOMATIC screening. what first steps?

A

start with CXR and confirm with AFB.

53
Q

UW. TBC. SYMPTOMATIC screening. positive xray –>?

A

confirm with AFB.

airborne precaution and RIPE.

54
Q

UW. TBC. SYMPTOMATIC screening. Positive xray –> negative AFB –>?

A

latent TB –> isoniazid and B6 for 9 months.

55
Q

UW. TBC. SYMPTOMATIC screening. Negative xray –> AFB negative–>?

A

something else, not TBC

56
Q

UW. TBC. SYMPTOMATIC screening. Negative xray –> AFB positive on culture –>?

A

nontubercular mycobacteria.

57
Q

UW. TBC. SYMPTOMATIC screening. what perform if pleural effusions present?

A

thoracentesis –> adenosine deaminase positive.

58
Q

UW. TBC. SYMPTOMATIC screening. what is the last resort of diagnostic?

A

NAAT PCR is a very last resort to ELIMINATE TB as a possibility.

59
Q

UW. TBC. SYMPTOMATIC screening. how to take sample from children?

A

Children who cannot generate sputum –> do gastric lavage which recover M. tuberculosis from the swallowed secretions.

60
Q

UW. Diagnostic tests table. AFB smear microscopy. price, sensitivity?

A

Low cost and rapid (minutes to hours)

Low sensitivity because high burden of mo/s required in sample (>10 000/ml).

61
Q

UW. Diagnostic tests table. AFB smear microscopy. what can/cannot differentiate?

A

CANNOT differentiate TB from non-TB mycobacteria

62
Q

UW. Diagnostic tests table. Nucleic acid amplification testing. cost, sensitivity?

A

Higher cost, slightly less rapid (1-2days)
Higher sensitivity (only 10 bacilli/ml required for positive test)

63
Q

UW. Diagnostic tests table. Nucleic acid amplification testing. how about differentiation?

A

CAN differentiate TB from non-TB mycobacteria

64
Q

UW. Diagnostic tests table. Sputum culture. in general?

A

GOLD STANDARD
Quantitative and allows for drug sensitivity testing

Slow - takes 3-8 weeks.

65
Q

UW. Diagnostic tests table. what is gold standard?

A

Sputum culture.

66
Q

UW. Diagnostic tests table. what allows for drug sensitivity?

A

Sputum culture.

67
Q

UW. Diagnostic tests table. which CAN differentiates TB and nonTB mycobacteria?

A

Nucleic acid amplification testing.

68
Q

UW. Diagnostic tests table. which CANNOT differentiate TB and nonTB mycobacteria?

A

AFB smear microscopy

69
Q

UW table. PPD/TST induration table. >=5 mm. what patients to treat?

A

HIV-positive patients

Recent contact of known TB case

Nodular or fibrotic changes on xray consistent with previously healed TB

Organ transplant recipients and other immunosuppressed patients

70
Q

UW table. PPD/TST induration table. >=10 mm. what patients to treat?

A

Recent immigrants (<5years) from TB endemic areas

Injection drug users

Residents and employess of high-risk settings (prisons, nursing homes, hospitals, homeless shelter)

Mycobacteriology lab personnel

High risk for reactivation TB (DM, prolonged corticosteroid therapy, leukemia, ESRD, chronic malabsorption syndromes)

Children < 4y/o, or those exposed to adults in high-risk categories

71
Q
A
72
Q

UW table. PPD/TST induration table. >=15 mm. what patients to treat?

A

All of above plus healthy individuals

73
Q

Ghon focus?

A

granuloma

74
Q

Ghon complex?

A

Ghon focus + lymphadenopathy

75
Q

Latent infection?

A

Dormant bacteria contained within walled-off foci

76
Q

LATENT infection –> reactivated bacteria spread bronchogenically and cause extensive cavitation (IT IS CALLED SECONDARY TBC) ———–> spread to other organs (hematologic dissemination)

A

.

77
Q

RESOLUTION?

A

Bacterial clearance and scar formation

78
Q

PROGRESSIVE PRIMARY TBC = Failed immune response results in progressive lung consolidation and necrosis –> milliary TBC –> spread extrapulmonary (hematologic dissemination)

A

.

79
Q

M. first Dx test?

A

PPD

80
Q

M. first Dx test if Hx of BCG vaccine?

A

IGRA

81
Q

M. PPD/IGRA positive –> next best step?

A

chest x ray

82
Q

M. xray positive –> next best step?

A

Tx of active TB

83
Q

M. PPD/IGRA positive –> x ray negative -> next best step?

A

Tx of latent Tb/prophylaxis of TB

84
Q

M. what need to add if isoniazid is used for Tx?

A

pyridodine (vit B) - to prevent neuropathy

85
Q

M. when after exposure, culture is positive?

A

2-5 weeks

86
Q

M. >-5 mm one more population not mentioned before?

A

Use prednisone (1,5 mg day for 1 month); also anti-TNF alfa use

87
Q

M. Disseminated (miliary), what organs?

A

PSOAS abscess, POTT disease (TB in vertebral), adrenal insuff, meningitis, arthritis, osteomyelitis

STEP 2 Pulmonary (30 decks)

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