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clinical medicine II exam 2 > TB/Histo/Cocci > Flashcards

TB/Histo/Cocci Flashcards

1
Q

what organism causes TB

A

Mycobacterium tuberculosis

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2
Q

how is TB transmitted

A
  • airborne droplet nuclei
    • usually requires prolonged exposure
  • pt must have active TB to spread infection
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3
Q

when will a skin test show up positive after exposure to TB

A

6-8 weeks

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4
Q

of people who get infected with TB, what percentage will have active disease (primary)

A

5%

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5
Q

of people who get infected with TB, what percentage will have active disease (secondary) after latent TB

A

5%

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6
Q

of people who get infected with TB, what percentage will become latent infections

A

95%

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7
Q

describe latent TB infection

A
  • TB present in body without symptoms
  • TB live in granuloma
  • unable to transmit infection to others
  • Latent TB may activate to disease if pt becomes immunocompromised and granulomas break down
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8
Q

what percentage of patients infected with TB get active TB

A
  • 10%, 5% intially, and 5% develop from latent
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9
Q

list steps of medical evaluation of TB

A
  1. medical history
  2. physical exam
  3. TB infection testing
  4. CXR
  5. bacteriological examination
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10
Q

risk factors for TB

A
  • immunocompromised
    • HIV
  • immigrants from areas of high TB prevalence
  • IV drug users
  • close living quarters
    • nursing homes, correctional facilities, hospitals
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11
Q

clinical presentation

  • fever
  • cough
    • 3+ weeks
      • +/- hemoptysis
      • +/- productive
  • CP
  • weakness, weight loss, chills, night sweats
  • PE: posttussive rales
A

TB

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12
Q

what are possible complications from TB

A
  • pneumothorax
  • bronchiectasis
  • malignancy
  • pulmonary aspergillosis
  • septic shock
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13
Q

Describe TB skin testing

A
  • Mantoux tuberculin skin test (TST)
    • given in forearm intradermal
    • read in 48-72 hours
    • measure induration, not erythema
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14
Q

For what groups is a reaction size of > or = 5 mm considered positive TB skin test

A
  • HIV +
  • recent contacts of person with active TB
  • persons with evidence of TB on CXR
  • immunosuppressed
  • organ transplant
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15
Q

For what groups is a reaction size of > or = 10 mm considered positive TB skin test

A
  1. recent immagrants from areas with high rate of TB
  2. IV drug users
  3. mycobacteriology lab personnel
  4. residents.employees of high risk congregate setting
  5. children < 4 yo
  6. infants, children, adolescents exposed to adults at high risk
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16
Q

For what groups is a reaction size of > or = 15 mm considered positive TB skin test

A

positive in anyone even without risk factors for TB

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17
Q

describe the 2 step skin test for TB. When it is recommended

A
  • recommended as initial test for health care workers and individuals requiring periodic retesting
    • 1st negative, repeat in 1-3 weeks
    • 2nd positive, TB infection present (creates boosted response)
  • ** BCG vaccine may create false positive
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18
Q

what is the interferon gamma release assay: Quantiferon TB Gold

A
  • measure immune response in blood to TB
  • may be used in place of TST if patient has recieved BCG vaccination
  • unable to differentiate between TB disease and latent TB infection
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19
Q

what initial presentation may be seen on CXR when you suspect a patient has TB

A
  • normal or hilar lymphadenopathy
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20
Q

What is typical on CXR of a person with latent TB

A
  • typically normal
  • can see dense nodules or lesions with possible calcification
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21
Q

TB usually settles in what part of lung

A
  • apical/posterior upper lobes
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22
Q

If patient has positive TB skin test, and suspicious CXR, what is the third step? describe it

A
  • bacteriological exam: sputum collection
    • ​3 specimens (8-24 h apart)
    • at least 1 in the morning
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23
Q

What three things are you looking for in sputum collection for TB patient

A
  1. smear: acid fast bacilli
  2. cytology: nucleic acid ampification test (NAA)
  3. culture: gold standard **confirms diagnosis but may take weeks
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24
Q

how is TB diagnosed

A
  • if both smear (showing acid fast bacteria) and nucleic acid amplification test are positive, TB disease is presumed and treatment begins
    • DO NOT delay treatment waiting for culture
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25
Q

Treatment of active TB

A
  • isolated negative pressure inpatient hospital room
  • drugs (RIPE)
    • Isoniazid
    • Rifampin
    • Pyrazinamide
    • Ethambutol
  • **DOT: direct observed treatment
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26
Q

side effects of isoniazid

A
  • hepatotoxicity; monitor LFT
  • peripheral neuropathy; patients given Vitamin B6
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27
Q

side effects of rifampin

A

red-orange tears, sweat, urine

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28
Q

side effects of pyrazinamide

A
  • hepatotoxicity
  • hyperuricemia
29
Q

side effects of ethambutol

A

optic neuritis: test visual acuity and color vision

30
Q

length of treatment for TB

A
  • initial phase: 4 meds daily x 8 weeks, then
  • continuation phase:
    • RIF and INH daily x 18 weeks or
    • INH and RIF twice weekly for 18 weeks
31
Q

length of treatment for TB in HIV +

A

treatment is extended 9-12+ months

32
Q

treatment for TB in pregnant women

A

Pyrazinamide not given

33
Q

treatment for TB in infants/children

A

ethambutol not given and may extend treatment

34
Q

When is a person on TB medication not considered infectious

A
  • 2 weeks of treatment regimen
  • 3 negative sputum smears
  • symptoms improve
35
Q

treatment for latent TB

A
  • 9 month daily regimen of isoniazid
  • monitor LFT
  • give with vit B6
36
Q

What classifies TB as MDR-TB

A

does not respond to at least INH and RIF

37
Q

What classifies TB as XDR-TB

A

does not respond to INH, RIF or fluoroquinolones

38
Q

is there a test available to quickly determine if TB is drug resistant

A

Xpert MTB/RIF test

  • rapid TB test: result in 2 hours
39
Q

Describe the bacille calmette guerin vaccine. type and purpose

A
  • intradermal live strain vacccine
  • purpose: decrease risk of severe consequences due to TB disease
    • does not prevent primary infection or activation of LTBI
40
Q

CDC recommendations for who should get BCG vaccine

A
  • children with negative TST and continual exposure
    • does not recommend HIV positive children
  • health care workers if high risk of MDR-TB
41
Q

CDC recommendations for who should NOT get BCG vaccine

A
  • immunosuppressed
  • pregnancy
42
Q

is TST or blood test contraindicated if person has recieved BCG vaccine

A

No, blood test will likely produce false positive

43
Q

where is histoplasmosis normally found

A
  • soil contaminated with bird or bat droppings
  • midwestern states: ohio and mississippe river valleys
44
Q

how is histoplasmosis transmitted

A
  • inhalation of fungal spores from contaminated soil
  • body temp converts spores to yeast
  • yeast proliferates in lungs and spreads to lymphatics -> other organs
45
Q

histoplasmosis is most commonly found in what patient populations

A
  • HIV/AIDS
  • weakened immune systems
46
Q

clinical presentation

  • recent activity: spelunking, construction, mining, farming, gardening
  • mild flu like symtpoms
A

histoplasmosis

47
Q

define asymptomatic primary histoplasmosis

A
  • most common in otherwise healthy people
  • CXR may show residual granuloma
48
Q

define acute symptomatic pulmonary histoplasmosis

A
  • fever and marked fatigue, few respiratory symptoms
  • symptoms 1 week-6 months
  • typically self limitied
49
Q

define progressive disseminated histoplasmosis

A
  • pt typically immunocompromised
  • fever, marked fatigue, cough, dyspnea, weight loss
  • mutliple organ involvement
  • fatal within 6 weeks
50
Q

older COPD patients who get histoplasmosis, usually present with

A
  • chronic pulmonary histoplasmosis
  • see progressive lung changes
    • apical cavities
51
Q

how is histoplasmosis diagnosed

A
  • **antigen detection: enzyme immunoassay (EIA test) : recommended to get this first
    • ​typically urine or serum testing
  • antibody tests
    • immunodiffusion (ID) test
      • tests for acute and chronic infection
    • complement fixation
  • culture: gold standard
    • definitive diagnosis; may take 6 weeks
52
Q

When does a patient start to get treatment for histoplasmosis? What is the treatment?

A
  • acute pulmonary: mild-moderate > 4 weeks
  • treatment: itraconazole x 6-12 weeks
53
Q

What CXR findings are consistent with histoplasmosis

A
  • hilar adenopathy
  • patchy or nodular infiltrates in lower lobes
54
Q

If patient /o pulmonary sx with rheumatologic arthritis and erythema nodosum, what should you be concerned about

A

fungal infection

55
Q

How is Coccidioidomycosis (valley fever) transmitted

A
  • inhalation of spores from contaminated soil
  • endemic to lower desserts of western hemisphere
  • outbreaks occur following dust storms
56
Q

high risk groups who tend to have a more severe presentation of Coccidioidomycosis (valley fever)

A
  • immunocompromised
  • pregnant
  • DM
  • African or Filipino ethnicity
57
Q

What percentage of people who are exposed to histoplasmosis are symptomatic

A

90% are asymptomatic or have mild flu-like symptoms

58
Q

what percentage of individuals exposed to Coccidioidomycosis (valley fever) are symptomatic

A
  • 60% are asymptomatic
  • 40% symptomatic (<1/2 seek medical care)
59
Q

if a person has asymptomatic Coccidioidomycosis (valley fever), what could still be present on CXR

A

residual granuloma

60
Q

What are typical symptoms of Coccidioidomycosis (valley fever) in previously healthy people

A
  • mild respiratory sx; self limited, lasting weeks-months
  • may progress to chronic pulmonary or disseminated disease in high risk group
61
Q

clinical presentation

  • CAP 7-12 days following exposure
  • fever, cough, pleuritic CP
  • marked fatigue, HA, arthralgia
  • rash: erythema multiform, erythema nodosum
A

primary infection Coccidioidomycosis (valley fever)

62
Q

if Coccidioidomycosis (valley fever) disseminates, where does it usually go

A
  • Lungs, Bones, Brain
    • more pronounced lung findinds: abscess
    • bone lesions
    • lymphadenitis, meningitis
63
Q

how is Coccidioidomycosis (valley fever) diagnosed

A
  • immunodiffusion (ID) test
    • detects IgM
  • enzyme immunoassay (EIA)
  • complement fixation
    • detect IgG
64
Q

what immune cell type is prominant in Coccidioidomycosis (valley fever) infection

A

eosinophilia

65
Q

what CXR findings are consistent with Coccidioidomycosis (valley fever)

A
  • vary
    • hilar adenopathy
    • patchy, nodular pulm infiltrates
    • miliar infiltrates
    • thin wall cavities
  • chronic pulm dz: residual lung nodules thin walled cavities or chronic cavitary lesions with infiltrates
66
Q

treatment for Coccidioidomycosis (valley fever)

A
  • typically not required, if appear healthy, do NOT need treatment
  • tx recommended for high risk or severe illness
    • fluconazole and itraconazole
      • **check LFTs
67
Q

treatment of Coccidioidomycosis (valley fever) in pregnant females

A

amphotericin B (azoles are teratogenic)

68
Q

what is highest on your differential with these:

  • pulmonary complaints
  • ertyhema nodosum
  • erythema multiforme
  • eosinophilia
A

Coccidioidomycosis (valley fever)

clinical medicine II exam 2 (7 decks)

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