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pulm 2 > TB > Flashcards

TB Flashcards

1
Q

progression to lung pneumonitis

A
  1. inhaled
  2. macrophages eat–> blood
  3. lung pneumonitis, lymph nodes, etc
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2
Q

what makes it “latent” TB

A

lung pneumonitis gets resolved

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3
Q

list 3 things that can activate LTBI

A

pregnancy
HIV or DM
taking immunomodulators

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4
Q

how is TST read? (3)

A

measure induration perpendicular to long axis
ignore redness
record in mm

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5
Q

induration cut off for high pretest probability vs middle vs very low

A
  • high: 5mm
  • middle: 10
  • very low: 15
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6
Q

examples of people w/ high pretest probability (4)

A
  • ppl w/ HIV
  • close contacts
  • immunocompromised/using steroids
  • fibrotic change on CXR/ old TB
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7
Q

examples of people w/ “mid” pre-test prob (5)

A
  • healthcare workers or long term facility ppl
  • recent immigrants
  • injection drugs
  • younger exposed to high risk adults
  • underlying illness
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8
Q

Having these conditions can cause false ____ with TST

general illness, steroids, immunosuppression, long duration since infection, malnutrition

A

false negative

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9
Q

Having these conditions can cause false ____ with TST

nontuberculous mycobacteria

A

false positive

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10
Q

list some P.E. findings with TB (5)

A
  • dullness to percussion
  • rales
  • tubular breath sounds
  • whispered pectoriloquy
  • distant hollow/amphoric breath sounds
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11
Q

6 radiographic findings

A
  • infiltrates in upper lobes
  • Cavity formation esp at the apical area
  • Hilar adenopathy
  • Atelectasis
  • Pleural effusion
  • Miliary TB
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12
Q

list 5 extrapulmonary findings w/ TB seen more in kids

A
  • meningitis
  • osteomyelitis
  • GI issues
  • renal issues or GU tract
  • scrofula– isolated infected neck node
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13
Q

4 diagnostic tests/procedures used for TB

A
  • TST
  • IGRA
  • sputum smear
  • culture
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14
Q

media used to culture TB

A

AFP culture on jensen media

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15
Q

when do you get sputum smear?

A

(+) PPD or IGRA
AND
abnormal CXR

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16
Q

Whole blood assay that measures immune response to M. TB antigens

A

IGRA

17
Q

which test shows no response to non-TB mycobacteria or BCG

A

IGRA

18
Q

4 limitations of IGRA

A
  • LTBI has no gold standard
  • not standard
  • may be falsely negative in active dz
  • not reliable for kids under 5
19
Q

3 situations where we use IGRA

A
  • at risk over 5yo
  • confirm positive TST in BCG
  • confirm TST when non-TB mycobacteria suspected
20
Q

if patient has negative TST, negative IGR but you think they might have TB, can you r/o TB?

A

no, investigate more

21
Q

list the first line agents (5)

A

Isoniazid (INH), Rifampin (RIF), Pyrazinamide (PZA), Ethambutol (EMB), Streptomycin (STM)

22
Q

can you treat close contacts?

A

yes w/ prophylactic abx

22
Q

medication regimen in first 2 months of tx of active TB

A

INH + RIF + PZA + (EMB* or STM*)

drop last two after confirming susceptibility

23
Q

medication regimen for last 4 months for active TB

A

INH + RIF

24
Q

total tx duration for active TB

A

6 months

25
Q

while doing sputum smears Q 2 wks, if it doesn’t become negative, what does that mean?

A

non adherence or drug resistance

26
Q

two things to do during treatment of active TB other than sputum smears

A
  • toxicity labs PRN
  • CXR at end to establish new baseline
27
Q

first line treatmetn (& duration) in LTBI vs alternative

A
  1. INH x 9 months
  2. rifampin x 4-6months or INH + rifapen. x 3 months (DOT)
28
Q

things to monitor during LTBI tx

A

liver panel in adults & symptomatic kids

29
Q

what to do if trying to get sputum from uncooperative pt

A

gastric aspirates
bronchoalveolar lavage

30
Q

limitation of sputum smears

A

tells that its mycobacteria but not if its the TB one specifically

31
Q

should you do next if theres positive TST?

A

get xray to see if active or latent

32
Q

go review meds

A

ok!

pulm 2 (8 decks)

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