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MJ- Foundations 2 Exam 3 > TB, Cocci, Histo, PCP > Flashcards

TB, Cocci, Histo, PCP Flashcards

1
Q

Affects 1/4 of world’s population. Global pandemic with HIV

A

TB

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2
Q

Causative agent of TB

A

Mycobacterium tuberculosis

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3
Q

How does TB spread

A

by airborne droplets from Active TB patients

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4
Q

Is TB chronic or acute

A

Chronic

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5
Q

After inhaling TB, there are 4 possible outcomes. What are they?

A

1) clear bacteria
2) Active TB case
3) Latent infection (wall off)
4) Re-activation TB (necrosis breaks through walled off are)

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6
Q

Popcorn: caseous necrosis

A

TB

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7
Q

Non-necrotising necrosis

A

Sarcoidosis

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8
Q

How long dose it take for macrophages to wall off TB?

A

2-8 weeks

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9
Q

Is latent TB infectious?

A

No

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10
Q

Is Re-activated TB infectious?

A

Yep

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11
Q

Why do latent TB patients take prophylaxis?

A

to not develop reactivated TB

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12
Q

What are TB risk factors (CHARMS)?

A

Children <5, HIV, Alcohol, Radiation (immunetherapy), malnutrition, SUD,

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13
Q

What nationalities have high TB? Triple As

A

Africans, Asians, Latin Americans

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14
Q

Will a skin test (PPD) for TB be positive for Latent TB?

A

Yes, Next step is a CXR

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15
Q

SXS of active TB? Classic TB

A

Fevers, Chills, night sweats, chest pain, anorexia, weakness, fatigue, weight loss.

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16
Q

What does TB look like (another infection)?

A

Like Pneumonia, post-tussive rales = classic

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17
Q

What does TB look like with a CXR?

A

Hilar adenopathy at MIDDLE lobe

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18
Q

What does reactivated TB look like with a CXR?

A

Apical/ Upper lobe infiltrates and cavitations

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19
Q

How do you Diagnose TB

A 
Sputum cytology - NAT
Sputum culture = GOLD STND
need 3 consecutive in the morning
3 AFB sputum smears = not diagnosable
Biopsy = necrotizing caseating granuloma
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20
Q

What do you measure on a TB test?

A

induration not erythema

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21
Q

what is the 2 step TB test?

A

Do the first PPD and read it 2-3 days after it is placed. Then repeat the PPD1-3 weeks later if the first one came back negative.

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22
Q

If a patient has a BCG vaccine, will they be positive on the skin test?

A

yes

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23
Q

What factors causes a patient to have a positive PPD of 5mm?

A

HIV, Recent contacts, TB on CXR, immune comp

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24
Q

Are the blood draws for TB?

A

Yes, the IGRA and the T Spot

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25
What are some advantages to an IGRA blood draw for TB?
Done in one visit, results in 24 hours, no booster needed, no reader bias, isnt affected by BCG Vax
26
What are some disadvantages to an IGRA blood draw for TB?
expensive, blood sample needs to be processed w/n 12 hours, and prone to blood draw errors.
27
Is TB reportable?
Yes within 24 hours by phone
28
How do you treat a patient with active TB?
Isolate in a negative pressure room (patient gets a mask, pcp gets a respirator). Give RIPE with Directly observed Therapy.
29
How do you treat LTBI (Latent)
Prophylaxis with INH and Vit B6 for 9 months
30
What are 2 complications to TB infection?
Miliary spread and Multi-drug-resistant
31
What are some side effects to RIPE?
R - red/orange tears, sweat, urine, stool I - hepatic toxicity P - hepatic toxicity E - Optic neuritis
32
Who gets TB target testing?
patients at high risk of developing disease once infected - annual skin test, and offer phrophylaxis
33
Latent TB signs and sxs include..
None, patient feels normal and is not contagious, but will be positive on the skin test or IGRA
34
What is the most common Non TB mycobacteria?
MAC - mycobacterium avium complex.
35
Where is MAC found?
in the soil and water
36
Chronic lung infections account for __% of NTM infections.
90%
37
What are other TB bacterias?
M. africanum
38
What signs will a MAC patient have?
SF lymphadenitis and Cervical lymphadenitis in kids
39
Wheres does MAC Like to infect?
skin and soft tissue - direct innoculation
40
what are the 2 MAC presentations?
1) cavitary - COPD smoking Men. | 2) Nodular bronchiectatic disease in non-smoking women >50
41
How do you Diagnose MAC
Sputum or bronchial wash with an AFB culture.
42
First line MAC tx is...
Macrolides, ethambutal and RIF for 12 months.
43
Where is Histo and Cocci from?
Histo - Ohio river valley and bat/bird stool | Cocci - SW US
44
What is the most common form of Histo infection?
Asymptomatic with granumola (scars) on CXR
45
Active diffused pulmonary disease with Histo sxs are...
fever, Marked Fatigue lasting for 1 week to 6 months but is almost never fatal.
46
Acute localized pulm disease with Histo presents as...
pneunomia with LOCAL infiltrates.
47
Histo in older COPD patients with Apical cavities is .....
Chronic cavitary pulm Hostoplasmosis
48
Rarely occurs in immunecompentent patietns, but sxs include fever, Marked Fatigue, cough, dynspea, and wt. loss
Disseminated Histoplasmosis - often fatal
49
How can you diagnosis Histo
``` Differentiate from Sarcoidosis or TB No. 1 = Cultures for chronic cases. CXR - Hilar adenopathy, patchy, nodular infiltrates in LOWER lung fields. Lab - Antigen in bronchoalveolar lavage. Serology - weeks to detect antibodies ```
50
Where is Histo found on a CXR
Hilar adenopathy
51
How can you treat Histo?
``` no tx for Asxs patients (sxs control) Symptomatic patients dont need tx but can receive Itraconazole. Severe = Amphotericin B IV Chronic = Amphotericin B or Itraconazole AIDS = Amphotericin B and Itraconazole ```
52
What is cocci' s incubation time?
7-21 days
53
what percent of cocci patients have sxs?
40% but only 1/2 of them seek treatment
54
what are Cocci infection sxs? | what do you see on a CXR
fever, cough, pleuritic pain, Headache, arthralgia, Marked Fatigue, rash (3Es) CXR - scar granuloma
55
What are the 3 Es and in what disease are they present?
Eosinophilia, Erythema nodosum, erythema multiforme
56
what patient demographics gets complications for Disseminated Cocci?
Africans, Asian, and women in 3rd trimester at greater risk for disseminated cocci
57
What does cocci look like if the infection is serious?
Lymphadenitis, Meningities, Bone lesions at bony prominances
58
What makes a patient immunecompromised?
- solid organ transplant - high dose steriod - chemo - immunosuppressed meds - pre-existing cardiopulm conditions - frail and old
59
how can you diagnose cocci?
CRX- hilar adenopathy, patchy nodular infiltrates, miliary, THIN WALLED CAVITIES
60
What are some lab findings for Cocci?
High Eosinophils, IgM, and IgG. | Phoenix = 10-50% positive for skin test
61
How can you treat cocci?
NO Steroids | Immunsuppressed- Fluconazole 3-6 months + Amphotericin B IV (if 1st trimester of pregnancy)
62
What the the prognosis for Cocci?
very good, unless its disseminated or meningeal (50% mortality rate)
63
Why are Azoles a crappy medication?
interact with CYP 450, GI, HEPATOTOXIC
64
Most common infection in AIDS patients?
jiroveci pneumonia > 200 cd4 t cells = hypoxia

MJ- Foundations 2 Exam 3 (15 decks)

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