TB/CAP/Influenza Flashcards
What is the most common pattern of TB
TB is reportable by law.
Post Primary Disease
Pt is asymptomatic with + TST test
Latent TB
+ Tests
CXR result
can they spread bacteria?
do they get treated?
Asymptomatic
+ TST/IGRA result
CXR nl
does not spread bacteria but needs to be treated
Pulmonary TB
Symptomatic
fever, cough, c.p., weight loss, nigh sweats, hemoptysis, dc appetite, irregular menses
What is the diagnostic of TB
Does this test for active TB?
TST or Quantiferon (IGRA) Postive Negative Indeterminate
For those who have been treated for TB or had + TST, should you keep doing TST?
NO
How much induration for +TST with no known risk factors
> 15 mm
What is anergy
DC or absent response to TST that is caused by severe illnesss or pulmonary disease
Not useful for the immunocomp
What should you do for false negative testing
Repeat TST in 1 -3 weeks. + mean boosted reaction
What does a CXR indicate in TB
AFB Culture in TB
Suggestive of TB
3 sputum cx needed + specimen
Class 2 TB
+ TST/Quant
- CXR
INH x 9 months
INHRPT x 12 weeks
so LTBI don’t become Active
Class 3 TB
M. Tuberculosis cultured
Multi drug therapy
See TB Specialist
Class 5
TB suspected Diagnosis pending
Clinically active (with symptoms)
start MD Therapy
First Line Drugs TB RRRIPE
Rifampin
Rifabutin
Rifapentine
INH**
Pyrazinamide
Ethambutol
Isoniazid: #1
300 mg x 9 months
which lab work q month
a.e.
DORTT
INH induced hepatitis. No ETOH
Monthly LFT and physical exam
Take with Pyridoxine
DORTT (meds that inc INH Hepatitis
Dilantin, Ortho-Est, Reglan, Tylenol, Tapazole
INH-RPT 12 week course LTBI
what color secretions turn
What should you not take Rifapentine with
Monthly physical exam
Secretions turn red, in liver enzyme, neutropenia, stain contact lenses.
Don’t take with Coumadin and methadone
When should you use Rifampin
INH intolerant pts. Turns secretions orange urine sweat tears, don’t give to HIV pts.
Clinically active RB pts are considered no longer a threat after how many weeks
2 weeks.
Hospital Acquired PNA
Ventilator Associated PNA
48 hours after admission
48 hours after intubation
How long should you have been in the community to be DIAGNOSED with CAP
Most common bacterium
DIEHR Rule
14 days
S. Pneumoniae (mucopurulent sputum)
Predict PNA probability in primary care
Outpatient setting DX
CXR and CBC with Diff
What is gold standard for dx PNA
CXR AP/Lateral :Shows infiltrate
Medication for CAP
Healthy <65 y.o , no abx in 3 month
(AD/ACE)
Amoxicillin
Doxycycline
Azithro/Clarithro/Erythro
Medications for CAP
>65 y/o, comorbidities, used abx in 3 mo
B Lactam/Fluoroquinolone
x 5 days
Amoxicillin/Amoxicillin-clauvunate (Augmentin)
Alt: Cefpodoxime (Vantin) , Cefuroxime (Ceftin) PLUS Macrolide Doxycycline, Azithro,Clarithro,Erythro
OR
Fluoroquinolone Moxiflox,Gemiflox, Levoflox
Primary Care Tool for admission of PNA
Greater than 1 point - HOSPITAL
CRB-65 Score
Confusion
RR
BP 90/60
Age > 65
What is the vaccine for PNA >65 y.o.
What should you give first PCV13 or PPSV23?
PPSV23. give 5 years apart
Give PCV13 should be given first before PPSV23 then one year later give PPSV23
but depends on patient and provider convo.
Influenza A
Influenza B
Gold standart test for flu
Influenza A: birds and pigs
Influenza B: Humans
Droplet ‘
Viral culture or RT-PCR
Antivirals for Influenza A and B
How Many hours should you start after fever
Tamiflu- oral
Relenza ZanavimirL Puff
RapIVab - IV use
Start 48 hrs
Allergy to egg , what immunization
Intranasal option
Recombinant
FluMist
