Respiratory CIS Flashcards
What is our differential list for TB, or for cavitation lung lesions? 7 things.
Non TB mycobacterial infection Fungal infection Lung cancer Lymphoma Sarcoidosis Septic emboli Lung abscess
6 patient populations more at risk for getting
Close contact with people who have it Immigrants from a place with it Employees of high risk places Medically underserved areas IV drug users Immunocompromised
What test can we use in patients who received a BCG vaccination and why?
We can use the IFN gamma release assay because it is more sensitive to a true TB exposure than a positive test being because of BCG vaccination.
5 symptoms associated with active TB?
Fever, night sweats, cough greater than 2 weeks, weight loss and LAD
What are the 4 situations where we would consider a TB skin test positive when it is greater than or equal to 5mm?
HIV
Close contact with someone who has it
Immunosuppression
Chest x ray with fibrotic changes
What 3 situations would we consider greater than 10 a positive test?
Person has increased risk for reactivation
Children less than 4
Employees at high risk work place
What 1 situation do we consider greater than 15 to be a positive test?
Healthy individual older than 4 with very low likelihood of getting TB
What is the gold standard for diagnosing TB, but what is the problem?
Sputum culture. But it can take 6-8 weeks to grow.
What are the two acid fast bacillus tests to do for TB? Which one is the initial test and which one is the confirmatory test?
Rhodamine auramine stain - initial
Zeel Neelsen stain - confirmatory
What does the skin test actually test for?
Currently infected or previously infected
What is the purpose of the IGRA test?
Indicates there has been a cellular response to TB
What is the purpose of the chest x ray and what would we see?
Chest x ray shows reactivation TB. Cavitary lesions involving the top of the lungs.
What does NAAT TB detect and what does NAAT R detect?
TB genetic material
Detects INH and rifampin resistance
2 adverse effects of rifampin? Iso? Pyra? Ethambutol?
Red/ orange piss and hepatitis
Hepatitis and peripheral neuropathy
Hepatitis and gout
Optic neuritis and color blindness
What do you need to monitor in patients with TB meds?
CMP to monitor kidney and liver
What happens if you have a patient hat has a positive PPD or IGRA but no symptoms. Basically what do you do to treat latent TB?
Check x ray for active TB. If x ray is negative, give iso for 9 months.
What are the three levels of control for TB in a healthcare setting?
Administrative control
Environmental control like negative pressure rooms
Respiratory controls
What is the FIO2 for room air, nasal cannula, simple face mask, Venturi mask, and non rebreather?
21, 24-44, 40-70, 25-50, and 80-100
What are we thinking with OMT and TB?
Relative contraindication in the acute phase
5 treatment types that are good for TB?
CS, ME, BLT, SFT and MFR
Two lymph treatment for TB?
Thoracic inlet and rib raising
What viscerosomatic reflexes are we dealing with?
T1-6
OA, AA
Chapman upper lobe and lower lobe
Phrenic nerve
