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Foundations II Exam 3 (Jess) > TB > Flashcards

TB Flashcards

1
Q

The global pandemic of TB is fueled by?

A

spread of HIV/AIDS
poverty
lack of health services
emergence of drug-resistent strains

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2
Q

Causative organism of TB?

How is it spread

A

Mycobacterium tuberculosis

spread through airborne droplets by person w/ active TB
generally prolonged exposure required for transmission

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3
Q

Are patients with LTBI infectious? Do they show symptoms?

A

NO! Not infectious

don’t show symptoms

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4
Q

How does Latent TB develop?

A

immune system responds 2-8 weeks after lungs infected with TB

Macrophages “wall off” the bacteria in the lungs where it may remain dormant for years

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5
Q

Active TB primarily has what kind of granulomas?

A

Primarily necrotizing (caveating) granulomas

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6
Q

What groups are at highest risk for reactivation to active TB? In what time frame?

A 
Immunocompromised
young children
substance abuse
receiving immunosuppressive therapy
malnutrition 
crowded living spaces
nationality (highest in Africa, Asia, Latin America)

greatest risk in first 2 years

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7
Q

During initial infection, what percentage of people develop active (progressive primary TB) vs latent TB?

A

~5% active- progressive primary TB

~95% latent TB

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8
Q

What percentage of people will develop reactivated TB if not given prophylaxis tx?

A

10%

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9
Q

Strongest known risk factor for progression to active TB?

A

HIV

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10
Q

If your patient has sudden onset of TB infection what do you need to be concerned about?

A

HIV

may be first indication!

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11
Q

If you breathe TB bacteria, list the 4 things that might happen

A
  1. You don’t become infected
  2. You develop latent TB (LTBI)
  3. You develop active TB (PPTB)
  4. You develop active TB years after initial infection (reactivation TB)
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12
Q

In a patient with latent TB, what will their sx be? What will their skin test show?

A

No sx!

+ skin test

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13
Q

In a patient with active TB, what will their sx be?

A 
bad cough >3 weeks
chest pain
fever, chills, night sweats
weakness, fatigue
anorexia, weight loss
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14
Q

On physical exam, what sign is considered classic of TB?

A

post-tussive rales (like pneumonia)

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15
Q

On CXR, what would you see in primary active TB

A

Hilar adenopathy
Pleural effusions
Hilar/middle lobe infiltrates

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16
Q

On CXR, what would you see in reactivation dz?

A

Apical/upper lobe infiltrates and cavitations

17
Q

Repetitive question but need to know:

How would you differentiate primary TB vs reactivation TB on CXR?

A

Primary: infiltates in hilar/middle lobe

Reactivated: infiltates in apical/upper lobe

18
Q

What is a Ghon /Ranke complex and what does it signify?

A

calcified primary focus and hilarity lymph node

residual evidence of healed primary TB

19
Q

What is the gold standard for dx TB?

A

Sputum culture

-3 consecutive morning sputum specimens

20
Q

Options of diagnostic testing of TB

A
  • Nucleic acid amplification test (NAT)
  • Sputum culture
  • Sputum spear for acid-fast bacilli (AFB)
  • Biopsy
21
Q

With the PPD test, what do you measure?

A

Induration

not erythema!

22
Q

If your patient has a positive PPD test, what do you do next?

A

CXR to rule out active TB

23
Q

What might give a pt a false positive PPD? What do you do next?

A

BCG (bacillus Calmette-Guerin) vaccine

follow-up with blood test (IGRA)

24
Q

List the reaction size that is needed to have a positive skin test (all 3 groups/sizes)

A
  • HIV pts, recent contact w/ TB, immunosuppressed= greater than or equal to 5 mm
  • People at high risk of TB (medical workers, HIV negative IV drug users, recent immigrants from countries w/ high TB)= greater than or equal to 10 mm
  • People w/ no risk factors= greater than or equal to 15 mm
25
Q

Advantages and disadvantages of IGRAs

A

Advantages:

  • requires single visit
  • results in 24 hrs
  • does not boost subsequent tests
  • not subject to reader bias
  • not affected by BCG vaccine

Disadvantages:

  • must be processed within 12 hrs
  • limited data regarding use in children, immunocompromised
  • errors in blood collection can occur
  • expensive
26
Q

When do you report active TB?

A

Confirmed AND suspected cases
within 24 hours
identify contacts

27
Q

What protective measures are taken when a pt is in the hospital w/ active TB?

A
  • Pt is in an isolated, negative pressure room

- pt wears mask, provider wears respirator

28
Q

How do you treat Active TB?

A 
4 drug regimen: (RIPE)
Rifampin (RIF)
Isoniazid (INH)
Pyrazinamide (PZA)
Ethambutol (EMB)
29
Q

What is done to confirm compliance of medications?

A

Directly observed therapy (DOT) for all initiation of tx for all pts

30
Q

When and why is prophylaxis given in Latent TB?

A

When: only after active TB is ruled out

Why: to prevent active TB

31
Q

What is given for prophylaxis in latent TB? What must you monitor?

A

INH (w/ vit. B6) x 9 months

Monitor LFTs

32
Q

What is a bad complication of TB (hint: learned about it in Path)? Describe it

A

Miliary TB

  • uncontrolled hematogenous spread of TB
  • mult-organ involvement
  • dx and treat like pulmonary TB
33
Q 
Side effects of TB drugs:
RIF
INH
PZA
EMB
A

RIF: red-orange tears, sweat, urine, stool

INH: hepatic toxicity (monitor LFTs), peripheral neuropathy (give w/ B6)

PZA: hepatic toxicity, hyperuricemia

EMB: optic neuritis

34
Q

What can be done for TB prevention?

A
  • targeting testing (those at high risk)
  • annual skin testing for pts w/ risk factors
  • offer prophylaxis tx to pts with LTBI
35
Q 
Differentiate latent vs active TB:
Sx
feel sick?
Can they spread TB?
Skin test results
CXR/sputum smear
A 
Latent:
no sx
do not feel sick
cannot spread TB
\+ skin test
Nl CXR
Active:
Has sx
feels sick
can spread TB
\+ skin test
may have abnormal CXR or + sputum smear

Foundations II Exam 3 (Jess) (6 decks)

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