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Foundations-Pulmonary > 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 spread?

A

airborne droplets with ACTIVE TB infection

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3
Q

What are the two types of primary TB?

A
  1. Latent TB= 95%

2. Progressice Primary TB=5%= Active infection

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4
Q

Secondary TB

A

Reactivated TB from LTBI

Active Dz

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5
Q

What are the risk factors for TB

A
  1. Immunocompromised
    - HIV/AIDS=#1
    - Pt’s receiving immunosuppressive therapy
    - Children <5 y.o
  2. Crowded living conditions
  3. Exposure to someone with active infection
  4. Nationality/Geography
    - Africa, Asia, Latin America
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6
Q

What is considered a classic physical exam finding in TB?

A

Post-tussive rales

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7
Q

CXR findings in primary progressive active infection?

A
  1. Hilar adenopathy
  2. Hilar/middle lobe infiltrate
  3. Pleural effusions
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8
Q

CXR findings in reactive active infection?

A

Apical/upper lobe infiltrates and cavitation

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9
Q

Ghon/Ranke complex

A

Calcified primary focus and hilar lymph nodes= evidence of healed primary TB

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10
Q

What is the diagnostic gold standard for TB?

A

Sputum culture

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11
Q

What is the histologic hallmark in TB?

A

Biopsy showing necrotizing, caseating granuloma

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12
Q

What does the Mantoux test, PPD measure?

A

Induration

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13
Q

What could give you a false positive for TB on a skin test?

A

Bacillus Calmette-Guerin (BCG) vaccine

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14
Q

What test has better sensitivity and specificity than PPD for diagnosing TB?

A

Interferon Gamma Release Assays (IGRAs) blood test

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15
Q

What are the advantages of IGRAs blood test?

A
  1. Single visit
  2. Results in 24 hrs
  3. Not subjet to reader bias
  4. Not affected by BCG vaccine
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16
Q

What are the disadvantages of IGRAs blood test?

A
  1. Expensive
  2. Blood sample must be processed in 12 hrs
  3. Limited availability
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17
Q

Drug treatment for Active TB

A 
RIPE
R-Rifampin
I-Isoniazid
P-Pyrazinamide
E-Ethambutol
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18
Q

What is the main goal of latent TB treatment?

A

Prophylaxis tx to prevent active TB

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19
Q

Drug treatment for Latent TB

A

Isoniazid (INH) x 9 months

-AFTER you r/o active TB with hx and normal CXR

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20
Q

Rifampin (RIF) side effects

A

Excreted as red-orange compound in:

  • Tears
  • Sweat
  • Urine
  • Stool
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21
Q

Isonaizid (INH) side effects

A
  1. Hepatic toxicity- Monitor LFTs!

2. Peripheral neuropathy- Co-administer Vitamin B6 (pyridoxine)

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22
Q

Pyrazivlamide (PZA) side effects

A
  1. Hepatic toxicity

2. Hyperuricemia

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23
Q

Ethambutol (EMB) side effects

A

Optic neuritis

24
Q

What organism causes Histoplasmosis fungal infection?

A

Histoplasma capsulatum

25
Q

Where do you find Histoplasma capsulatum

A

Isolated from soil contaminated with bird or bad droppings

26
Q

Where is Histoplasma capsulatum more common?

A

Midwestern states

-Oho and Mississippi River valleys

27
Q

What is the most common form of histoplasmosis?

A

Asymptomatic primary histoplasmosis

28
Q

Sign and sx’s of acute diffuse pulmonary dz in histoplasmosis infection

A
  • Health people with intense exposure
  • Fever and fatigue
  • Duration: 1 wk-6 mos.
29
Q

Signs and sx’s of acute localized pulmonary dz in histoplasmosis infection

A
  1. Pneumonia like sx’s: fever, cough, dyspnea

2. Local infiltrates

30
Q

Signs and sx’s of chronic cavitary pulmonary histoplasmosis

A
  1. Apical cavities

2. Occurs in older COPD pt’s

31
Q

Signs and sx’s of disseminated histoplasmosis

A
  1. Fever, fatigue, cough, dyspnea, wt. loss
  2. Multiple organ failure-often fatal
  3. Rare in immunocompetent host
32
Q

CXR findings in histoplasmosis

A
  1. Hilar adenopathy

2. Patchy or nodular infiltrates in lower lung fields

33
Q

Lab studies in histoplasmosis

A
  1. Antigen detection- acute xz
  2. Serology
  3. Biopsy
  4. Cultures- chronic dz
34
Q

Histoplasmosis treatment for asymptotic pt’s

A

No treatment

35
Q

Histoplasmosis treatment for acute pulmonary infection

A

Oral itraconazole or Ketoconazole

36
Q

Histoplasmosis treatment for Severe infections

A

Amphotericin B IV

37
Q

Histoplasmosis treatment for chronic infections

A

Amphotericin B or itraconazole

38
Q

Histoplasmosis treatment for AIDS pt’s

A

Amphotericin B, maintenance therapy with itraconazole

39
Q

What organism causes Coccidiodomycosis

A

Coccidioides immitis OR

Coccidioides posadasii

40
Q

Where are Coccidiodomycosis organisms found?

A

Soil in semiarid areas

  • SW US
  • Mexico
  • South America
41
Q

Incubation period of Coccidiodomycosis

A

7-21 days (1-3 wks)

42
Q

Coccidiodomycosis clinical presentation

A
  1. Pneumonia manifestations-Fever, cough, pleuritic CP
  2. HA, arthralgias
  3. Marked fatigue
  4. Rash- erythema multiform,e, erythema nodosum
  5. Disseminated extra pulmonary infection
  6. Residual granuloma (scar) on CXR
43
Q

Who is @ an increased risk for disseminated cocci?

A
  1. HIV/immunocompromised pt’s
  2. African Americans, Asians
  3. Women in 3rd trimester
44
Q

How does disseminated cocci present differently?

A
  1. Pulmonary findings more pronounced- lung abscess
  2. Meningitis, lymphadenitis
  3. Bone lesions @ bony bony prominences
45
Q

Coccidiodomycosis CXR findings

A
  1. Hilar adenopathy
  2. Patchy, nodular pulmonary infiltrates
  3. Miliary infiltrates-disseminated dz
46
Q

Coccidiodomycosis lab findings

A
  1. Eosinophilia
  2. Serologic (blood) detection of IgM, IgG antibodies
  3. Culture
47
Q

When do you treat Coccidiodomycosis?

A
  1. > 10% loss body wt.
  2. Night sweats >3 wks
  3. Infiltrates >1/2 of one lung OR portions of both lungs
  4. Prominent/persistent hilar adenopathy
  5. Inability to work
  6. Sx’s > or equal 2 months
48
Q

Coccidiodomycosis treatment

A

Fluconazole 3-6 months

49
Q

What is the prognosis for disseminated and meningeal forms of Coccidiodomycosis?

A
  • High mortality rate

- 50% in absence of therapy

50
Q

Coccidiodomycosis treatment in 1st trimester of pregnancy? Why?

A

Amphotericin B IV

Azoles are contraindicated in 1st trimester

51
Q

What do you want to watch out for when using Itraconazole?

A

CHF

52
Q

What are -azoles (antifungals) drug interactions?

A
  • Interact with everything

- CYP450

53
Q

Major adverse reaction of Antifungal?

A

Hepatotoxicity

54
Q

When would we want to use Amphotericin B-IV? Why?

A

Only for severe cases: progressive, potentially life-threatening
MANY adverse rxns

55
Q

What is the most common opportunistic infection associated with AIDS?

A

Pneumocystis jiroveci pneumonia (formerly PCP)

56
Q

Pneumocystis jiroveci pneumonia clinical presentation

A
  1. Fever, cough, SOB (pneumonia)
  2. Hypoxemia
  3. CXR- diffuse perihilar infiltrates

Foundations-Pulmonary (9 decks)

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