Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

clin med > TB > Flashcards

TB Flashcards

1
Q

__% of Virginia’s TB cases were reported among foreign-born persons

A

83%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the top five countries with TB?

A

Ethiopia, India, Viet Nam, the Philippines, and El Salvador

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is TB transmitted?

A

transmitted through Inhaled airborne droplets containing viable organisms
- Someone with active disease, talks coughs, sneezes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how does the immune system react when TB first comes into the body?

A

lymph nodes wall it off, creating caseating granulomas and calcified areas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what does “caseating” look like? what is this appearance suggestive of?

A

cheesy material in middle suggesting destruction

of tissue on pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

___% of people will not be successful at “walling off” the TB. it will go from primary to become progressive primary TB

A

5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

___% of people have latent TB

A

95%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

____% of latent TB pts will have reactivated TB

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what populations are at risk for TB?

A

poorer populations, less developed countries, homeless, those on dialysis (for some reason… dont know why). etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

calcified TB in lungs can be seen with what kind of imaging?

A

Chest Xray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

primary TB presents how?

A

usually clinically silent with normal CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Calcified granuloma is called _______

Calcified granuloma and calcified hilar lymph node is called ____________. which of these is the more common one?

A

Calcified granuloma called Ghon complex (common)

Calcified granuloma and calcified hilar lymph node termed Ranke complex (not commonly seen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the time period requirement between latent and reactivation?

A

Reactivation:

had TB for > 2 years, was latent and now active again

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Clinical presentation: 3 types for TB. which is the most common

A

pulmonary (most common), extrapulmonary and disseminated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

clinical presentation- pulmonary: where is it found and what are the two characteristic presentations?

A

-likes O2, so its found in upper lobes
-Slowly progressive constitutional symptoms
(Malaise, anorexia, weight loss, fever, and drenching night sweats)
-Chronic cough: Dry, then productive then bloody

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

extrapulmonary vs disseminated: where they are found and what are their clinical presentations?

A

Extrapulmonary: Spread through lymph or blood
Does not occur in primary – usually means reactivation TB

Disseminated (TB all throughout the body) in immunocomprimised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how does a pulmonary TB patient look on physical exam? what is the classic symptom?

A

Chronically ill and malnourished (b/c chronic infection is a huge metabolic demand)

Classic post-tussive rales: Crackles heard after cough (usually these are cleared with cough)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

TB was called _________ in the old days. why?

A

Consumption

b/c of the malnourishment, looked like it “consumed” people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are the parts of the extrapulmonary TB (GU, skin and skeletal?)

A

Skeletal TB – osteomyelitis or septic arthritis (Potts disease located in the lumbosacral spine)

GU TB – sterile pyuria (WBCs in urine from TB)

Miliary TB – Spread through other parts of lung through blood and not direct extension. looks like little Millett seeds in the lung. or a shot-gun pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

____ Dx is key for TB

A

Early diagnosis key

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is considered to make someone a high index of suspicion for TB?

A

bloody cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Chest Xray for primary progressive TB will show what?

A
  • homogenous infiltrates

- hilar and paratracheal lymph node enlargments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Chest Xray for reactivation TB shows what?

A

-Fibrocavitary in Apical or posterior segment of upper lobes or superior segments of lower lobes (O2 highest here)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are cavitations?

A

looks like walled off bubbles in primary progressive and reactivation TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

how do you take cultures for TB?

A

Three early a.m. sputums, gastric aspiration, or bronchial washings

26
Q

Positive culture takes_________ to grow and get sensitivity. This is definitive Dx.

A

6-8wks (very slow growing)

27
Q

how do you Dx TB?

A

culture (three early am sputums most likely)

28
Q

why would you test gastric aspirations for TB dx?

A

Gastric aspiration, b/c Pt will swallow pulmonary secretions while sleeping

29
Q

what is the prevention for primary TB? what type of vaccine is this?

A

BCG vaccine- Attenuated strain of M. bovis

a LIVE VACCINE

30
Q

PPD Measures what type of hypersensitivity ?

A

delayed (type IV)

31
Q

PPD tests Identifies those _______ _______ but does not tell if _______ or _______

A

likely infects, but does not tell if active or latent

32
Q

how do you tell if a PPD is positive? how long does it take for someone to show positive result after infection?

A 
by induration (not just erythema) 
2-12 weeks.
33
Q

5mm PPD is positive for what populations? (4)

A

HIV-positive persons

Recent contacts of TB case

Persons with fibrotic changes on chest radiograph consistent with old healed TB

Patients with organ transplants and other immunosuppressed patients

34
Q

10mm PPD is positive in what populations? (7)

A

Recent arrivals from high-prevalence countries

Injection drug users

Residents and employees of high-risk congregate settings (which is us)

Mycobacteriology laboratory personnel

Persons with clinical conditions that place them at high risk

Children < 4 years of age, or children and adolescents
exposed to adults in high-risk categories

Recent converters (those with an increase of 10 mm or more in size of TST reaction within a 2-year period)

35
Q

15mm is positive for PPD in what populations?

A

everyone else!

36
Q

what is a “recent converter” when we talk about TB patients?

A

people whose past PPD tests were negative but then had a positive result

37
Q

why do a 2 step PPD?

A

2 step PPD to be sure that a first negative response is not due to a waning immune response in someone infected long ago

38
Q

2 step PPD, if the first test is negative, check ____ week(s) later, and what if the second is … positive? negative?

A

If the first one is negative, check a second one a week later; if second one is:
POS, then Pt was previously exposed, and response was enhanced from the boost
NEG, then Pt is very anergic or not exposed

39
Q

Quantiferon Gold measures what?

A

it is a blood test that measures patient’s immune reactivity to TB bacterium

40
Q

_____, _____ and ______ suggest but DO NOT diagnose active TB

A

CXR, positive stain for AFB, PPD suggest but DO NOT DIAGNOSE active TB

41
Q

what is the only thing that can Dx TB?

A

culture

42
Q

do we treat TB if theres no definitive Dx but there is a high suspicion?

A

YES!

43
Q

there are many other non-TB ____ diseases.

A

mycobacterium

44
Q

what is the best place to find the newest treatment goals for TB?

A

CDC - the latest is 2016

45
Q

principle of TB txt : administer ____ drugs for ____ to _____months.

A

Administer multiple, susceptible drugs, generally for 6-9 mo

46
Q

how do you ensure adherence to TB treatment? why is this important?

A

DOT – Directly observed therapy, decrease MDR-TB (Multi drug resistance)

47
Q

what is the general treatment regiment for those with high index of suspicion of TB?

A

you start them on 4 drug cocktail for 8weeks on meds then get culture then change to fewer, more specific drugs (more specific drugs based on the sensitivity and specificity). (6-9mmonths after that)

48
Q

if there is multi-drug resistance for TB? what do you do?

A

consult an ID expert!

49
Q

after treatment for TB patients are _____ and _____.

A

cured and immune to TB (according to hadley). but you will always show up positive on PPD and quantifuron

50
Q

how is treatment different for HIV positive TB patients?

A

need longer therapy regiment b/c the immune system doesnt work well
Also, still use DOT and ID.

51
Q

Treatment monitoring to TB, patients need what to be deemed “no longer infective”? How frequent are checkups following this? What if they are at risk?

A

3 negative a.m. sputums

See monthly, if at risk, check hepatic panel for drug toxicity

52
Q

what ADRs are you worried about with TB treatment?

A

toxicities - liver and neuropathy

53
Q

complications with TB txt: destruction of the lung in TB is from _______ _______ and not ________ .

A

Destruction of lung is from immune reaction and not bacilli.

54
Q

what patient education is important for TB treatment?

A

Noncompliance a major problem
Education increases compliance
Case manager helps improve compliance
DOT

55
Q

mortality with DOT is < __% , what is the significance of this?

A

<5%, means drug therapy works if patients stick with it!

56
Q

dont forget to report active TB to who?

A

Board of Health!

57
Q

Positive PPD, no symptoms, normal CXR … what it the Dx?

A

latent TB

58
Q

latent TB: concern is that approximately 10% go on to develop active TB in a later stage of life. ___ % in the first ____ years after infection and ___ % per year thereafter. higher risk if what?

A

Concern is that approximately 10% go on to develop active tuberculosis at a later stage of their life
5% in the first 2 years after infection and 0.1% per year thereafter – higher risk if immunosuppressed

59
Q

what do you consider when trying to decide whether to treat latent TB or not?

A

Balance risk of disease against risk of liver and nerve toxicity from treatment drugs
(younger patients are less likely to have ADRs from drugs so they are more likely to take treatment)

60
Q

which drug is the shortest duration for TB and how long is this? what is another major benefit of it?

A

Isoniazid is shortest txt- 6 months and least likely to cause hepatotoxicity

clin med (88 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions