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CPR Exam 2 > TB DSA > Flashcards

TB DSA Flashcards

1
Q

As immunity to Mycobacterium TB develops, how does the patient react to the tuberculin skin test (TST) and the interferon-y release assay (IGRA)?

A

Positive

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2
Q

If the TB infection is contained, a person is said to be what?

A

In a state of latent TB infection (LTBI), without systemic manifestations, however the risk for reactivation remains for years.

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3
Q

Reactivation TB is usually localized to the _____.

A

Lungs

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4
Q

What are risk factors for primary progression and reactivation of quiescent TB?

A
  1. HIV/AIDS***
  2. Malnutrition
  3. Immunosuppressed states
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5
Q

What form the cornerstone of control of active TB infection?

A
    1. Agressive screening
    1. High amount of suspicion
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6
Q

How can we promote primary and secondary prevention of TB?

A
  • Primary: isolate (in hospital, put in room with (-) air pressure and all entering people should have masks with filtering capacity of 95%)
  • Secondary: treat patients with suspected LTBI
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7
Q

ALL high-risk patients with + TST/IGRA should be offered _______, unless prior treatment is noted or medically contraindicated.

A

LTBI treatment

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8
Q

Who is screening for TB performed for and via what methods?

A
    • Screening is NOT needed for low-risk indiviuals.
    • High risk of exposure or contraction: Mantoux TST or IGRA
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9
Q

A (+) TST is defined by _________

A

the diameter of the indurated area, considering risk profile.

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10
Q

Induration >5mm is postive for whom?

A
    1. HIV infection
    1. Recent contract with case of active TB
    1. Person with fibrotic changes changes on CXR that show old TB
    1. Organ transplant/immunosupressed.
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11
Q

Induration >10mm is postive for whom?

A
    1. Immigrant from country with high TB prevelance within 5 yrs
    1. IV drug user
    1. Person who works are high-risk congregate area
    1. Health care worker, child under 4 YO or expossed to adult
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12
Q

Induration >15mm is postive for whom?

A

Person w no risk factors for TB

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13
Q

Why should re-testing or empiral treatment be done for high risk patients (ex. those with HIV)?

A

Skin test results may not become + for 12 weeks after exposure to active infection.

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14
Q

When should two-step testing be performed and why?

A
  • Pt exposed to TB in the distant past could have a (-) skin test.
    • Thus, a second test done 7-21 days after first can help reduce false (-) response rate => uncover a true positive.
  • Perform at regular testing programs (nursing home, hospital)
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15
Q

How is IGRA different from TST?

What population is it preferred for?

A
  1. IGRA asses T-cell response to M. TB.
  2. More expensive, but done in a single blood draw and no need to come back.
  3. Does not give a false postive in person w BCG vaccine
  4. Preferred for: person w BCG vaccine and those unlikely to return for TST interpretation,
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16
Q

What test is preffered for children UNDER 5 YO?

A

TST

17
Q

IGRA and TST are used separtely.

In what specific situations are they performed separetly?

A
  • Initial test is is indeterminate or (-), but high clinical suspicion.
18
Q

Which test can differentiate between LTBI and active TB?

A

Neither

19
Q

If IGRA or TST is (+), how do we determine is patient has active TB or LTBI?

A

CXR, hx, PE

20
Q

Patients with pulmonary TB, often have what sx?

A

ASYMPTOMATIC.

Constitutional symptoms, as well as local sx (cough) can develop.

21
Q

The most common pulmonary finding in patients with active tuberculosis is

A

Normal examination

22
Q

HIV or immunocompromised TB patients will …

A
  • have a greater liklihood of dissemination/extrapulmonary infection

but classic sx of TB are absent and CXR may be NL

23
Q

What are the differential dx of TB?

A
    1. Non-TB mycobacterial infection: perform CT
    1. Sarcoidosis
    1. Aspiration pneumonia
    1. Lung abscess
    1. Histoplasmosis cocidiodomycosis
    1. Wegners
    1. Actinomycosis
    1. Lung cancer
24
Q

What is the cornerstone of management of TB?

A
  • 1. Bacteriologic confirmation
  • 2. Susceptibility testing
25
Q

In patients with infection, TST is usually positive within ________ hours.

A

48-72

26
Q

Which patients with active TB can show a false-negative?

A

- Anergic patients

- 25% of patients with active TB

27
Q

What tests should be run on a patient suspected of ACTIVE TB?

A
  1. Acid-fast bacili smear
  2. Cultures of pulmonary and suspected site of infection
  3. CXR
  4. TST or IGRA
28
Q

What test can be formed to exclude TB in patients with false (+) sputum or to confirm TB in some patients with false (-) smears?

A

Nucleic acid amplication test of sputum

29
Q

What is the gold standard used for diagnosis of TB?

A

Solid media culture + liquid media culture

30
Q

What test is run for patients suspected of pleural TB?

A

thoracentesis or pleural biopsy

31
Q

On radiology, what does reactivation of TB look like?

A

Lesions in the apical posterior segments of the upper lung and superior segments of the lower lobe

32
Q

What can we see on radiology for patients with

  1. Primary progressive TB
  2. immunocompromised pts
A
    1. Hilar adenopathy or infiltrates in any part of lung
    1. Atypical or absent findings
33
Q

What is the standard treatment for suspected or confirmed active TB?

A

RIPE (rifampin, isoniazid, pyrazinamide and ethambutol) for 6 months.

34
Q

How can we monitor treatment administered to patients with suspective/active TB infection?

A
  • Repeat suptum smear and culture after 2 month phase, to determine whether patient should continue for 4 months or 7 months.
35
Q
  • MDR TB is resistant to
  • Extensively drug-resitant TB (XDR) is resistant to
A
  • Isoniazid and rifampin
  • Isoniazid and rifampin + fluoroqinolones and at least kanamycin, amikacin or capreomycin.
36
Q

How do we treat MDR or XDR?

A

Individualized regimen based on comphrensive drug susceptilbilty and consutation with a expert.

37
Q

How are patients with LTBI treated?

A

Individualized:

    1. Isoniazid/day/ 9 months
    1. Rifampin/day/4 months
    1. Rifapentine + isonizid/1wk/3months via directly observed therapy.

B4 tx: exclude active TB, risk and benefits, obtain blood tests to test for drug toxicities that may complicate tx.

38
Q

How should we follow up with TB patients

A

Careful monitoring

    1. Monthly sputum cultures
    1. Adjust drugs
    1. Contact TB expert if sputum culture remains positive or if pt has not improved clinically after 3 months.
    1. Periodic assessments for adverse reactions

CPR Exam 2 (29 decks)

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