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WI-18 Pulmonary > TB > Flashcards

TB Flashcards

1
Q

fatality and Tb from _____

A

HIV

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2
Q

organism causing TB

A

Mycobacterium tuberculosis

acid-fast aerobic rod

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3
Q

transmission

A

inhalation of aerosolized infectious droplets

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4
Q

initial pathophys

A
  1. bacilli grow in lungs
  2. vigorous immune response
  3. droplet nuclei deposited in lung airspaces
  4. alveolar macrophages engulf bacilli
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5
Q

types of TB

A
  1. Primary TB
  2. Progressive primary tuberculosis
  3. Latent TB
  4. Reactive TB
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6
Q

primary TB

A

growth occurs, kills macrophages and releases bacilli

local infection and destruction

Unable to be walled off, active form of Dz

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7
Q

progressive primary tuberculosis

A

hematogenous and lymphatic spread of infection

targets: lymph nodes, vertebrae, adrenal gland, meninges, GI tract

OXYGEN rich areas

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8
Q

latent TB

A

lung collects and encaseates within granulomas

lies dormant in lungs (can’t get rid of it!)

NOT infectious, NO active infection

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9
Q

reactive TB

A

disruption of cellular immune function that cause break down of granuloma and development of TB years to months following exposure

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10
Q

when is risk of development of reactive TB

A

<2 yrs following exposure

young and old increased risk

impaired immune action

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11
Q

populations in US at risk for TB

A

immigrants

low SES

homeless

crowded conditions

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12
Q

lesions of TB

A

granuloma with central caseation necrosis

has low levels of O2, low pH, high levels of fatty acids to inhibit growth

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13
Q

symptoms of active TB

A

insidious

cough, weight loss, fatigue, fever, night sweats, hemoptysis

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14
Q

extrapulmonary TB

A

involvement of sites with high O2 tension

mediastinal, retroperitoneal, cervical/scrofula lymph nodes, vertebrae, adrenal glands, meninges and GI tract

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15
Q

TB exposure

A

purified TB injected into skin and strong cell mediated immune response will occur if exposed again

delayed type hypersensitivity response then read again in 47-72 hrs

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16
Q

PPD results high risk

A

5 mm or greater

close contacts, immunosuppressed, clinical or radiographic evidence of TB

17
Q

PPD results low-intermediate risk

A

10 mm +

persons born in high TB incidence, occupational exposure

18
Q

PPD results unlikely risk

A

15 mm +

19
Q

qunatiferon test

A

T cells from those infected with TB release measurable amounts of interferon gamma when mixed with Ags of TB

screen for latent AND active TB

20
Q

evaluation for Active TB infection

A

PA and lateral CXR

if abnormal - contrast CT of chest

21
Q

if TB is suggestive after imaging…

A

sputum smear, sputum culture, nucleic acid testing of sputum

22
Q

sputum smear for TB

A

suggestive but not diagnostic

may take long time for results

23
Q

nucleic acid testing

A

rapidly diagnostic and can guid treatment

24
Q

lymph node biopsy

A

preformed if lymphadenopathy present

determine second disorder present or due to TB

25
Q

typical TB CXR

A

apical cavitary disease, nodules, infiltrates

26
Q

miliary TB

A

hematologic or lymphatic spread

widespread small nodular densities

27
Q

tx of active TB

A

hospitalization

negative pressure ventilation and air exhausted to outside/filtered

report of confirmed AND suspected cases to CDC

4 drug regimen

28
Q

labs done for active TB tx

A 
baseline CBC 
renal function 
LFTs 
pregnancy 
HIV status
29
Q

4 drug regimen

A

isoniazid
rifampin
pyrazinamide
ethambutol/streptomycin

30
Q

isoniazid toxicity

A

peripheral neuropathy

increased transaminases

weakness

31
Q

Rifampin toxicity

A

increased transaminases

pancreatitis

fever, rash, N/V/D

32
Q

pyrazinamide toxicity

A

increased transaminases, NV

33
Q

ethambutol toxicity

A

optic neuritis (decreased visual acuity)

color blindness

34
Q

how often are sputum spheres collected?

A

weekly during tx

isolation until 3 consecutive negative smears

35
Q

tx concomitant HIV

A

longer duration of rx

some drug interactions with HAART

36
Q

tx of extrapulmonary TB

A

longer duration of rx

consider surgical debridement of bone and corticosteroid

37
Q

tx of TB in pregnancy

A

teratogen risk of meds

breast feeing OK

38
Q

MDR TB

A

associated with high mortality and short survival

prolonged (2-3 yrs) survival

39
Q

how do you tx latent TB?

A

3-9 mo tx of anti TB meds

have to rule out active disease and concomitant HIV

WI-18 Pulmonary (11 decks)

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