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Clin Med II Exam 2 (Lauren) > TB, Histo, Cocci > Flashcards

TB, Histo, Cocci Flashcards

1
Q

How is TB transmitted?

A

Airborne droplet nuclei

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2
Q

Can you get TB from a homeless person coughing when they walk past you?

A

Not likely. Usually requires prolonged exposure, like someone you live with.

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3
Q

How long after TB exposure will the PPD skin test be positive?

A

6-8 weeks

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4
Q

A latent TB infection involves macrophages surrounding the tubercle bacilli and creating a barrier shell called a ________

A

Granuloma

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5
Q

What can cause latent TB to reactivate

A

An immunocompromised state

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6
Q

After exposure, how many peopel develop active disease?

A

5%

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7
Q

How many peopel with latent TB have a reactivation?

A

5%

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8
Q

Can a chest X ray confirm TB diagnosis?

A

No, need diagnostic microbiology

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9
Q

What is the number one killer of HIV patients?

A

TB

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10
Q

What are the symptoms of TB?

A

Fever

Cough (3 wks) may or may not be productive/bloody

Chest pain

VAGUE SYMPTOMS

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11
Q

What is the classic finding of TB on physical exam?

A

Posttussive Crackles

****

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12
Q

How do you inject the Mantoux tuberculin skin test?

A

Given in forearm intradermal*

Create wheal with 0.1 mL PPD

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13
Q

How long after injecting PPD do you read the TST?

A

48-72 hrs

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14
Q

When reading a TST, what do you measure?

A

Induration, not redness

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15
Q

If a patient comes in and says they were hanging out with someone with active TB one week ago, and they want to know if they caught it, should you do a TST?

A

No, becasue it wont be positive for 6-8 weeks following exposure

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16
Q

A TST skin test is considered positive at 5mm of induration for what 5 groups of peopel?

A
  1. HIV +
  2. Recent contacts of those with active TB
  3. Evidence of TB on CXR
  4. Immunosuppressed (Chronic steroids)
  5. Organ transplant patients
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17
Q

A TST test is considered positive at 10mm for what 7 groups of peopel?

A
  1. Recent immigrants from countries with lots of TB
  2. IV drug users
  3. Mycobacterial lab personnel
  4. Residents/employees of high risk settings (healthcare workers, inmates, correction officers etc)
  5. High risk medical conditions
  6. Children under 4
  7. Youth who are exposed to high risk adults
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18
Q

A TST skin test is considered positive at _____mm for anyone without risk factors for TB

A

15

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19
Q

Why do healthcare workers neeed a 2 step TB test for their initial test?

A

1st test: negative

2nd test 1-3 weeks later: positive, TB infection present (creates “boosted” response and is likely due to past exposure)

I have nooooooooo clue what this means

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20
Q

What is the name of the TB vaccine that may create false positive TSTs

A

BCG (bacillus Calmette-Guerin)

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21
Q

What is the name of the interferon Gamma Release Assays (Blood tests) for TB testing

A

QuantiFeron TB Gold

T-SPOT TB

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22
Q

When would be good situations to do the more expensive TB blood test instead of the skin test?

A
  • concerns that patient won’t return for the reading

- received BCG vaccine

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23
Q

Will the TB blood test differentiate between active/latent TB

A

No

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24
Q

What will you see on CXR of primary active TB?

A

NORMAL**

OR

Hilar lymphadenopathy*****

Cavities

Miliary pattern**

Pleural effusions/infiltrates

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25
Q

Will a CXR tell you if the pt has active or latent TB

A

No

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26
Q

What are you likely to see on CXR of latent TB

A

Dense nodules or lesions with possible calcification

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27
Q

What will you see on CXR of someone with a reactivation of latent TB

A

Cavities

Infiltrates

Adenopathy

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28
Q

Where in the lung fields do TB abnormalities appear?

A

Apical/posterior upper lobes

Superior areas of lower lobe

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29
Q

What does a Ranke complex indicate?

A

Healed primary TB

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30
Q

What does a Ranke Complex consist of?

A
  1. Ghon Lesion(Focus): calcified granuloma (tuberuloma)

2. Calcified hilar lymph node

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31
Q

How much sputum do you need to get to do TB sputum tests?

A

3 specimens 8-24 hours apart

At least 1 in the morning

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32
Q

What are the 3 TB tests you can do on sputum?

A

Smear

Cytology

Culture

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33
Q

What does a sputum smear look for and how long does it take?

A

Looks for acid-fast bacilli

Easy and fast results

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34
Q

What kind of Cytology test is done on sputum to look for TB?

A

Nuclei Acid amplification test (NAA)

Takes 48 hours

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35
Q

What is the only thing that will CONFIRM a diagnosis of TB?

A

Sputum culture
***

Sputum smear and cytology will support your dx, but can’t confirm it

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36
Q

What should you do if the AFB and NAA sputum tests are positive, but you don’t have the sputum culture results back yet?

A

TB disease is presumed, Pt is quarantined, and treatment is initiated immediately

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37
Q

If the sputum culture comes back positive, what do you need to do next?

A

Drug susceptibility treatment

38
Q

If you do a biopsy to confirm TB, what is the hallmark finding?

A

Necrotizing (Caseating) Granulomas

39
Q

If the sputum culture comes back negative, but you really think they have TB, what should you do?

A

Start treatment anyways and “monitor response”

40
Q

What is the Xpert MTB/RIF Assay?

A

Its the automated NAA test using disposable cartilages that checks for:
TB

Rifampin Resistance

41
Q

How long does the XPert MTB/RIF Assay test take?

A

2 hours

42
Q

Where is the patient when you are treating them for active TB?

A

Isolated in a negative pressure inpatient hospital room

Taking their meds under DIRECT OBSERVED TREATMENT

43
Q

What are the 4 drugs you use to treat active TB

A

Rifampin

Isoniazid

Pyrazinamide

Ethambutol

44
Q

What are the 2 side effects of Rifampin?

A

Orange secretions

Skin sensitivity

45
Q

What are the side effects of Isoniazid?

A

Hepatotoxicity: must monitor LFTs

Peripheral neuropathy (Vit B6 helps)

Fatal hepatitis (pregnant women at high risk)

46
Q

What are the side effects of pyrazinamide?

A

Hepatotoxicity

Hyperuricemia

47
Q

What are the side effects of ethambutol?

A

Optic neuritis: test visual acuity and color vision

48
Q

What happens during the Initial (Intensive) Phase?

A

4 meds daily x 2 months

Then repeat the CXR, AFB smear and culture to see how they’re doing

49
Q

What happens in the Continuation phase of active TB and how long does it last?

A

Rifampin and Isoniazid daily OR twice a week x 4 months

50
Q

How does TB treatment change if the patient is HIV+

A

Extended by 9-12 months

51
Q

Which of the 4 TB drugs do you not give to pregnant women?

A

Pyrazinamide

52
Q

Which TB drug do you not give to babies and children?

A

Ethambutol 👁

Don’t want them to go blind

53
Q

What conditions must be met to be considered not contagious anymore after starting TB treatment?

A

2 weeks of treatment regimen

3 negative sputum smears

Symptoms improve

(So yes you could potentially come out of quarantine and go home before the culture even comes back)

54
Q

What are the rules for going home while you’re still contagious if you have TB?

A

DOT has to come watch you take your meds every day

No children under 5 in the home

No immunocompromised ppl in the home

Can only leave the house to go to the doctor

Strict follow up

55
Q

TB treatment is based on (duration of treatment/number of doses)

A

Number of doses

56
Q

How many doses of TB meds are taken during the Initial phase of TB treatment?

A

56 doses

Everyday for 8 weeks

57
Q

How many doses of TB meds are taken in the Continuation phase?

A

Continuation phase 18 weeks:

126 doses (daily)
 Or

36 doses (twice weekly)

58
Q

Which drug do you give to treat Latent TB in pregnant women and kids 2-11?

A

Isoniazid

300mg daily x 9 months

Or 900mg twice a week x 9 months

(I don;t know if the doses/length of treatment are important)

59
Q

What is the brand new preferred treatment of latent TB in adults and children 12 and up?

A

Isoniazid + Rifapentine

12 weekly doses under DOT
*****

(The once weekly dose x 12 weeks seems important to know)

60
Q

Is DOT necessary for the treatment of latent TB?

A

Yes

61
Q

Can you give the fancy new Isoniazid+Rifapentine therapy to pregnant women with latent TB?

A

No

62
Q

Can you give the fancy new Isoniazid+Rifapentine drug to HIV+ people for treating latent TB?

A

Yes

63
Q

What should you give to treat latent TB if your patient can’t take Isoniazid?

A

Rifampin

Daily x 4 months

64
Q

Who needs to be tested for TB?

A

People with high risk of exposure (IVDU, etc)

People with high risk for developing disease once infected (HIV)

Healthcare workers

65
Q

MDR-TB does not respond to which drugs?

A

Isoniazid

Rifampin

66
Q

XDR-TB is resistant to even more drugs than MDR-TB, including fluoroquinolones. How do you treat it?

A

Surgery to remove necrotic tissue

67
Q

We don’t give the BCG vaccine in America except to these 2 groups of people:

A

Children w/ negative TST and continuous exposure (like mom or dad has TB)

Healthcare workers with HIGH risk of MDR-TB (like Doctors Without Borders stuff)

68
Q

You get Histoplasmosis from_____________

A

Soil contaminated with bird or bat shit

🦜🦇💩

69
Q

What part of the country do you find Histoplasmosis?

A

Ohio and Mississippi River valleys

70
Q

What kind of activities puts someone at high risk for Histoplasmosis?

A

Spelunking lmao **

Chicken coops

Construction, gardening, roofing, installing AC units (?)

71
Q

What are the 4 presentations of histoplasmosis?

A

Asymptomatic Primary Histoplasmosis (90%)

Acute Symptomatic Histoplasmosis

Progressive Disseminated Histoplasmosis

Chronic Pulmonary Histoplasmosis

72
Q

Do most people with histoplasmosis get symptoms?

A

No

73
Q

How do you treat symptomatic histoplasmosis?

A

You usually don’t.

Self -limited

74
Q

How do you treat asymptomatic histoplasmosis?

A

No treatment ***

75
Q

What kind of patient will develop Progressive Disseminated Histoplasmosis?

A

AIDS patients

76
Q

What kind of patient will develop Chronic Pulmonary Histoplasmosis?

A

Old peopel with COPD

Let’s face it their lungs were already circling the drain

77
Q

How do you test for Histoplasmosis?

A

Enzyme immunoassay of Urine** or serum

(She had the urine part underlined)

There were two other tests on the slide: immunodiffusion and complement fixation. Seems unimportant though

78
Q

What disease can Histoplasmosis mimic on CXR?

A

TB

79
Q

What does histoplasmosis look like on CXR?

A

Hilar adenopathy

Patchy/nodular infiltrates in lower lobes

80
Q

How do you contract Coccidiomycosis (Valley Fever)?

A

Inhaling spores in contaminated soil

81
Q

Where do you find Coccidiomycosis?

A

Lower deserts of Western Hemisphere AKA Arizona

82
Q

Do most people show symptoms if they have Valley Fever?

A

No

60% are asymptomatic

83
Q

What is sub-acute valley fever?

A

A mild, self limited bout of vague respiratory symptoms that go away on their own and are protective from future disease

84
Q

What are the symptoms of a primary infection of Cocci/Valley Fever?

A

Marked fatigue**

Erythema nodosum**

Erythema multiforme

Plus regular pneumonia sx

85
Q

What happens with disseminated disease form of cocci/valley fever?

A

Goes to your lungs, bones, and brain

In HIV+, African/Filipino descent, or 3rd trimester of pregnancy

86
Q

Do you usually need to treat cocci/valley fever?

A

No

87
Q

What is her take home point of treating cocci/valley fever

A

Recognizing the disease and treating early is critical **

88
Q

You should think of Cocci if a patient comes in with pulmonary complaints and has one or more of these:

A

The 3 E’s:
Erythema Nodosum

Erythema Multiforme

Eosinophilia

89
Q

How do you treat Cocci in patients who are at high risk of developing disseminated disease?

A

-azole

Amphotericin B if pregnant

90
Q

What ethnicities are hit hardest by cocci/valley fever?

A

African

Filipino

91
Q

What two events can increase chances of cocci/valley fever exposure?

A

Dust storm

Earthquake

Clin Med II Exam 2 (Lauren) (3 decks)

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