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Pathophysiology > TB > Flashcards

TB Flashcards

** = Pink Pigs **

1
Q

What is the 2nd leading cause of infectious disease in the U.S.?

A

Tuberculosis…Duh, look @ the deck name bro!

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2
Q

Who is @ highest risk?

A

HIV infected patients bc they are immunocompromised

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3
Q

What are the 2 major reasons for multidrug-resistant strains?

A
  1. Ineffective regimen

2. Non-complience

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4
Q

How is TB spread?

A

Airborne DROPLETS when a person infected:

a. Coughs
b. Speaks
c. Sneezes
d. Sings

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5
Q

Am I @ risk if I am close to a TB infected pt for a short time?

A

@ risk? Sure, but transmission requires CLOSE, FREQUENT, or PROLONGED exposure

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6
Q

Where do they hang their hat & how long should I expect replication to be?

A
  1. Once inhaled bacilli travel down bronchial system & implant on BRONCHIOLES or ALVEOLI.
  2. Replication is SLOW (Dividing Q25–32 hrs) & spread via the lymphatic system
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7
Q

What happens if I inhale TB but my immune system is activated?

A
  1. Tissue GRANULOMA forms
  2. TB Contained & preventing replication & spread
  3. Caseous Necrosis forms w/i 2-3 wks
  4. Further growth is restricted & Latency establishes
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8
Q

What happens if I inhale TB & my immune system is compromised?

A
  1. TB is not maintained
  2. Granuloma initiated but unsuccessful @ containing TB
  3. Liguefaction of tissue drains into bronchus, blood vessels & lymphatics
  4. This creates air filled cavities @ original site & Droplets are coughed up
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9
Q

Are other organs affected besides the lungs?

A

Yes, mainly:

  1. Blood stream
  2. Bone & Joint tissue
  3. Kidneys
  4. Adrenal Glands
    * 5* Lymph Nodes
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10
Q

What exactly is LATENT TB?

A

That you have TB but it is dormant & you cannot spread it.

  1. TB can be dormant for years
  2. Few cases even develop/reactivate
  3. Reactivation is not well understood @ this time
  4. We do know immunosuppressive state can trigger TB to reactivate
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11
Q

There are Different Classification Classes of TB

A 
0 = No TB exposure
1 = Exposure, no infection
2 = Latent, no Disease
3 = Clinically Active
4 = Not clinically active
5 = Suspected
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12
Q

** What do the TB Classification Classes Mean?**

A 
0--> Negative TB test
1--> + TB test/Negative CxR/Negative Sputum
2 (Latent)-->+ Culture & + CxR
3--> Hx TB/Negative CxR & Sputum
4--> +Skin/Negative Qelse
5-->Dx Pending
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13
Q

TB Clinical Manifestations

A
  1. Symptom-free @ Beginning
  2. FATIGUE
  3. Malaise
  4. Anorexia
  5. WT LOSS
  6. Low-grade fever
  7. Night Sweats
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14
Q

What are the S/S in the Latent Stage?

A
  1. No S/S
  2. Susceptible to reactivation
  3. CxR may reveal Fibrotic Granulomas
  4. Negative Sputum Culture
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15
Q

What is “Early Primary Progressive”?

A

1.Immune Response Lacks Control
2. Inflammation of tissues
3. Nonspecific S/S:
> Fever, Fatigue, Wt loss
4. Nonproductive cough
5. Early Dx is difficult:
>CxR & Sputum may be Negative

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16
Q

How many ppl develop Active TB p immediate exposure?

A

Approximately 5–10%

17
Q

What S/S would you see in “Late Primary Progressive” TB?

A
  1. Productive, Purulent Cough
  2. Progressive wt Loss
  3. Anemia
  4. Dyspnea
  5. Low Grade Fever
  6. Chills/Night Sweats
  7. CRACKLES IN LUNGS
  8. CxR = Normal
    • Sputum culture(May be blood tinged)
  10. Dull on Percussion of Lungs bc of Air Filled Sacs
  11. Lack of breath sounds
  12. Finger Clubbing
18
Q

What are the Complications of TB?

A
  1. Pleural Effusion & Empyema(Pus in lungs)
    a. Caused by bacteria in pleural space
    b. Inflammatory reaction c plural exudate of protein-rich fluid.
19
Q

What are the Diagnostic Studies Used to Dx TB?

A
  1. Skin Test
  2. CxR
  3. Bacteriologic Studies
    a. Stain
    b. Sputum Culture
  4. Bronchoscopy Washing
  5. Fluid from abscess or Effusion
  6. CSF
  7. QuantiFERON - TB (New Blood test)
20
Q

Skin Test for TB Dx

A
  1. Intradermal administration of tuberculin.
  2. Induration (Hardness-Due to mast cell accumulation) @ injection site = Exposure
    a. Sensitivity remains for life & should not use this test again.
  3. Reactions >/= 10mm are +
  4. False negatives can occur c HIV
21
Q

CxR for TB Dx

A
  1. Cannot Dx on CxR only

>Infiltrates, Cavitary Infiltrates, & Lymph node involvement Suggest TB, but not the diagnostic factor.

22
Q

Bacteriologic Studies for TB Dx

A 
1. Stained Sputum Smears examined for Aacid-Fast-Bacilli
>**Required for Dx**
>Less than 24 hrs
2. **Sputum Culture**
>Needed for **Definitive Dx**
>4--14 days or 3--6 weeks
23
Q

QuantiFERON–TB

A
  1. New Test
  2. Rapid Blood Test
    >W/I 12–24hrs
  3. Does not replace cultures
  4. May detect Active & Latent TB
24
Q

What Drugs are used for Tx of Active TB?

A 
Initial Phase:
1. Isoniazid
2. Rifampin
3. Pyrazinamide
>Contraindicated in Liver Disease & Pregnancy
4. Ethambutol
All 4 are used bc of High Resistance
25
Q

What does “Direct Observed Therapy (DOT)” mean?

A
  1. Bc noncomplience is a major issue in multidrug resistance, Tx fails!
  2. DOT means we are required to WATCH pt swallow medications then check
  3. This is to ensure adherence to the regimen.
26
Q

What should I educate my pt about concerning Active TB?

A
  1. Educate them on Side Effects
  2. When to seek Medical Attention
  3. Liver Function should be Monitored.
27
Q

Is there Drug therapy for Latent TB?

A

Yes, Usually treated c INH for 6–9 months

>HIV pt’s should take INH for 9 months

28
Q

Is there a vaccine or something that I can attempt to protect myself?

A
  1. Yes, but not widely used in the U.S.
  2. Bacille Calmette-Guerin (BCG) Vaccine to prevent TB is used in other countries
  3. The vaccine can lead to a + PPD reaction
  4. Ask your pt if they’ve had it p jumping to conclusions if their PPD comes out +

Pathophysiology (5 decks)

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