Respiratory CIS

Question 1

What is our differential list for TB, or for cavitation lung lesions? 7 things.

Answer 1

Non TB mycobacterial infection
Fungal infection
Lung cancer
Lymphoma
Sarcoidosis 
Septic emboli
Lung abscess

Question 2

6 patient populations more at risk for getting

Answer 2

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

Question 3

What test can we use in patients who received a BCG vaccination and why?

Answer 3

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.

Question 4

5 symptoms associated with active TB?

Answer 4

Fever, night sweats, cough greater than 2 weeks, weight loss and LAD

Question 5

What are the 4 situations where we would consider a TB skin test positive when it is greater than or equal to 5mm?

Answer 5

HIV
Close contact with someone who has it
Immunosuppression
Chest x ray with fibrotic changes

Question 6

What 3 situations would we consider greater than 10 a positive test?

Answer 6

Person has increased risk for reactivation
Children less than 4
Employees at high risk work place

Question 7

What 1 situation do we consider greater than 15 to be a positive test?

Answer 7

Healthy individual older than 4 with very low likelihood of getting TB

Question 8

What is the gold standard for diagnosing TB, but what is the problem?

Answer 8

Sputum culture. But it can take 6-8 weeks to grow.

Question 9

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?

Answer 9

Rhodamine auramine stain - initial

Zeel Neelsen stain - confirmatory

Question 10

What does the skin test actually test for?

Answer 10

Currently infected or previously infected

Question 11

What is the purpose of the IGRA test?

Answer 11

Indicates there has been a cellular response to TB

Question 12

What is the purpose of the chest x ray and what would we see?

Answer 12

Chest x ray shows reactivation TB. Cavitary lesions involving the top of the lungs.

Question 13

What does NAAT TB detect and what does NAAT R detect?

Answer 13

TB genetic material

Detects INH and rifampin resistance

Question 14

2 adverse effects of rifampin? Iso? Pyra? Ethambutol?

Answer 14

Red/ orange piss and hepatitis
Hepatitis and peripheral neuropathy
Hepatitis and gout
Optic neuritis and color blindness

Question 15

What do you need to monitor in patients with TB meds?

Answer 15

CMP to monitor kidney and liver

Question 16

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?

Answer 16

Check x ray for active TB. If x ray is negative, give iso for 9 months.

Question 17

What are the three levels of control for TB in a healthcare setting?

Answer 17

Administrative control
Environmental control like negative pressure rooms
Respiratory controls

Question 18

What is the FIO2 for room air, nasal cannula, simple face mask, Venturi mask, and non rebreather?

Answer 18

21, 24-44, 40-70, 25-50, and 80-100

Question 19

What are we thinking with OMT and TB?

Answer 19

Relative contraindication in the acute phase

Question 20

5 treatment types that are good for TB?

Answer 20

CS, ME, BLT, SFT and MFR

Question 21

Two lymph treatment for TB?

Answer 21

Thoracic inlet and rib raising

Question 22

What viscerosomatic reflexes are we dealing with?

Answer 22

T1-6
OA, AA
Chapman upper lobe and lower lobe
Phrenic nerve