Respiratory CIS high yield handout 3

Question 1

PPD rxn of 5mm or more

Answer 1

HIV
close contact with active infected person
CXR with fibrotic changes consistent with TB
immunosuppression

Question 2

ethambutol side effects

Answer 2

optic neuritis, color blindness

Question 3

4 drugs of TB

Answer 3

isoniazid
rifampin
pyrazinamide
ethambutol

Question 4

follow TB pts on TB drugs with what

Answer 4

CMPs to monitor kidney and liver funct, also sputum collected to monitor treatment efficacy

Question 5

DD for TB

Answer 5

nontuberculosis mycobacterial infection (M kansaii)
fungal infection
lung cancer
lyphoma

Question 6

latent TB consideration

-get screening PPD, with no history of BCG vaccine

Answer 6

check chest xray to make sure no active TB

-if negative then treat as latent TB with 9 months INH

Question 7

pyrazinamide side effects

Answer 7

urticaria, hyperuricemia/gout, hepatitis, joint aches

Question 8

side effect isoniazid

Answer 8

hepatitis, N/V, peipheral neuropathy (give pt B6) rash

Question 9

side effect rifampin

Answer 9

red/orange body fluids, hepatitis, steven johnson syndrome

Question 10

latent TB consideration

-get screening PPD, with history of BCG vaccine

Answer 10

check CXR and interferon gamma release assay
-CXR negative for active TB, IGRA positive then 9 months INH

-if both negative then no active or latent TB, positive PPD was from BCG vaccine

Question 11

signs and symptoms associated with active pulmonary TB

Answer 11

fever
night sweats
cough over 2 weeks (bloody or sputum)
weight loss
lympadenopathy

Question 12

diagnosis of TB

Answer 12

sputum culture
3 separate morning sputum samples
results can take 6-8 weeks

sptum staining

• rhodamine auramine stain (initial)
• ziehl neelsen or kinyun stain (confirmatory AFB stain)

PPD skin test

Interferon gamma release assay- for latent TB
-for people who have had BCG vaccination and those with positive PPD in whom latent tb suspected

chest x-ray- cavity lesion in apice of lungs

NAAT-TB: detects TB genetic material
NAAT:R: detects INH and rifampin resistnace

Question 13

pts population at risk for exposure and infection with TB

Answer 13

close contact with someone who has active TB
immigrants from endemic area (<5 years ago)
residents and emplyees at high risk areas
medically underserved, low income pop
IV drug abuse
HIV/AIDS pts and other immunocomp