TB/Fungal Pneumo

Question 1

TB etiology?

Spread?

Answer 1

myco tuberculosis

Spread: PROLONGED airborn exposure to droplets from ACTIVE infection

droplets contain tubercle bacilli

Question 2

Normal immune response to TB?

Abn response to TB?

Answer 2

macrophages wall off bacteria in lungs (LTBI)

macrophages form granulomas -> TB multiply inside gran -> necrotizing granulomas -> break and bacteria spill into lungs

Question 3

2º TB is?

Answer 3

reactivation of LTBI

Question 4

TB epidemiology?

Answer 4

immuno-compromised

non-whites

Question 5

TB presentation?

Answer 5

Pneumonia-like

post-tussove rales

Question 6

TB lab findings?

Answer 6

(U) normal
hypoN+ (SIADH)
↑ CRP

Question 7

TB CXR findings?

Answer 7

determine active/latent

Active:
focal infilt up lobes, hilar adeno, effusions, cavitation

Ghon-Ranke Complex:
calcified primary focus and hilar lymph node

Question 8

TB sputum findings?

Answer 8

Nucleic Acid Amp test
Cx for tx (3 consecutive a.m. specimens)
Smear = acid-fast bacilli (not definitive for TB)

Question 9

TB bx findings?

Answer 9

necrotizing granulomas!

Question 10

TB blood test?

Answer 10

interferon gamma release assay

Question 11

Active TB tx?

Answer 11

isolation
RIPE drugs x 6 mo:
Rifampin (RIF)
Isoniazid (INH)
Pyrazinamide (PZA)
Ethambutol (EMB)

Question 12

LTBI tx?

Answer 12

prophylaxis:
Isoniazid x 9 mo

monitor LFT

Question 13

Drug toxicities:

RIF?

INH?

PZA?

EMB?

Answer 13

RIF = orange excretions

INH = hepatitis, peripheral neuropathy

PZA = hepatitis, hyperuricemia

EMB = optic neuritis

Question 14

Fungal pneumo: common types?

Answer 14

histoplasmosis

coccidioidomycosis

Question 15

Histoplasmosis etiology?

Epidemiology?

Answer 15

h. capsulatum
(bird/bat poop)

midwest, spore inhalation

Question 16

Histoplasmosis presentation?

Progressive?

Chronic?

Answer 16

(U) asymp
fever, ↑↑ fatigue, few respiratory sxs
1 wk- 6 mo

+ cough, dysp, wgt loss
multi organ, fatal

(U) older COPD
progressive lung Δs

Question 17

Histoplasmosis CXR findings?

Answer 17

hilar adeno

patchy/nodular infilt, low lobes

Question 18

Histoplasmosis labs?

Answer 18

antigens (lung fluid, blood, urine)
Bx
Cx for chronic

Question 19

Histoplasmosis tx?

Asymp?

Acute?

Severe?

Chronic?

AIDS?

Answer 19

Φ for asymp

Acute: Φ or conazoles

Severe: amphotericin B IV

Chronic: amphotericin B or itraconazoles

AIDS: amphotericin B PLUS itraconazoles maintenance

Question 20

Coccidioidomycosis (valley fever) etiology?

Answer 20

c. immitis or c. posadasii (molds)
south US and mexico desert
spore inhalation

Question 21

Coccidioidomycosis sxs?

Answer 21

(U) pneumonia, ↑↑ fatigue, HA, arthralgias
ERYTHEMA NODOSUM (on shins)
Erythema multiforme

Question 22

Coccidioidomycosis disseminated epidemiology?

Sxs?

Answer 22

immuno-comp
blacks, asians, 3rd tri preggos

↑ pulmo sxs
Lymphadenitis
Meningitis
Bone lesions at prominences

Question 23

Coccidioidomycosis CXR findings?

Answer 23

hilar adeno,
patchy/nodular infiltrates,
miliary infilt w/ disseminated dz,
thin-walled cavities

Question 24

Coccidioidomycosis lab findings?

Answer 24

EOSINOPHILLA

serum antibodies

Question 25

Coccidioidomycosis tx?

Answer 25

NO steroids
progressive dz: fluconazole, ampho B
thoracic srugery

Question 26

Conazoles to treat fungus interactions?

Answer 26

metabolized by CYP450 so ↑↑ interactions

monitor liver fxn for toxicity